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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 1457- 25 January 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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Case History: The patient is a 53-year-old man with a biopsy of a lesion on the left anterior thigh.

Case posted by Dr Mark Hurt


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Raul Perret

Posted

Ossifying dermatofibroma with osteoclast-like giant cells

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Raul Perret

Posted

Am j Dermatopathol. 2009 Jun;31 (4) :379-83

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vincenzo polizzi

Posted

What about a Extrasrticular Ossifying Pigmented villonodular synovitis?

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Nitin Khirwadkar

Posted

Agree. Did think about a soft tissue giant cell tumour as a differential. However, this case lacks the peripheral ossification usually seen with giant cell tumours. Not sure if cases of ossifying DFs have this uniform distribution of osteoclastic giant cells. The central bone formation and osteoblastic rimming, along with other features is more in favour of ossifying dermatofibroma.

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Dr. Mona Abdel-Halim

Posted

Yes agree with Raul, very nice :-)

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Mark A. Hurt MD

Posted

I had trouble with this case, and so I consulted a soft tissue tumor expert in the US.

 

My initial diagnosis was:  "Giant Cell Tumor Of Tendon Sheath With Osteoid And Osseous Metaplasia."  As I had never made this diagnosis before, I consulted it out.  The consultant's diagnosis was:  "Soft tissue giant cell tumor".

 

My report comment was as follows:  "After I had rendered the original diagnosis (below) I had expanded my differential to think that this might be in the soft tissue tumor category rather than occurring mainly in skin.  Apparently Dr. xxxx agrees that this lesion should be considered a soft tissue giant cell tumor, which can be more aggressive, at least locally.  Apparently, it has only minimal capacity for distant disease, at least in published cases.  As Dr. xxxxx indicates, complete excision of the lesion is warranted based on this diagnosis.

 

I encourage more discussion

 

MAH

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Dr. Mona Abdel-Halim

Posted

I thought of giant cell tumor of soft tissue first but after reading Raul's suggestion, I read the article he mentioned and found that it fits very much with the reported ossified DF with osteoclast like giant cells. I have not find ossification in giant cell tumor of soft tissue... Interesting case..

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Nitin Khirwadkar

Posted

Read this from the chapter of 'tumours of osteoarticular origin' in Diagnostic Histopathology of tumours 3rd edition. Not sure how this translates to cutaneous lesions.

'a rare giant cell tumour shows new bone formation within the substance of the tumour'.

There is another comment regarding 'fibrous histiocytoma like areas within GCT'.

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