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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 1066 - 24th July 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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26 year-old male with biopsy from forearm.

Case posted by Dr. Hafeez Diwan.


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Giant cell-rich, pleomorphic, epithelioid and clear cell tumour, in the distal limb of a young adult. The final say is for immunohistochemistry, but I'm thinking of clear cell sarcoma of tendon sheath (although this is not ususally this pleomorphic or this epithelioid) and malignant giant cell tumour of tendon sheath.

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Difficult case with only H&E stains. I see an epithelioid and pleomorphic cell neoplasm admixed with some multinucleated and clear cells. My differential diagnosis includes metastatic carcinoma with clear cell cytoplasm, anaplastic large cell lymphoma, pleomorphic sarcoma and sebaceous carcinoma (only because i see some vesiculated cytoplasms in figures 3 and 4). IHQ is necessary.

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Dr. Richard Carr

Posted

Before clinical I wondered about various things (including sebaceous carcinoma) and also postulated seminoma / germ cell tumour. After clinical (age / sex) think a testicular primary is perhaps more likely than a cutaneous / soft tissue primary.

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Robledo F. Rocha

Posted

I go with metastatic choriocarcinoma. Tumor is hemorrhagic and comprises a bifasic cellular composition of cytotrophoblast with clear cytoplasm and vesicular round nucleus, and of syncytiotrophoblast with dense cytoplasm and hyperchromatic irregular nuclei.

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Dr. Mona Abdel-Halim

Posted

First impression before reading any comment, I thought of metastatic lesion (carcinoma or melanoma).. After reading the comments, I liked the suggestions of Dr Carr and Dr Robledo of a testicular tumor metastasizing to the skin especially with the young age. Lovely case...

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Guest Romualdo

Posted

I liked the suggestion of metastasis of testicular germinal cell neoplasia. Despite the young age, I would like to add the possibility of a pleomorphic liposarcoma, epithelioid variant. I think there are clear cytoplasmic vacuoles indenting the nuclei in some pleomorphic cells.

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Dr. Hafeez Diwan

Posted

Metastastic choriocarcinoma.

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