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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 986 - 3rd April Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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80 year-old Hispanic female with a lesion on her left shin. Clinical impression: rule out BCC.

Case posted by Dr. Hafeez Diwan.


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Dr. Mona Abdel-Halim

Posted

I think this is a cutaneous metastases. The specimen shows only small part of the lesion. I think we should ask for complete excision and do IHC to verify.

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Robledo F. Rocha

Posted

A very small sample of the lesion makes this case hard. My initial impression is adenocarcinoma due to the pleomorphic cells showing vesicular nuclei with prominent nucleoli and slight foamy cytoplasm, and to some subtle tubular structures.

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Hard to say. Superficial sample with a neoplastic infiltration. Agree with metastatic adenocarcinoma as first impression.

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Dr. Richard Carr

Posted

Does look quite "epithelioid". A rare suggestion to add in the differential is a symplastic glomus (fried egg cells). Would also consider epithelioid haemangioendothelioma (long shot).

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Guest Tiberiu Tebeica

Posted

agree with all the above differentials. i would add metastatic melanoma. curious what immunos show

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Dr. Hafeez Diwan

Posted

This turned out to be melanoma, presumably metastatic; there is scar and so it could be a recurrent or residual, but we didn't have a history of anything at this site. The tumor was not present on levels, and so we destained one of the H&E slides. The tumor cells were Melan-A positive. There was no prior history of melanoma.

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