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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 1585 - 22 July Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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M80. Plaque on Chest

Dr Richard Carr


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vincenzo polizzi

Posted

Sebaceous Carcinoma?

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vincenzo polizzi

Posted

Or Balloon cell Melanoma, pseudolipoblastic type?

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Arti Bakshi

Posted

Doesnt have the germinative/basaloid element for sebaceous carcinoma. Balloon cell melanoma is a good possibility. Other d/d of clear cell tumours including metastatic RCC need to be excluded. Needs a wide panel of immunos...awaiting aditional images!

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Dr. Richard Carr

Posted

I really enjoyed catching up with this week's cases after our hospital internet was down most of the week.  Arti's case spectacular (I want a copy section!).  Can I suggest checking out Case 552 (one of mine) and Case 1378 for those who want to revise lipomembranous fat necrosis.  I have started using google to search Dermpathpro cases to good effect!  Warm regards to all.

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Nitin Khirwadkar

Posted

Agree, needs a wide IHC panel. Would add an atypical lipomatous tumour to the list.

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Raul Perret

Posted

Agree need immunos, I think my favourite choice is melanoma with balloon/clear cell change. There is some cytoplasmic retraction in some cells and sclerosis so just to throw a more exotic option could consider an atypical Pecoma.

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Nitin Khirwadkar

Posted

Like the second suggestion Raul.

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Arti Bakshi

Posted

Ofcourse Richard, will send a copy section next week...  

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vincenzo polizzi

Posted

Thanks Dr Richard!!!

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For immuno
Balloon cell melanoma versus seb.carcinoma and metastatic RCC

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Guest Arash Daryakarr

Posted

Balloon cell melanoma

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Nitin Khirwadkar

Posted

Wow! Balloon cell/sebocyte like melanoma!

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Arti Bakshi

Posted

Yes, balloon cell melanoma.

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Dr. Richard Carr

Posted

Yes very well done to all.

 

I think these are an admixture of balloon cells (very low nuclear to cytoplasmic ratio), intermediate and sebocyte-like malignant melanoma cells (higher nuclear to cytoplasmic ratio according to the definitions in the paper by Kazlouskaya et al Am J Dermpath 2014;35:380-386.  I recommend you also read a fascinating little piece yet to come in the printed journal by Dr Resnik, Am J Dermpath, "Sebocyte-like melanocytes - Additional relevant (and behind the scenes) historical information. I'm pretty sure sebocytes-like and balloon cells are merely ends of a spectrum as suggested by Kazlouskaya et al.

 

It seems sebocyte-like cells in melanoma is in any case very rare.  In this case the clear cells only made up about 10% of the melanoma but they were quite striking.

 

Yo! to all 

[you have to read Resnik reference to understand this sign off].

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