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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 1422- 4 December 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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Case History: F85. Clinically BCC, left cheek. c/o Dr Charles Acuda

Case posted by Dr Richard Carr


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Raul Perret

Posted

Nice, totally agree. I did not know about this entity and I was hesitating on making a simple diagnosis of well differentiated squamous carcinoma without seeing continuity of the tumor with the epidermis. Thanks for illustrating me. I leave an article that I found about it:

 

Follicular cutaneous squamous cell carcinoma: an under recognized neoplasm arising from hair appendage structures. Magro CM, et al. 

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Dr. Mona Abdel-Halim

Posted

Well, we have to thank Dr Carr for enlightening us about this entity :-)

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vincenzo polizzi

Posted

I'm learning about this entity. I would thought of a KA, on the appropriate clinical ground of course, because of the round deep edge and some elastotic material.

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Arti Bakshi

Posted

KA is a good thought too, certainly with the distinctive pattern of keratinisation maintained throughout the tumour and the elastotic material. There is quite a bit of cytological atypia and I think this is one of the (many)  controversial aspects of KA . Some will consider this indicative of SCC, whilst others would easily accept this degree of atypia in a KA. Clinical history is ofcourse important (?rapidly growing lesion)

I'm sure Richard will educate us on this!

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Arti Bakshi

Posted

Just seen the immunos...B catenin positive ??? 

I had wondered about pilomatrical differentiation when I looked at the images  and looking at them again, are there ghost cells in image 4 and red trichohyalin granules in image 5?

So, is this follicular SCC with pilomatrical differentiation???...probably completely on the wrong track!!

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Raul Perret

Posted

Beta catenin expression is quite particular as is seen mainly on tumors with matrical differentiation

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Dr. Mona Abdel-Halim

Posted

After some reading, beta catenin strong positivity points to matrical differentiation, so I agree with Arti that this could be follicular SCC with pilomatrical differentiation. I think a hint of red trichohyaline as Arti said can be seen in image 5...

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Dr. Richard Carr

Posted

Well it has taken a little while but seems I have caught you all today.  This is of course a "follicular" carcinoma but sadly not the one I have been banging on about - i.e. Infundibular-tricholemmal although the top bit would be typical for that diagnosis.  Arti has correctly rescued it with the IHC but the trichohyaline (bright orange) granules and ghosted keratinocytes throughout were a good clue to a pilomatrical neoplasm.  So yes given that there is significant pleomophism and despite the rather circumscribed profile I opted for a pilomatrical carcinoma.  I think this will have a very low risk for metastasis given the circumscript borders.  I guess you could argue for a malignant panfolliculoma but I am not certain the limited superficial infundibular/isthmic component is not just reactive in this case.  I put the EMA in to indicate it was not a BCC with matrical differentiation (also diffuse nuclear/cytoplasm Beta-catenin is typical for metrical tumorus). Great Royal College Update meeting today in London.  Warm regards from the train back to Warwick.

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Arti Bakshi

Posted

Ha!... That did stump us all!!.. Great case!

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