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 1118 - 6th October 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 an 85 year old white man with a history of two basal cell carcinomas from the right ear, now with a shave biopsy of a rapidly enlarging, red nodule present 2 weeks on the lower aspect of the right pinna helical rim.

Case posted by Dr. Mark Hurt


  Report Record

User Feedback


Guest Romualdo

Posted

Although there is a grenz zone, immunostains are necessary to exclude squamous cell carcinoma and melanoma. Leiomyosarcoma and angiosacoma need to be excluded too. If all are excluded, and probably they will, then a diagnosis of superficial undifferentiated pleomorphic sarcoma is justified. Apparently there is too much infiltration of subcutaneous adipose tissue to render a diagnosis of atypical fibroxanthoma (undifferentiated pleomorphic sarcoma of the skin).

Share this comment


Link to comment
Share on other sites

Guest Tiberiu Tebeica

Posted

I agree with Romualdo. On H&E is a matter of guess and I look forward for some immunos. Since there is some bubbling of the cytoplasm, I would also throw in adipophilin and EMA, but without expecting them to be positive.

Share this comment


Link to comment
Share on other sites

Robledo F. Rocha

Posted

I favor sarcoma. Waiting for images of immunostains.

Share this comment


Link to comment
Share on other sites

Dr. Mona Abdel-Halim

Posted

Totally agree and will add also metastasis

Share this comment


Link to comment
Share on other sites

Dr. Richard Carr

Posted

I would run a limited AFX/sarcoma NOS panel: p63, pan-keratin, S100, CD10 expecting the first 3 to be negative.

Share this comment


Link to comment
Share on other sites

Mark A. Hurt MD

Posted

There seems to be a problem with the follow-up images. The first is Melan-A; the second, S100.

Mark

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1118_Image%2008.jpg[/img]
[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1118_Image%2009.jpg[/img]

Share this comment


Link to comment
Share on other sites

Guest Giovanni Falconieri

Posted

Melanoma goes now on top of the differential. Due the inconspicuous junctional/epidermal component I suspect this could be metastatic. Primary dermal clear cell sarcoma might be also considered

Share this comment


Link to comment
Share on other sites

Robledo F. Rocha

Posted

[quote name='Giovanni Falconieri' timestamp='1412615218']
Melanoma goes now on top of the differential. Due the inconspicuous junctional/epidermal component I suspect this could be metastatic. Primary dermal clear cell sarcoma might be also considered
[/quote]
Agree.

Share this comment


Link to comment
Share on other sites

Mark A. Hurt MD

Posted

My diagnosis was melanoma, probably metastatic. The history of BCC was researched, and those prior lesions were, indeed, BCC. I don't know any more information at this point.

Share this comment


Link to comment
Share on other sites

Mark A. Hurt MD

Posted

Also, I thought initially that this was probably epithelial, as I have seen this pattern go both ways before IHC (i.e., SCC in some and melanoma in others, and even other conditions). It's very important in these cases to do at least a limited panel to start -- then to obtain other stains as necessary.

Share this comment


Link to comment
Share on other sites



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...