Jump to content
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 992 - 11th April Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
   (0 reviews)

34 years old male. Skin tag on back.

Case posted by Dr. Richard Carr.


  Report Record

User Feedback


Guest Romualdo

Posted

Low-power magnification shows a polypoid vascular lesion resembling a pyogenic granuloma, except by the absence of lobularity. At higher power magnifications we can see epithelioid endothelial cells, intersticial neutrophils and nuclear dust. I hope a Warthin-Starry stain unmasks clumps of bacilli confirming my impression of bacillary angiomatosis.

Share this comment


Link to comment
Share on other sites

Agree with Epithelioid Hemangioma.
Once I read the entity called Cutaneous Epithelioid Angiomatous Nodule (CEAN), described in 2004 (see [url="http://www.ncbi.nlm.nih.gov/pubmed/14726818"]http://www.ncbi.nlm.nih.gov/pubmed/14726818[/url]), which differs from Epithelioid Hemangioma by some clinical (trunk and extremities) and histologic features. In 2008, other paper (see [url="http://www.ncbi.nlm.nih.gov/pubmed/18212538"]http://www.ncbi.nlm.nih.gov/pubmed/18212538[/url], with Dr. Omar Sangueza and Dr. Luiz Requena) described CEAN lesions also compromising head and neck location, and suggestes that CEAN are part of the spectrum of Epithelioid Hemangioma. I would like to know what are the opinion of the participants of this site.

Share this comment


Link to comment
Share on other sites

Eman El-Nabarawy

Posted

Cutaneous epithelioid angiomatous nodule.

Share this comment


Link to comment
Share on other sites

Robledo F. Rocha

Posted

Vascular proliferation with plump endothelial lining associated to slight microabscesses, the latter feature a clue for bacillary angiomatosis or, in the proper epidemiologic setting, verruga peruana.

Share this comment


Link to comment
Share on other sites

Dr. Mona Abdel-Halim

Posted

My impression is: cutaneous epithelioid angiomatous nodule.

Share this comment


Link to comment
Share on other sites

Dr. Richard Carr

Posted

Sorry I was at Eduardo Calonje's update today. This is not a vascular tumour as far as I remember but I am away from the office. Why don't you have another think
Regards to all from very sunny London

Share this comment


Link to comment
Share on other sites

Eman El-Nabarawy

Posted

So I will try the other idea that I thought as a DD: epithelioid benign fibrous histiocytoma.

Share this comment


Link to comment
Share on other sites

Dr. Mona Abdel-Halim

Posted

If not vascular, then as Eman said it should be epithelioid fibrous histiocytoma...

Share this comment


Link to comment
Share on other sites

Another differential diagnosis could be Angoimatoid Spitz nevus.

Share this comment


Link to comment
Share on other sites

Guest Romualdo

Posted

Agree with this new possibility: [color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]epithelioid fibrous histiocytoma.[/size][/font][/color]

Share this comment


Link to comment
Share on other sites

Dr. Richard Carr

Posted

Immunohistochemistry for S100, MelanA, HMB45, EMA, MNF116 and AE1/AE3 is negative. CD31 and CD34 highlights the vessels. CD68, S100 and CD1a highlight scattered dendritic cells throughout the lesion and CD68 is weakly positive in tumour cells.

Share this comment


Link to comment
Share on other sites

Eman El-Nabarawy

Posted

Indeterminate dendritic cell tumor.

Share this comment


Link to comment
Share on other sites

Guest Tiberiu Tebeica

Posted

This could be solitary reticulohistiocytoma. I see oncocytic mononuclear histiocytes, but no multinucleate giant cells. Are there other stains available, such as CD163, factor XIIIa, lysozyme?

Share this comment


Link to comment
Share on other sites

Dr. Richard Carr

Posted

No sorry it is from a few years ago and sadly we don't stock those markers in any case.

Share this comment


Link to comment
Share on other sites

Eman El-Nabarawy

Posted

I am sorry. I think I made a mistake. Indeterminate dendritic cell tumor must be diffuse lay positive for S100 and CD1a..so it's not the case..I think I will agree with Tiberiu for solitary reticulohistiocytoma..

Share this comment


Link to comment
Share on other sites

Mark A. Hurt MD

Posted

I like the proposal of epithelioid cell histiocytoma. Someone remind me to relate a story about a similar lesion that confounded me a few years ago.

Share this comment


Link to comment
Share on other sites

Dr. Richard Carr

Posted

Yes I reported this as epithelioid fibrous histiocytoma. The polypoid nature and collarette are typical. Eduardo Calonje kindly reviewed this case and agreed. Looking forward to Mark's anecdote. Regards to all and pleased some of you are happy to contribute during your weekend.

Share this comment


Link to comment
Share on other sites

Dr. Richard Carr

Posted

Whoops just checked my database and this particular case was not seen by Eduardo, I was thinking of another case even older. I did call it epithelioid cell histiocytoma though but I am sure we use epithelioid fibrous histiocytoma synonymously.

Share this comment


Link to comment
Share on other sites

Mark A. Hurt MD

Posted

Here's the anecdote: It must have been in the early 1990's, because epithelioid cell histiocytoma had been in the literature a few years (I believe it was [url="http://www.ncbi.nlm.nih.gov/pubmed/2466472"]Introduced in 1989[/url]). I had seen a lesion, very similar to the one above, and I must have done every vascular marker I could find at the time to "prove" it was endothelial. I also went through the melanocytic markers -- all negative. Then I went through the lymphoid markers - again negative. I can't remember clearly if or how I used any of the histiocytic (macrophagic) markers -- but whatever I did, it lead to no firm conclusion. I consulted an associate, who had similar diagnostic problems with the case, then I sent it to and international consultant, who, in short order, got the diagnosis right and referred, somewhat embarrassingly, to an article that one of us had co-authored!

As I had seen the case originally in consultation myself, I was even more embarrassed by the fact that not only did I not know the diagnosis as a consultant, but that I had to consult outside of my own sphere after applying so many antibodies. The original referring pathologist even accused me of "playing around" with the antibodies as an "experiment" (which was not the case). I never saw a consultation from him again -- not surprisingly.

The moral of the story is this. Even when you have seen seen lesions of a given type many times and understand the differential, you will find cases of that same condition that baffle you -- cases that will embarrass you in the end simply because you did not consider a single piece of evidence on a particular day, or you were not able to expand the differential for some reason. This is a human limitation and it affects us all in different ways.

As you can see here, I made the same error on this case.

Very instructive case, Richard!

Share this comment


Link to comment
Share on other sites



Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Add a comment...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...