Jump to content
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 974 - 18th March Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
   (0 reviews)

The patient is a 35 year old white woman with a punch biopsy taken from the anterior scalp.

Case posted by Dr. Mark Hurt


  • Like 1
  Report Record

User Feedback


Dr. Richard Carr

Posted

Apologies for delay - I have made a detailed post for Friday's case. I am on my holidays and wanted to leave you a bit more time to have a think about it (which is code for I forgot completely).

Share this comment


Link to comment
share_externally

Despite the hyperchromasia and hobnailing, my feeling is that this is not an angiosarcoma. Also, I have not come up with an alternative. Maybe an angiofibroma.

Share this comment


Link to comment
share_externally

Dr. Mona Abdel-Halim

Posted

My opinion is that these are metastatic adenocarcinoma strands embedded in a sclerotic collagen. Mostly the clinical presentation was scarring alopecia, hence the specimen was transversly cut. Alopecia neoplastica. The spaces are not lined all around with these atypical cells so I did not perceive them as vascular spaces. I think Immunos at the end of the day will solve it. Nice case...

Share this comment


Link to comment
share_externally

Mark A. Hurt MD

Posted

Here are two additional images, which should solve the diagnostic dilemma -- at least I hope so!





[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE974_Image%2005.jpg[/img]


[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE974_Image%2006.jpg[/img]

Share this comment


Link to comment
share_externally

Dr. Mona Abdel-Halim

Posted

Trichilemmal cyst !!!!!!!

Share this comment


Link to comment
share_externally

Eman El-Nabarawy

Posted

So deeper cuts are the best special stain!!! It was the epithelium of the wall of trichilemmal cyst that makes confusion.

Share this comment


Link to comment
share_externally

Robledo F. Rocha

Posted

It’s not uncommon the outermost epithelial layer of tricholemmal cysts be found torn out from the remainder of the cyst wall, hence the pseudovascular features of the lesion in the first four pictures.

Share this comment


Link to comment
share_externally

Mark A. Hurt MD

Posted

Yes, this is an isthmus-catagen cyst (tricholemmal cyst, pilar cyst). As Dr. Rocha states, this is not an uncommon finding to see part of the cyst separate from the basal layer, thus producing a single cell layer that can mimic a number of conditions, but being aware of the phenomenon will save you a lot of grief. The differential is usually some type of ductal cyst, such as a cystadenoma or hidrocystoma. Yet, vascular neoplasms are in the differential morphologically as well, but are excluded easily if necessary.

Share this comment


Link to comment
share_externally



Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Add a comment...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...