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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm 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 :
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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
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  Report Record
Go to records October 2014

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Guest Romualdo

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).

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Guest Tiberiu Tebeica

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.

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Robledo F. Rocha

Robledo F. Rocha 336

Posted

I favor sarcoma. Waiting for images of immunostains.

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Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim 508

Posted

Totally agree and will add also metastasis

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Dr. Richard Carr

Dr. Richard Carr 622

Posted

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

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Guest Giovanni Falconieri

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

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Robledo F. Rocha

Robledo F. Rocha 336

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.

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