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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 1048 - 30th 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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The patient is a 56 year old woman with an excision with margin examination (if malignant), of a lesion taken from the scalp.

Case posted by Dr. Mark Hurt


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Arti Bakshi

Posted

Proliferating trichilemmal cyst (pilar tumour of scalp)

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Squamous cell carcinoma with trichilemmal keratinisation (malignant proliferating trichilemmal cyst).

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Robledo F. Rocha

Posted

Proliferating tricholemmal tumor. I don’t believe this could be considered a variant of squamous cell carcinoma because these two tumors differ in the cytokeratin profile and in behavior. Proliferating tricholemmal tumors express [url="http://journals.lww.com/amjdermatopathology/pages/articleviewer.aspx?year=2002&issue=08000&article=00011&type=abstract"]fetal and tricholemmal hair follicle phenotypes[/url], suggesting differentiation from hair stem cells.

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Dr. Mona Abdel-Halim

Posted

Proliferating trichilemmal cyst (pilar tumor)

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Proliferating trichilemmal tumor. This kind of lesion can evolve to malignancy very rarelly, generally occuring after many relapses. Other histological features that are generally seen in Malignant proliferating trichilemmal tumor area infiltrating borders, high mitotic count and high nuclear grande that we don´t see in this case.
I recently recieved 2 opinion cases of Proliferating trichilemmal tumor that were diagnosed before as SCC.

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Guest Romualdo

Posted

Proliferating trichilemmal (pilar) cyst (tumor).

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Guest Jim Davie MD

Posted

Agree with Proliferating pilar (trichilemmal) cyst.

Architecture is spherical/expansile with partial pseudocapsule, gentle displacement/distortion of adnexa, and absence of definitive infiltrative edges that I'd expect in the carcinomatous variant. The prominent foreign body type granulomatous reaction (featuring very large, "ancient type" foreign-body type giant cells with numerous nuclei), suggests a very long-standing lesion with indolent growth. There is sparse mitotic activity with balancing apoptotic activity within the atypical keratinocytes.

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Mark A. Hurt MD

Posted

My diagnosis:

[b]-- PROLIFERATIVE TRICHOLEMMAL CYSTIC CARCINOMA[/b]
[b](INVOLVING MARGINS PERIPHERAL AND DEEP)[/b]

[b]COMMENT:[/b] Proliferative tricholemmal cystic carcinomas tend to be relatively low grade histopathologically, but they still have the capacity to metastasize. Generally, they produce local destruction before they metastasize. Thus, they have been called - historically - “proliferative tricholemmal cysts” or “pilar tumors.” Historically, it was also thought that many of these were benign, but it has been shown in recent years that there have been patients who have developed metastasis to local nodes, so further follow-up is strongly suggested in this case, especially in light of positive margins.

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Dr. Richard Carr

Posted

Looks nicely circumscript so would have gone with majority (benign diagnosis) here I think with a comment on the possibility of local recurrence. Obviously tumours that have been interferred with by the surgical knife can be implanted in to lymphatics so spread to local nodes would not prove malignancy beyond all reasonable doubt. Hopefully in the future we will get the molecular tools to help us.

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