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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 1431- 17 December 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)
Case History: 93 year-old male with right face lesion.

Case posted by Dr Hafeez Diwan
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  Report Record
Go to records December 2015

User Feedback


Nitin Khirwadkar

Nitin Khirwadkar 63

Posted

Looks like an angiosarcoma. A small IHC panel to rule out usual mimics like pseudovascular SCC etc.

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Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim 508

Posted

The face affection and the presence of large multinucleated giant cells made me think of AFX/pleomorphic dermal (undifferentiated) sarcoma spectrum. Looks deep not contiguous to the epidermis and separated from it by a wide zone of collagen favouring pleomorphic sarcoma over AFX. IHC is definitely needed before finalizing the diagnosis. Would love to see the scanning power to assess exact depth and SC affection.

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Raul Perret

Raul Perret 262

Posted

I favor atypical fibroxanthoma with osteoclast giant cells.  Epithelioid angiosarcoma is my second differential. But of course that a wide panel of immunos should be performed. The differential of AFX vs pleomorphic undifferentiated sarcoma as far as I have read is usually based on: size of the tumor >2cm, Deep infiltration (subcutis, fascia, etc.), presence of necrosis and vascular invasión, all these characteristics favour PUS.

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Guest Romualdo

Guest Romualdo

Posted

Dr. Hafeez, in relation to yesterday's case, what was the nature of the pigment, lipofuscin or melanin?

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vincenzo polizzi

vincenzo polizzi 185

Posted

what about metastasis of undifferentiated carcinoma ( lung? ), beacuase of round-pushing margins?

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Sasi Attili

Sasi Attili 85

Posted

Difficult without seeing silhouette. Thinking metastasis as looks to have no epidermal connection....need immunos

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Dr. Richard Carr

Dr. Richard Carr 622

Posted

I think there is a recent report of SCC with malignant giant cell tumour areas (these here looked more like malignant GCs to me but any high grade tumour with haemorrhage can attract reactive osteoclastic GC - IHC will sort).

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Dr. Hafeez Diwan

Dr. Hafeez Diwan 125

Posted

Atypical fibroxanthoma.  Multiple keratins were negative, as were CD31, CD34, and melanocytic markers.

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Dr. Hafeez Diwan

Dr. Hafeez Diwan 125

Posted

In response to Dr. Romualdo's question about the pigment in yesterday's case, I am guessing melanin. 

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