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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 933 - 20th January 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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The patient is a 77 year old white woman with a shave biopsy taken from the upper aspect of the back.

Case posted by Dr. Mark Hurt


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Eman El-Nabarawy

Posted

Plexiform schwannoma.
(Presence of capsule and palisading favor it over plexiform neurofibroma).

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Agree with plexiform schwannoma. The capsule is a good tip. S-100 and EMA stains are helpfull.
I think that If this diagnosis were plexiform neurofibroma the patient would probably have Neurofibromatosis.

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Mark A. Hurt MD

Posted

Here are two more H&E images (more coming later):

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE933_Image%2007.jpg[/img]
[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE933_Image%2008.jpg[/img]

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Guest Dr.Yüksel Okumuş

Posted

After these images, the diagnosis must be palisaded encapsulated neuroma

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Dr. Mona Abdel-Halim

Posted

My diagnosis is palisaded encapsulated neuroma, plexiform pattern.

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Eman El-Nabarawy

Posted

Yes. Solitary circumscribed neuroma (Palisaded encapsulated neuroma)

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Guest Romualdo

Posted

Agree with palisaded encapsulated neuroma, plexiform variant.

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Guest Saleem Taibjee

Posted

agree, plexiform schwannoma.
Main issue is to distinguish from plexiform neurofibroma, since the latter is virtually pathognomonic of NF1

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Mark A. Hurt MD

Posted

Here are the immunostains. Do they cause you to alter your opinions? My diagnosis at 20:00 GMT

[img]https://dermpathpro.com//uploads/spot_diagnosis_comment_img/CASE933_Image%2009.jpg[/img]

Neurofilament below:
[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE933_Image%2010.jpg[/img]
[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE933_Image%2012.jpg[/img]

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Eman El-Nabarawy

Posted

So it's solitary circumscribed neuroma.

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Dr. Richard Carr

Posted

In my experience plexiform neurofibromas are deeper subcutaneous lesions and are entirely encapsulated and surrounded by perineurium although I have seen some odd dermal hybrid lesions that I could not fit neatly. I don't think this is a plexiform neurofibroma however. Like colleagues above I was thinking of a plexiform schwannoma on the initial images but feel it is either a hybrid with or just a plexiform variant of encapsulated neuroma. Don't expect lesions to read text-books and hybrids seem to be ever more common!

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Dr. Mona Abdel-Halim

Posted

I still think it is palisaded encapsulated neuroma, plexiform variant.

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Mark A. Hurt MD

Posted

My diagnosis was as follows:

[b]-- PLEXIFORM PALISADED ENCAPSULATED NEUROMA [/b]
[indent=1][b](CIRCUMSCRIBED NEUROMA)[/b][/indent]

[indent=1][b]COMMENT:[/b] The findings in this biopsy support what has been called palisading encapsulated neuroma (circumscribed neuroma) and are strikingly similar to those published in the literature. A few cases in the literature have plexiform patterns and are not thought to be associated with neurofibromatosis, at least in the published literature. The argument is whether these are areas of hyperplasia, secondary to injury, or whether they represent a "true neuroma".[/indent]

[center]References:[/center]

Argenyi ZB, Cooper PH, Santa Cruz D. Plexiform and other unusual variants of palisaded encapsulated neuroma. J Cutan Pathol. 1993 Feb;20(1):34-9. PubMed PMID: 8468415.

Koutlas IG, Scheithauer BW. Palisaded encapsulated ("solitary circumscribed") neuroma of the oral cavity: a review of 55 cases. Head Neck Pathol. 2010 Mar;4(1):15-26. doi: 10.1007/s12105-010-0162-x. Epub 2010 Jan 23. PubMed PMID: 20237984; PubMed Central PMCID: PMC2825527.

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