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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 1698 - 30 November - 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: 65 year old male with erythematous scalp lesion

Case Posted by Dr Hafeez Diwan


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Admin_Dermpath

Posted

Dr Hafeez Diwan rounds of what has been a great month for DermpathPRO.

Cheers, Geoff Cross - DermpathPRO Projects

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urmilapandey

Posted

necrosis, some endothelial atypia, can't see any pre-existing vascular space where this proliferation is occuring, hence am thinking on the lines of an angiosarcoma

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Robledo F. Rocha

Posted

Taking into account the patient’s age and the lesion’s site, I’d tend to construe those irregularly branching thin-walled vessels with dissecting growth pattern as an angiosarcoma.

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vincenzo polizzi

Posted

Agree with above, but I would like know about EMA- CD31-D2-40, to rule out an odd ectopic meningothelial hamartomatous lesion in adult ( never seen before! )

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vincenzo polizzi

Posted

Is there a psammoma body in last fig bottom right??? 

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Raul Perret

Posted

I have heard of a case that dr. Diwan had once but never actually saw the case. It was about a patient that had findings compatible with angiosarcoma but concomitantly showed large areas of necrosis and bacterial colonies. Apparently he suggested to treat the patient for the infection before confirming the dx of angiosarc. Apparently the treatment for the infection made also dissapear the vascular proliferation. If it is this case, I find it extremely challenging

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Dr. Mona Abdel-Halim

Posted

20 minutes ago, Raul Perret said:

I have heard of a case that dr. Diwan had once but never actually saw the case. It was about a patient that had findings compatible with angiosarcoma but concomitantly showed large areas of necrosis and bacterial colonies. Apparently he suggested to treat the patient for the infection before confirming the dx of angiosarc. Apparently the treatment for the infection made also dissapear the vascular proliferation. If it is this case, I find it extremely challenging

Wao :-)

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Dr. Richard Carr

Posted

Angiosarcoma is a treacherous diagnosis!  I would recommend looking at the patient but one has to consider the possibility on this histology. I find immunos can be quite helpful.  Reactive vascular proliferations usually have endothelial staining for endothelial markes and rings of smooth muscle actin staining around the vessels (pericytes and smooth muscle cells), the latter not seen in angiosarcomas. Raul's post is most interesting!

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Raul Perret

Posted

I was searching where did I heard that and actually is in Dr. Diwan's blog link 

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Thank Dr. Diwan for this interesting case. To me this is angiosarcoma until proven otherwise. Can't wait to see the dx. Cheers!

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Nitin Khirwadkar

Posted

Raul, thanks for referring to the blog. Just had a look at what Dr Diwan said about that case, and it looks that this is the case! 

Without the reference, would have probably favoured/consistent with an angiosarcoma . Right clinical setting, age! However, I have never seen angiosarcomas with so much necrosis or bacterial debris.

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Arti Bakshi

Posted

Wow! ....i'm sure i had read that blog at some point but didnt connect it with this case... Raul's memory is clearly photographic!

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Dr. Hafeez Diwan

Posted

Angiosarcoma, superinfected with Enterobacter.  This was a large, erythematous lesion on the scalp of this patient.

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