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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 1194 - 20th January 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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20 year old woman with papule on nose of about 6 month duration. Clinical dx: r/o IDN.

Case posted by Dr Uma Sundram


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Agree with cellular neurothekeoma with frequent myxoid foci.

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Dr. Mona Abdel-Halim

Posted

Neurothekoma (nerve sheath myxoma)

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Guest Romualdo

Posted

Mona, neurothekeomas and nerve sheath myxomas are distinct neoplasms. While the predilect site of occurrence of neurothekeomas is the head and neck region, especially the nose and face, and they are uncommon in the hands, the opposite is true in relation to nerve sheath myxomas: they are most common in distal extremities, especially the fingers, and are rare in the head. Neurothekeomas are positive for MITF, CD63 and CD10, and negative for S100. Nerve sheath myxomas are positive for S100 and GFAP.

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Further to Romualdo's comment, I think it's best not to use the term "neurothekeoma" without a preceding adjective. [i]Cellular[/i] neurothekeoma (with or without myxoid stroma) is fibroblastic/fibrohistiocytic. [i]Myxoid [/i]neurothekeoma (dermal nerve sheath myxoma) is neurilemmal. The two can be easily separated by IHC.

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Uma Sundram

Posted

You all are spot on with differential diagnoses! Attached is my image of NKI/C3:

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Uma Sundram

Posted

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/Case_1194_Watermarked_SD-US-030-F4.jpg[/img]

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Uma Sundram

Posted

Given positivity of NKI/C3 and negativity of S100, and clinical location, I went with cellular neurothekeoma.

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Dr. Mona Abdel-Halim

Posted

Nice case
Thanks Romualdo and Abdul Kadir :-))

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