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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 1283 - 25 May 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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45 years male; mass anterior abdominal wall.

Case posted by Dr Iskander Chaudhry


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Dr. Mona Abdel-Halim

Posted

I also thought first in epithelioid angiosarcoma. IHC is needed.

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Eman El-Nabarawy

Posted

Yes. I also thought of epithelioid angiosarcoma.

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I will add epithelioid sarcoma as a differential.

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Mark A. Hurt MD

Posted

I'm just not there yet. I think the differential should be expanded to carcinoma, melanoma, perhaps metastatic. I'm not opposed to angiosarcoma, but we need a few more steps to prove it.

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Dr. Richard Carr

Posted

DDx: In rough order - Carcinoma (probably metastatic, epithelioid, rhabdoid, hepatoid & focally syncytial - consider hepatocellular carcinoma given site and age), less likely melanoma, sarcoma, germ cell (embryonal carcinoma/MTU) etc. Just also thought of mesothelioma - should not forget it.

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Dr. Richard Carr

Posted

Forgot to say I just posted Friday's "opinion" - I seem to be in the minority!

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Iskander H. Chaudhry

Posted

I would like to thank everyone for your comments. The final diagnosis can not be rendered without Immuno' and based on this and the morphology the diagnosis is Proximal type Epithelioid Sarcoma. The most helpful image is the low power - the 'proximal type' ES's show more pleomorphism and necrosis and are more aggressive than their distal counterparts.

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