Jump to content
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 1792 - 11 April - Dr Uma Sundram Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
   (0 reviews)

Clinical History: 89 year old woman with ‘infected’ skin lesion on right gluteus.

Case Posted by Dr Uma Sundram


  Report Record

User Feedback


vincenzo polizzi

Posted

Yes, agree with Mona! Melanoma in situ! There was some concern in fig 2 because of busy dermis, but I think it's an inflammatory reaction, so favour an "intraepidermal lesion"!

Share this comment


Link to comment
share_externally

Dr. Richard Carr

Posted

Odd history and site for melanoma. Did you see melanin?

Share this comment


Link to comment
share_externally

Raul Perret

Posted

Tought of Paget's when I saw the case and the weird location

Share this comment


Link to comment
share_externally

Nitin Khirwadkar

Posted

Looks like an in-situ melanoma with some regression in the dermis. Agree with Richard's comment regarding 'odd -site'. IHC to rule out an odd extramammary Paget's (although the pattern of spread along the epidermis  is a bit odd).

Share this comment


Link to comment
share_externally

vincenzo polizzi

Posted

Agree with above comments, and I thought of Paget too, but a junctional and nested arrangement like this, instead a "pagetoid" one, would be very unusual for a Paget . The intraepidermal growth pattern seems much "melanocytic" in fig 3, 4.    IHC is mandatory of course.

Share this comment


Link to comment
share_externally

Dr. Mona Abdel-Halim

Posted

Definitly EMPD is a ddx .. IHC mandatory

Share this comment


Link to comment
share_externally

Sasi Attili

Posted

Difficult case!. Some cells look pagetoid?

Share this comment


Link to comment
share_externally

Raul Perret

Posted

34 minutes ago, Sasi Attili said:

Difficult case!. Some cells look pagetoid?

Yes. For me even if they grow mainly in nests, the cells have rather clear abundant cytoplasm and even in the last pic it looks like there are some with signet-ring cell like morphology

Share this comment


Link to comment
share_externally

Robledo F. Rocha

Posted

Hard to distinguish, without mucin and immunohistochemical stains, between nested extramammary Paget’s disease and nested superficial spreading melanoma in situ. I favor the former, taking into account the site (perianal region is rich in apocrine sweat glands), cytologic findings (cells have abundant pale amphophilic cytoplasm, some of them with intracytoplasmic clear droplets and signet-ring appearance), and architectural features (neoplastic nests are detached from the underlying compressed basal layer). Rule out intraepithelial spread from an internal carcinoma from sigmoid colon or rectum is also important.

Share this comment


Link to comment
share_externally

Uma Sundram

Posted

Perfect. I too thought MIS at first glance, but indeed CK7 was positive and S100/MART-1 was negative, supporting extramammary Paget's disease. CK20 was negative and the patient had negative staging work up.

Share this comment


Link to comment
share_externally



Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Add a comment...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...