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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 1616 - 5 September 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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The patient is a 74 year old woman with an excision of a firm subcutaneous cyst taken from the right central frontal scalp. Clinical Diagnosis: Pilar cyst.

Case Posted by Dr Mark Hurt
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  Report Record
Go to records September 2016

User Feedback


Raul Perret

Raul Perret 262

Posted

Would perform p53 and ki67 but probably would dignose this case as low grade malignant proliferating pilar tumor. Should follow the patient but he is probably cured

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vincenzo polizzi

vincenzo polizzi 185

Posted

Broadly speaking I agree with above. I see a solid-cystic squamous tumor, with diffuse trichilemmal differentiation, peripheral palisading of basal cells, calcifications, fibrosis and multilobulated pseudocarcinomatous architecture. There is mild to moderate nuclear atypia and some focal irregular borders.  The lesion remain however well-circumscribed, without a definitive stromal infiltration...so  I would remain still within the limits of a Proliferating Trichilemmal Cyst.

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Sasi Attili

Sasi Attili 85

Posted

4th image looks like there is evidence of invasion? Was going to favour proliferating trichilemmal cyst, but changed my mind. Will go with Raul.

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Arti Bakshi

Arti Bakshi 286

Posted

Agree. Proliferating pilar tumours exist on a spectrum, and I think there are features in this case to suggest a low grade malignant potential. Not sure, however, if one should advise re-excision or just follow up in such cases...

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Nitin Khirwadkar

Nitin Khirwadkar 63

Posted

Would favour a malignant proliferating pilar tumour. At-least focal invasion is apparent in image 4.

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