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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 1367 - 18 September 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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F65. Skin tag on back, 5 years.

Case posted by Dr Richard Carr


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Dr. Mona Abdel-Halim

Posted

Pleomorphic fibroma. According to McKee's pathology of skin, similar cases have been reported as "pseudosarcomatous polyp"

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Guest Romualdo

Posted

Pleomorphic fibroma is also my preferred diagnosis.

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Arti Bakshi

Posted

Yes, certainly pleomorphic fibroma is the first thought with the polypoid architecture, bizarre pleomorhic cells and collagen.
Just worried a bit about the atypical mitoses. I know that 'rare' mitoses are allowed in pleomorhic fibroma, but there are 3 quite clearly seen (and all atypical!) in the images. But cant come up with any alternative diagnosis!

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Guest Romualdo

Posted

Arti, maybe these are not true atypical mitotic figures but degenerating caryorrhectic nuclei simulating them. A very low proliferative index (Ki67) would help to reassure the diagnosis of benignancy.

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Dr. Richard Carr

Posted

My report:
Skin tag with unusually prominent hyperchromatic and multinucleate cells
(pleomorphic fibroma). Surprisingly, we identified 3 mitotic figures.
If the lesion recurs , complete excision with clear margin would be
recommended.

I did not do a Ki67 but these are textbook mitotic figures and I agree they are all atypical. Clearly "multinucleate" cells can only produce atypical mitotic figures but I don't think in the context of an otherwise benign appearing lesion it affects the favoured benign interpretation but you can see how I expressed slight uncertainty in the report with specific advice just in case!!

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