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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 1708 - 14 December - Dr Hafeez Diwan 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 History: 26 year-old female with nose lesion.

Case Posted by Dr Hafeez Diwan


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Admin_Dermpath

Posted

Even as a layman this looks interesting, have fun with Dr Hafeez Diwan's case.

 

Cheers, Geoff Cross - DermpathPRO Projects

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Neil Catterall

Posted

Agree desmoplastic trichoepithelioma but quite extensive and I would like a combined stain to make sure there is no perineural infiltration.

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Nitin Khirwadkar

Posted

Agree, desmoplastic TE. I believe one of the IHCs is CK20 highlighting reactive Merkel cells and the other is CD10 showing stromal condensation. I think, Richard had put one case on Dermpathpro giving a list of 20 points to distinguish between DTE and BCC. Somehow, I am not getting that case in the search.

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vincenzo polizzi

Posted

Yes! Desmoplastic Trichoepithelioma. Well circumscribed in deep dermis, papillary mesenchymal bodies, thin strands and cords, absence of stroma cleft and mutinous changes, keratocysts and keratin granulomas fit well. Is last fig a CD34? And CEA  in fig5?

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Agree with desmoplastic trichoepithelioma. I believe the immunostains are CK20 for Merkel cells and the second one CD34. Nice case.

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Raul Perret

Posted

1 hour ago, Nitin Khirwadkar said:

Agree, desmoplastic TE. I believe one of the IHCs is CK20 highlighting reactive Merkel cells and the other is CD10 showing stromal condensation. I think, Richard had put one case on Dermpathpro giving a list of 20 points to distinguish between DTE and BCC. Somehow, I am not getting that case in the search.

I agree with all of you desmoplastic TE. This is the case you mention Nitin, a very useful one with a nice discussion

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vincenzo polizzi

Posted

I better checked IHC pictures and agree with CK20 in left bottom. 

Thanks Raul, very useful the mentioned case!

 

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Robledo F. Rocha

Posted

Columnar trichoblastoma (aka desmoplastic trichoepithelioma).

Dr. Carr have said here on more than one occasion that this is one of the most difficult diagnoses in Dermatopathology, so everyone is doing a good job!

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Robledo F. Rocha

Posted

11 hours ago, Cattsy said:

Agree desmoplastic trichoepithelioma but quite extensive and I would like a combined stain to make sure there is no perineural infiltration.

Columnar trichoblastoma may feature perineural involvement. This peculiarity should be interpreted with caution and together with other findings to make the correct distinction from its malignant differential diagnoses.

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Arash Daryakar

Posted

agree with colleagues. IHC for CK20 ,CD10 and androgen receptor can help to confirm the diagnosis.

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Arti Bakshi

Posted

Agree.

As Nitin and Raul mentioned, Richard's 20 points in case 813 are very useful and I have kept a printout of it to remind me in problematic cases!

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Dr. Hafeez Diwan

Posted

Desmoplastic trichoepithelioma.  Yes, the bottom left panel is CK20 and the bottom right is CD10.

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