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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 1007 - 2nd May Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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M75.?BCC on scalp.

Case posted by Dr. Richard Carr.


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Dr. Mona Abdel-Halim

Posted

Well differentiated seb carcinoma

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Guest Romualdo

Posted

Agree, sebaceous carcinoma with squamous differentiation (squamoid variant).

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Dr. Richard Carr

Posted

You will need to re-think. Immunos to be posted at 4pm British Summer Time!

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Dr. Mona Abdel-Halim

Posted

If not sebaceous, then Clear Cell SCC which is more favored over Clear cell hidradenocarcinoma.. Immunos will solve...

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Dr. Richard Carr

Posted

Okay Iskander's team must be busy as I have had not acknowledegment so I will have to describe the IHC. The epithelial component (about 30% of the combined tumour) is diffusely p63 and pan-keratin positive and also is widely strongly BerEP4 positive but EMA negative. The foamy cells are negative for all epithelial markers and weakly express CD68 only. I did not do vimentin!

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Dr. Mona Abdel-Halim

Posted

Epithelial component: BCC ( BerEP4 positive, EMA negative)
The foamy cell component: not epithelial, CD68 positive
This is a collision tumor of a BCC and AFX (clear cell variant).

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Dr. Richard Carr

Posted

Well done Mona - I reported it as a partly basosquamous BCC with sarcomatoid component (clear cell AFX-type). Obviously we only have the top of the specimen and would have to re-assess on a complete excision to see if the sarcomatoid component was more deeply invasive etc. This was a very difficult case and illustrates that sebocyte-like differentiation is not necessarily true sebaceous differentiation.

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Guest Jim Davie MD

Posted

Very nice case. For sake of the differential, clear cell melanoma may also be a consideration ... can be CD68 positive and CK negative. Any melanocytic markers performed?

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