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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 1705 - 9 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.
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Clinical Details: F75. Rt neck.  6/12 mass, v sore + unable to eat due to pain ? (illegible).

Case Posted by Dr Richard A Carr


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Admin_Dermpath

Posted

Dr Richard A Carr has got you a 'difficult' case to round of your week.

 

Cheers, Geoff Cross - DermpathPRO Projects

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urmilapandey

Posted (edited)

am thinking on the lines of a vasoformative lesion and given the history of a 'mass' would consider kaposi's, angiosarcoma. Immunos...

Edited by urmilapandey

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Dr. Mona Abdel-Halim

Posted

Very difficult!!

Got an impression of patch stage KS (especially from image 7 and from the extensive extravasated erythrocytes) but the clinical setting is weird??

The  4th image shows lymphoid infiltrate dissecting in between the collagen bundles with some cells showing indian filing., the cells do not look that atypical though!

So I am between two lines: weird presenttaion of KS (may be in an HIV patient) vs. a lymphoproliferative/leukemic infiltration..

I wish other images are yet to be presented or immunos!!!

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Raul Perret

Posted

I had the exactly same impression as Mona, we have good markers for assistance so would perform IHC. Just with this images I think the infiltrate looks rather polymorph for KS and image 4 really looks like the kind of infiltration I have seen in leukemia/some lymphomas.

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vincenzo polizzi

Posted

Me too am between two lines, but sincerely no impression of KS. My lines are: 

1) lymphoplasmacytic proliferation with systemic amyloidosis ( amyloidosis of the tongue could fit well on swallow pain ).

2) a weird systemic scleromyxedema starting as localized skin neck mass.

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Eman El-Nabarawy

Posted

Agree with amyloidoma or systemic amyloidosis presenting as neck mass.

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Dr. Richard Carr

Posted

This is an old case from my slide collection that a recent visitor brought to me because they could not really fathom the proffered diagnosis.  Yes it is very difficult and the visitor was quite surprised that on low power I raised the possibility of angiosarcoma based on some very important clues.  Severe solar elastosis with evident red cell extravasation and a slightly busy look to the dermis and subcutis.  I said we have to do vascular markers (although I agree the history was totally misleading that was the information submitted with the biopsy). The diagnosis is angiosarcoma (well done Urmila), endothelial markers highlighted the dissecting vessels that we can see in some of the images (also containing lymphocytes). I subsequently found the patient had had another biopsy 6 months earlier from a forehead lesion and angiosarcoma had not been considered clinically or histologically but retrospective endothelial markers confirmed it also showed angiosarcoma.  As I said on Hafeez's case angiosarcoma can be a perilous diagnosis but we must always think of it in severely sun-damaged skin with red cell extravasation and haemosiderin deposition.

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Nitin Khirwadkar

Posted

Just saw this case, along with the diagnosis. Yes, a sneaky angiosarcoma. 

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vincenzo polizzi

Posted

Well done Urmila. This was a very difficult case. And I have learnt something important from it. 

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Dr. Mona Abdel-Halim

Posted

Thanks for sharing Dr Carr.. nice case :-)

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urmilapandey

Posted (edited)

Thanks for sharing such interesting cases Richard and the dermpathpro team of specialists. Being a generalist, am learning so much from all you expert dermatopathologists through this exceptional website.

Edited by urmilapandey

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