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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 1264 - 28 April 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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60 year old man with long standing scalp tumor and sudden recent growth.

Case posted by Dr Uma Sundram


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Guest Romualdo

Posted

This tumor shows trichilemmal (pilar) type of keratinization so my diagnosis is proliferating trichilemmal (pilar) cyst/ tumor.

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Dr. Mona Abdel-Halim

Posted

Proliferating trichilemmal cyst

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Mark A. Hurt MD

Posted

The differential diagnosis is proliferative tricholemmal cystic acanthoma vs proliferative tricholemmal cystic carcinoma. Owing to the complexity of pattern, not cytology, I favor carcinoma. I will add that carcinoma will not be the favored diagnosis by most, in my experience, but I do think it is one.

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Uma Sundram

Posted

I called this a proliferating tricholemmal tumor with the caveat that morphology is not an accurate predictor of clinical outcome and a recommendation that this be treated as if it were a carcinoma. I completely agree with Dr. Hurt that calling this tumor a carcinoma is a perfectly valid approach as well.

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Dr. Richard Carr

Posted

Not surprisingly in this case I would suggest it looks benign and it will almost certainly behave so but local recurrence is a possibility. In the exceedingly unlikely event of a metastasis from this lesion it would not prove malignancy as the operator may have pushed tumour it into vessels during the procedure (assuming the lesion has not regrown and then undergone malignant transformation). Not sure I would be advising a re-excision as it may be shelled-out completely. I confess I have not read the original papers regarding malignant behavior or proliferating pilar tumours that are nicely circumscribed, appear cytologically bland and were adequately sampled (I do note the history might be a concern in this case but surely we should see some morphological evidence to support a diagnosis of carcinoma).

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