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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 1322 - 17 July 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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F55. Neck. ?intradermal naevus (punch biopsy).

Case posted by Dr Richard Carr


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Dr. Mona Abdel-Halim

Posted

Thinking of cutaneous apocrine carcinoma, favouring primary but will first exclude metastasis.

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Eman El-Nabarawy

Posted

Malignant cylindroma vs apocrine carcinoma. Of course metastasis should be ruled out.

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biswanath behera

Posted

cylindroma with apocrine tubular adenoma

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Guest Romualdo

Posted

Cylindroma with extensive ductal differentiation.

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Dr. Richard Carr

Posted

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/Case%201322_RAC7182x20_CK7_4pm.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/Case%201322_RAC7182x20_DPAS_AB_4pm.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/Case%201322_RAC7182x20_Ki67_4pm.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/Case%201322_RAC7182x20_p53_4pm.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/Case%201322_RAC7182x20_p63_4pm.jpg[/img]

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Dr. Mona Abdel-Halim

Posted

So with the striking PAS positivity, this is cylindoma as Romualdo said with extensive ductal differentiation. I was wrong. Actually, the extensive ductal and tubular formations confused me.

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Cylindroma, although I admit I first thought of apocrine carcinoma.

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Arti Bakshi

Posted

Agree, Cylindroma with prominent glandular/ductal structures. Described in Kazakov's textbook as adenomatous /adenomyoepitheliomatous component.

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Mark A. Hurt MD

Posted

I agree that it's an apocrine adenoma with cylindromatous features, but I have never seen one quite like this.

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Dr. Richard Carr

Posted

My report:
A relatively circumscribed adnexal tumour comprising tubules and more solid aggregates of basaloid cells that are closely packed and in areas have a distinct basement membrane. Mitotic activity is low (~1/mm2), nuclear proliferation wiht Ki67~10% and there is minimal cellular pleomorphism. No alcian blue positive mucin. p63 highlights well form peripheral myoepithelial layer around all cellular aggregates.
In my opinion appearances fit best wtih a cylindroma (benign sweat gland lesion) with unusually well form tubules. These lesions can grow to large size but malignant transformation is rare. In this case mitotic activity is moderate. The lesion is incompletely removed.

Discussion: Thanks all for excellent responses. I too had not seen such a tubular variation on cylindroma but, like Arti, think I had seen it described in Kazakov's book. I think the immunos and PAS were quite helpful in excluding a tubular variant of adenoid cystic or other low grade adenocarcinoma. Incidentally no one mentioned the couple of mature sebaceous cells in the bottom left image (not that uncommon in cylindromas).

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