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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 1507 - 04 April 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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The patient is a 58 year old woman with a biopsy taken from the frontal scalp.

Dr Mark Hurt.


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vincenzo polizzi

Posted

Nice CD10+ Peritumoral stromal condensation. Agree

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Dr. Mona Abdel-Halim

Posted

Trichoblastoma definitly.. Beautiful one :-)

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Guest Arash Daryakarr

Posted

Agree with trichoblastoma .stromal condesnsation is also evident together with stromal CD10 positivity.

i have a question: how can we make distinction between trichoblastoma and trichoepithelioma?

(except that trichoblastomas are bigger and deeply seated...)

Thanks in advance.

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Raul Perret

Posted

Arash: Trichoepitheliomas are usually considered variants of trichoblastoma (Mainly by Ackerman) but in particular they usually have a cribiform morphology, infundibular differentiation (usually in the form of keratocysts) whereas trichoblastomas are usually more immature (almost completely basophilic tumors). This is of course the criteria that I consider (I am not an expert) maybe the rest of the group can add other important points. I recommend you to get Kazakov's book of cutaneous adnexal tumors and check the special module's section (Dr Carr did a great review on adnexal neoplasms) 

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Arash:  Further to Raul's comment, Ackerman used trichoblastoma as a category, to include 6 types: 

 

- Large nodular and small nodular trichoblastomas (others limit the term "trichoblastoma" to these two types);
- cribriform, racemiform and/or retiform trichoblastomas (otherwise called trichoepitheliomas);
- and columnar trichoblastoma (otherwise called desmoplastic trichoepithelioma).  
 

To this, LeBoit adds fibroepithelioma of pinkus, as fenestrated trichoblastoma. 

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Dr. Mona Abdel-Halim

Posted

I add that TE are superficial lesions that may show focal connection to the epidermis, TB are large deep seated lesions. Otherwise they r the same, hair germ tumors with epithelial and mesenchymal components.

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Mark A. Hurt MD

Posted

Here is my diagnosis.  Thanks, everyone, for a good discussion.

 

SKIN, FRONTAL SCALP , BIOPSY :

-- TRICHOBLASTOMA, SMALL LOBULAR (small nodular)

COMMENT:  In my opinion the lesion fits trichoblastoma the best given the differential of basal cell carcinoma vs trichoblastoma.  Especially notable is the presence of CD10 positivity in the peri-epithelial stroma but not in the epithelial components, which is a classical presentation of trichoblastoma.  In basal cell carcinomas, the epithelial components stain for CD10.  I don't see that phenomenon in this lesion. This lesion extends into the peripheral edge of the biopsy, so it has not been excised in this procedure.  

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