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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 1226 - 05 March 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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64 year-old female with a vaginal biopsy.

Case posted by Dr Hafeez Diwan


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Dr. Mona Abdel-Halim

Posted

I think this is a hidradenoma papilliferum but appears distorted.

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Guest Romualdo

Posted

Metastatic high grade carcinoma, probably serous carcinoma from endometrium or ovary.

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biswanath behera

Posted

hidradenoma papilliferum- dermal tumor sorrounded by pseudocapsule, papillary projections, no plasma cells.

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Eman El-Nabarawy

Posted

Metastatic adenocarcinoma.

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Dr. Mona Abdel-Halim

Posted

Nice suggestions of metastaic lesion.. If malignant, it also can be malignant transformation in a hidradenoma papilliferum. I think there are areas of decapitation secretion (apocrine carcinoma of anogenital mammary like glands)...

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I think this could go either way, hidradenoma papilliferum or malignant. I would do myoepithelial markers to try and separate the two. If malignant, it could be either primary (apocrine carcinoma) or metastatic.

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Guest Romualdo

Posted

This is a vaginal neoplasm, not a vulvar neoplasm. Hidradenoma papilliferum has a predilection for the labia, where 90 % of cases occur. Other locations are fourchette, clitoris, perianal area and perineum. To the best of my knowledge, vagina is not a site of hidradenoma papilliferum.

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Sorry. My mistake. I thought I read "vulval". In this case, I entirely agree with a met.

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Guest Jim Davie MD

Posted

Agree with Romualdo. I favor villoglandular endometrioid adenocarcinoma given the lower nuclear grade (immunostains will help distinguish vs. papillary serous carcinoma).

This papillary neoplasm has some malignant cytologic features: hyperchromasia, nuclear pleomorphism and enlargement, high nuclear-cytoplasmic ratio, and subtle apoptotic activity. There is minimal mitotic activity with small nucleoli, and rare epithelioid clear cells.
It has malignant architectural features: multifocal nests, with expansile and fusiform infiltrative distribution, and absence of a distinct basal layer.

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Dr. Richard Carr

Posted

Favour adenocarcinoma too. Most likely female genital tract primary. IHC will be helpful.

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Dr. Mona Abdel-Halim

Posted

Actually, I did not expect that vaginal biopsies are in the subspeciality of dermatopathology !!! I interpreted vaginal biopsy as a biopsy from a vaginal introital lesion, some where at the mucocutaneous junction of the introitus. This is the rational behind my hypotheses. Initially, I overlooked the cytological features, which on subsequent looks , I find it quite well fitting with a malignant lesion. So, if this is not related to the introitus, and this is a biopsy from the inside of the vagina, then it is definitely metastatic. Mostly endometrial or ovarian. May be then the decapitation secretion perceived in some areas is an incidental finding in the context of adenocarcinoma.

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Dr. Hafeez Diwan

Posted

Metastatic endometrioid adenocarcinoma. There was a history of it.

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