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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 1502- 28 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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The patient is a 69-year-old man with an excision of a lesion on the left anterior neck.

Case posted by Dr Mark Hurt


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vincenzo polizzi

Posted

Metastatic adenosquamous carcinoma ( bronchial? upper airway? )

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Dr. Mona Abdel-Halim

Posted

Met adenocarc for work up

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Guest Arash Daryakarr

Posted

Hard to fit with any primary cutaneous tumors. i consider metastatic adenocarcinoma and suggest Immuno and taking history of possible neoplasms.

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Arti Bakshi

Posted

Agree with metastatic adnecocarcinoma. Would consider lung and liver as the most likely primaries (the latter due to trabecular pattern and prominent nucleoli).

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Raul Perret

Posted

I find this case really challenging. On my differential, I couldnt completely discard  a primary adnexal neoplasm, some features made me think of ACC and cribiform apocrine carcinoma from kazakov, although some features are lacking for both entities. The tumor is based on the dermis, has clearly a dual cell population, marked cellular pleomorphism and is well circumscribed so metástasis has to be ruled out. A good panel of immunos as well as CPC should help find the diagnosis. To your excelent differential of cutaneous metástasis I would add prostate adenocarcinoma

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Mark A. Hurt MD

Posted

I'm away from my main computer today, but I will respond tomorrow with my diagnosis and reasons for it. Mark

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Mark A. Hurt MD

Posted

Here was my diagnosis.  Thank you for the discussion!

 

SKIN, LEFT ANTERIOR NECK , EXCISION :

-- CRIBRIFORM CARCINOMA

COMMENT:  I think it is very likely that this is a primary neoplasm. It seems to phenotype as a primary neoplasm and not a metastasis; although with lesions like this, I always suggest at least some physical examination and investigation into whether there is a primary elsewhere.  The immunophenotype in the growth pattern characteristics of the lesion are characteristically seen in cribriform carcinomas, which are primary carcinomas, considered to be apocrine and relatively indolent in literature cases.

 

Reference:

 

Kazakov DV et al.  Cutaneous Adnexal Tumors.  2012; p92 (Cribriform carcinoma)

 

The H&E sections show a relatively circumscribed proliferation of interconnected ducts, some of which have cribriform patterns. There is nuclear pleomorphism of the cells within these cribriform patterns, some of them containing mitotic figures. Generally high nuclear cytoplasmic ratios and some degree of nuclear pleomorphism is characteristic in this lesion. I don't see any connection to the surface or to the adnexal structures, and I don't see any perineural involvement in this lesion. Immunophenotypically, the lesional cells are strongly positive with CK7 and negative with CK20. They are positive to a lesser degree with CAM 5.2. EMA is more strongly positive than CAM 5.2 but less positive than CK7. A small amount of CEA is noted in some of the lumina. TTF-1, CDX-2, Hepatocyte anagen, PSA, and PSAP are all negative. Additionally, Calponin is negative as is S100 protein. Ber-Ep4 was obtained, and it is positive about the same way EMA is positive. The p63 and p40 are both positive in the lesion, but I don't see any blush of positivity with D2-40 in the lesion. 

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