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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 1597 - 09 August Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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70 year old man with noticeable large lesion on left lower extremity which grew quickly. History of follicular lymphoma, status post treatment, with recent full body PET in May negative for residual tumor.

Case posted by Dr Uma Sundram


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Raul Perret

Posted

This is one of those cases where the digital slide would be great to analyze. There are two well defined areas: a myxoid cellular poor area, with numerous vessels some of them curvilinear, some of them branching, cellular atypia is minimal, no mast cells, no lipoblasts, no pseudolipoblasts, no ganglion like-cells. The second area is a cellular rich and in picture n 6 we see an arteriole that is being surrounded by the neoplasm so it seems to be infiltrative, the cytological aspect in this area is confusing, they are round to oval looking like activated fibroblasts/myofibroblasts, low grade atypia again, some mitotic figures are present. Many differentials have to be considered. I think because of statistics, morphology and clinics we must consider low grade myxofibrosarcoma in the first place (rare to see a rapidly growing tumor if its low grade though), secondly holding hands with first should come low grade fibromyxoid sarcoma but it is usually more fibrotic and the myxoid areas tend to be the more cellular ones, I dont think cellular myxoma, myxoid variant of spindle cell lipoma, superficial angiomyxoma. Another one to keep in mind that can have rich myxoid areas and look deceptively benign is myxoid synovial sarcoma but doubt this one here (lack of typical areas). So I think we should perform immunos: ck, demin, sma, cd34, s-100, cd99 molecular could be eventually considered.

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I think that the cells have low grade nuclear atypia and there are 2 types of cells, one of them is a roud cell type. The vesses are thin and branching. Despite the age of the patient I think the most probably diagnosis is Myxoid Liposarcoma.

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vincenzo polizzi

Posted

Diffuse Large B-Cell Lymphoma, spindle cell variant.

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Dr. Mona Abdel-Halim

Posted

I thought myxofibrosarcoma.

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vincenzo polizzi

Posted

I was wrong!!! Watching better on my computer ( before I was using smartphone ) the cells don't look lymphoma like, but more mesenchymal.  Myxofibrosarcoma is a good differential because of curvilinear vessels. But the last figs are reminiscent of smooth muscle tumor...what about myxoid leiomyosarcoma?

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Uma Sundram

Posted

Myxofibrosarcoma. All markers were negative (desmin, S100, CD34, keratins), and cytogenetics for liposarcoma and extraskeletal myxoid chondrosarcoma were negative as well. Raul's comment extremely well taken; the myxoid areas were side by side with solid cellular areas.

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