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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 1049 - 1st July 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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The patient is a 64 year old man with an excision of an enlarging lesion, present four years, taken from the midline upper chest.

Case posted by Dr. Mark Hurt


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Dr. Mona Abdel-Halim

Posted

My perception of spindle cell hemangioma is that it is a non circumscribed lesion, but other than this point, I do not think this lesion fits in anything else.

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Guest Jim Davie MD

Posted

Cellular Angiolipoma.
These are usually well-circumscribed lesions, with high cellularity, variable spindle cell component, and fibrin thrombi, lacking significant proliferative activity or high-grade atypia. Location on trunk is common.
[font=arial,helvetica,sans-serif]Ref: [/font][url="http://surgpathcriteria.stanford.edu/softfat/lipoma/angiolipoma.html"][size=4]surgpathcriteria.stanford.edu/softfat/lipoma/angiolipoma.html[/size][/url]

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Sangueza and Requena's treatise on vascular tumours says the following:

"Spindle cell hemangiomas are well-circumscribed but not encapsulated nodules … rich in dilated, thin-walled, blood vessels sometimes occupied by organized thrombi and phleboliths … (and) often contain round cells with vacuolated cytoplasm, sometimes so marked as to be misinterpreted as entrapped adipose tissue."

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Mark A. Hurt MD

Posted

Here are the immunostains:

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1049_Image%2009.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1049_Image%2010.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1049_Image%2011.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1049_Image%2012.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1049_Image%2013.jpg[/img]

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Mark A. Hurt MD

Posted

My diagnosis was:

[b]-- LOBULAR HEMANGIOMA (“PYOGENIC GRANULOMA”), INTRAVENOUS[/b]

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Guest Jim Davie MD

Posted

I recant. Agree with spindle cell hemangioma.

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Dr. Richard Carr

Posted

I was thinking intravenous pyogenic granuloma on the H&Es so agree with Mark's diagnosis. Nice SMA.

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