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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 973 - 17th March 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 68 year old man with a shave biopsy taken from the left pretibial area.

Case posted by Dr. Mark Hurt


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Robledo F. Rocha

Posted

[font=arial,helvetica,sans-serif][size=4][color=#000000]Dilated vessels surrounded by small clusters of round glomus cells. Agree with glomangioma.[/color]
[color=#000000]Were the vessels inconspicuous and the glomus cells more prominent, I'd call this glomus tumor.[/color][/size][/font]

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Mark A. Hurt MD

Posted

Here are the immunos:

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE973_Image%2005.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE973_Image%2006.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE973_Image%2007.jpg[/img]

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Dr. Mona Abdel-Halim

Posted

Dear Dr Mark, was there a rational behind asking for CK5/6 and Melan A or this is just a routine panel?

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Mark A. Hurt MD

Posted

My diagnosis was as follows:

[b]-- GLOMULOVENOUS MALFORMATION[/b]
[b]COMMENT: [/b] Glomulovenous malformation is the term that is thought to represent lesions that were once designated as glomangiomas. The distinction is that they are usually composed of large vessels surrounded by scant glomus cells, as is the case here. I don't see any evidence for malignancy.

-----

According to Weedon:

[color=#000000]"The glomulovenous malformation (GVM – OMIM 138000) was known in the past as a glomangioma, and regarded as a variant of glomus tumor.[/color][url="https://expertconsult.inkling.com/read/weedons-skin-pathology-weedon-3rd/chapter-38/chapter38-reader-8a#6ddcd91cbe7240e8bc411d1025aae12e"][sup]128–135[/sup][/url][color=#000000] Clinically they may simulate a venous malformation but they are histologically distinct.[/color][url="https://expertconsult.inkling.com/read/weedons-skin-pathology-weedon-3rd/chapter-38/chapter38-reader-8a#5a3a2d0303ec4e95b679ec80feb380f8"][sup]136[/sup][/url][color=#000000]They accounted for 5% of venous anomalies in one vascular unit.[/color][url="https://expertconsult.inkling.com/read/weedons-skin-pathology-weedon-3rd/chapter-38/chapter38-reader-8a#98b28db2d4914efcb3f0775b9f03f49e"][sup]137[/sup][/url][color=#000000] A majority of cases are familial with autosomal dominant inheritance but a significant number are sporadic. As relatives may have inconspicuous lesions, they may be missed. Familial GVM is due to a mutation in the [/color][i]glomulin[/i][color=#000000] gene on chromosome 1p21–p22.[/color][url="https://expertconsult.inkling.com/read/weedons-skin-pathology-weedon-3rd/chapter-38/chapter38-reader-8a#aecc3f1f75a547aab25f930f88750198"][sup]138,139[/sup][/url][color=#000000] Numerous mutations have been described; they appear to be loss of function mutations."[/color][sup][url="https://expertconsult.inkling.com/read/weedons-skin-pathology-weedon-3rd/chapter-38/chapter38-reader-8a#c087c0a43b0c4ac08fd78ff70406be22"]101,140[/url][/sup]

[size="1"][color="#006bb2"]-------------------------------[/color][/size]

[font="Meta Serif Office Pro, Georgia, serif"][color="#000000"][size=5]To Dr. Mona's question, some of these lesions mimic melanocytic lesions and others mimic ductal neoplasms, thus the reason for the markers.[/size][/color][/font]

[font="Meta Serif Office Pro, Georgia, serif"][color="#000000"][size=5]Mark[/size][/color][/font]

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