Jump to content
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 1701 - 5 December - Dr Richard A Carr Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
   (0 reviews)

Clinical Details: M10. Recurrent protuberant mass on the neck. African child. For newbies and trainees first please.

Case Posted by Dr Richard A Carr

Edited by Admin_Dermpath


  Report Record

User Feedback


Admin_Dermpath

Posted

Richard has given us a case for Newbies and Trainees, enjoy.

 

Geoff Cross - DermpathPRO Projects

Share this comment


Link to comment
share_externally

Dr. Richard Carr

Posted

This case is now open to all comers.

Share this comment


Link to comment
share_externally

Arash Daryakar

Posted

my first thought was plexiform neurofibroma..but there are foci of atypia and hypercellularity.

neurofibroma with atypical features?

Share this comment


Link to comment
share_externally

Raul Perret

Posted (edited)

Agree with Urmila it was my impression too but to be honest I did not find this case easy. You want to perform s-100 , desmin and cd34.

Edited by Raul Perret

Share this comment


Link to comment
share_externally

Raul Perret

Posted

I thought there were areas looking like cellular angiofibroma and superficial angiomyxoma. In the last picture the cells look rather irregular and sort of more immature (when you compare them to the small rounded plump happy looking cells from cellular angiofibroma). I would have liked to see the deeper portions of the sample as well as adnexal entrapment but again my impression was giant cell fibroblastoma as Urmila suggested

Share this comment


Link to comment
share_externally

urmilapandey

Posted (edited)

Agree Raul, need to see some immunohistochemistry: S100, CD34, Desmin, SMA, EMA. Some probable mast cells in one of the images, made me consider a neural lesion but the cellular areas not look particularly 'neural'. I too thought of a cellular angiofibroma but can't explain the scatted enlarged smudged nuclei. Also considered a lipoblastoma but can't see any convincing lipoblasts.

Edited by urmilapandey

Share this comment


Link to comment
share_externally

Dr. Mona Abdel-Halim

Posted

I am thinking of plexiform neurofibroma with areas showing features of cellular variant with atypical features.

Share this comment


Link to comment
share_externally

Neil Catterall

Posted

Also favour giant cell fibroblastoma. Have only seen 1 case in 30yrs!

Share this comment


Link to comment
share_externally

Dr. Richard Carr

Posted

This was not easy but I wanted the newbies and trainees to have a crack at it first. Well done Urmila for spotting the giant cell fibroblastoma and to Vincenzo for adding the dermatofibrosarcoma protuberans (in this case having large areas of the rare and challenging myxoid variant).  This (DFSP/GCF) is a rather classic association - I have seen it presented in meetings and saw another case myself. Childhood and indeed congenital DFSP is well reported.  This was a case I saw in Malawi while reporting the general histopathology case load during my regular visits to Blantyre doing an autopsy study on cerebral malaria (1995 to 1999) funded by the NIH.  The pathology there was very much biased towards immunosuppression related, infections and childhood. I brought this unusual case back to St Thomas' Hospital and Phillip McKee gave me the diagnosis (I was flummoxed having never seen examples). Clearly he'd recognised this case and remembered the association between DFSP and GCF during his work with Chris Fletcher - see references).

References:

1. https://www.ncbi.nlm.nih.gov/pubmed/17721193

2. https://www.ncbi.nlm.nih.gov/pubmed/1939782

3. https://www.ncbi.nlm.nih.gov/pubmed/2172145

4. https://www.ncbi.nlm.nih.gov/pubmed/12502925

5. https://www.ncbi.nlm.nih.gov/pubmed/2069214

6. https://www.ncbi.nlm.nih.gov/pubmed/2804904

Share this comment


Link to comment
share_externally



Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Add a comment...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...