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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 1369 - 22 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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51 year old man with 7 mm erythematous nodule on right upper arm.

Case posted by Dr Uma Sundram


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Dr. Mona Abdel-Halim

Posted

Circumscribed tumor, predominantely spindle cells, some epithelioid cells, prominent pseudo-nuclear inclusions, a storiform pattern is perceived in many areas in addition to whorled arrangements also. There are myxoid foci aalso. The Immunos are not labelled !! Based on morphology, I am thinking of perineurioma. Guessing the Immunos are CD34 (first one) and EMA (second one)!!!

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Arti Bakshi

Posted

Agree completely with Mona, first thought is perineurioma with the vague whorling/storiform pattern.
Need to know the immunos.

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My first thought, given the intranuclear inclusions, was of a melanocytic tumour, possibly a cellular blue naevus.

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Guest Romualdo

Posted

I see a very superficial lesion associated with some grade of epidermal hyperplasia. Collars of epithelia demarcate the lesion at lateral margins. Neoplastic cells are frequently epithelioid and have moderately abundant cytoplasm. Whorled arrangemens of cells around small vessels is seen in some areas. I think this is epithelioid cell dermatofibroma.

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Uma Sundram

Posted

I like to keep you guys guessing :)
Yes, perineurioma (great job Mona!). 1st immuno is CD163, showing the tumor cells are negative. 2nd immuno is EMA, strongly positive. Melanocytic markers are negative.

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