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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 1487- 07 March 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 44-year-old woman with shave biopsies of a lesion taken from the right buttock.

Case posted by Dr Mark Hurt


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Dr. Mona Abdel-Halim

Posted

The first image shows a very well circumscribed lesion with epidermal collarete. The cells show wholrly and storiform pattern. I am thinking actually in perineurioma. Will do EMA and CD34.

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Epitheliod histocytoma for factor13a

also, perineuroma is another dd for Ema , Glut-1

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vincenzo polizzi

Posted

Ancient Pacinian Neurofibroma

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Guest Mazen

Posted

DD
ossifying fibromyxoid tumor, non ossifying variant
perineurioma

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Raul Perret

Posted

Like Mona I also consider this case could be perineurioma, in the differential I also considered neoplasms in the spectrum of angiofibroma. This is a challenging case, I would perform: CD34, s-100, actin, desmin, ck, and EMA first

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Dr. Richard Carr

Posted

Looks benign. Epithelioid cell histiocytoma / DF was my favoured but agree with differentials as above.

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Guest Romualdo

Posted

Agree with epithelioid dermatofibroma.

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Nitin Khirwadkar

Posted

Agree with the differentials. Need IHC. 

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Raul Perret

Posted

I just wanted to share some articles that i found interesting when reviewing this case and could actually be useful in this occasion.

http://www.ncbi.nlm.nih.gov/pubmed/25857825

http://www.ncbi.nlm.nih.gov/pubmed/25413595

Apparently epithelioid histiocytoma/dermatofibroma has a high frequency of ALK mutations that can be demonstrated either with IHQ or FISH with a good sensitivity, it is useful not only as a diagnostic tool (excludes other mimics that are not ALK positive) but also supports an origin different to dermatofibroma. Maybe in the coming years this tumor will be reclassified....

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Mark A. Hurt MD

Posted

I'm going to chime in a bit early.  I diagnosed this as an epithelioid cell histiocytoma, but I am sympathetic with the ddx of perineurioma and will follow-up with EMA on this specimen.  Markers thus far were:

 

"negative with Melan-A and has a Ki67 (clone 30-9) index in the range of about 5% positive in these lesional cells.  SOX10 is negative, and CD34 shows a rarefied pattern.  Factor XIIIa shows that some of the lesional cells pick up the marker; there are some dendritic cells in the midst of them.  Actin and Desmin are both negative.  p40 is negative.  The elastic stain shows a loss of elastic fibers in the lesion."

 

More to come later.

 

Mark

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Mark A. Hurt MD

Posted

I obtained EMA, and it's negative.  Thus, the diagnosis of ECH stands.  Thanks for the discussion!

 

Mark

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