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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 1047 - 27th June 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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M71. 15 years enlarging nodule on scalp. Now 30mm ?BCC

Case posted by Dr. Richard Carr.


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[size=4][color=#000000][color=#000000][color=#000000]Trichoblastoma.[/color] [/color][/color][/size]

[i][color=#000000][size=3][size=3][color=#000000][size=4]Dr Carr. Are there differences between the immunohistochemistry of small and large nodular trichoblastoma, trichoepithelioma (cribriform trichoblastoma) and desmoplastic trichoepithelioma? I tried looking into the literature once, but was discouraged by contradictory findings and differences in lumping and splitting. Your opinion would be appreciated. Thank you. [/size][/color][/size][/size][/color][/i]

[i][color=#000000][size=3][size=3][color=#000000] [/color][/size][/size][/color][/i]

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Dr. Richard Carr

Posted

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1047_RAC6826x5_CD10_Label.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1047_RAC6826x10b_CD10_Label.jpg[/img]

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Dr. Richard Carr

Posted

Yes there are differences. DTE don't have papillary mesenchymal cells and the typical stromal pattern of CD10 that is seen in TB/TE (tight hugging of tumour epithelium). DTE almost always have Merkel cells (4 to 5 or more per x20 field) whereas TB/TE have >5 Merkel cells (in the whole tumour) in only around 30% of lesions (also seen in ~5% of nodular and TE-like BCC). Can you e-mail [email="richard.carr@swft.nhs.uk"]richard.carr@swft.nhs.uk[/email] and I will give you (or any other colleague) access to our review papers and talks (including my obsession with KA and follicular SCC). The review on basaloid tumours does have an error of a DTE with intra-tumoural perineural invasion I wrongly favoured as a BCC!! We live and learn!!

By the way this case is not resolved.

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Mark A. Hurt MD

Posted

Small lobular trichoblastoma with basal cell carcinoma (mostly in large lobules)

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Dr. Mona Abdel-Halim

Posted

There are two patterns of CD10 expression, the first one is typical of TB/TE spectrum and the second one is typical of BCC. So I am considering this as a BCC developing within an old standing trichoblastoma (small lobular trichoepithelioma like trichoblastoma).

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Robledo F. Rocha

Posted

Collision of trichoblastoma (left), evidenced by the specific follicular stroma which can be shelled out from the surrounding dermal stroma, and basal cell carcinoma (right), illustrated by relatively scarce non-cellular stroma with increased mucin that imparts an adenoid arrangement to the epithelial component. Also, CD10 staining highlights areas showing stromal expression, typically of trichoblastoma, and epithelial expression, typically of basal cell carcinoma.

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Arti Bakshi

Posted

Agree with trichoblastoma with nodular basal cell carcinoma.

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Dr. Richard Carr

Posted

Yes this was a case of trichoblastoma and BCC confirmed with CD10 as discussed by colleagues.
Thanks and enjoy your weekends.

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Guest Jim Davie MD

Posted

Nice case! In the context of the history, the asymmetric distribution of the tumor, with increased mitotic rate, larger nests, and decreased stromal cellularity suggested BCC arising in a long-standing trichoblastoma.

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