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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 1799 - 20 April - Dr Arti Bakshi Posted By: Guest

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Clinical History: 85/F, lesion left leg.

Case Posted by Dr Arti Bakshi


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Raul Perret

Posted

I thought of acantholytic SCC for immunohistochemical confirmation. There is actinic keratosis on the overlying epithelium and abnormal abrupt keratinization. In picture 3 I have doubts on whether we see a neoplastic emboli, also the cells have clearer cytoplasm in this foci. I would perform p63, keratins, CEA and PAS just to discard the presence of mucin and get some clinical information in case there is suspicion for metastatic disease.

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Mariantonieta Tirado

Posted

I agree with acantholytic SCC. I think there is epidermal connection (picture 3) and the cells seem to show keratinization. I would also add IHC (panel of keratins) and levels

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msofopoulos

Posted

I think its acantholytic SCC. I wouldlike to see p63....

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vincenzo polizzi

Posted

First thought: Acantholitic SCC.

 

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Robledo F. Rocha

Posted

Agree with acantholytic squamous cell carcinoma.

A question to the panel: comparing tumors with similar greatest dimension, thickness, anatomic level, margins status, and pathologic staging, in your experience, does the acantholytic type carry a worst prognosis than the conventional type? I feel data from literature are contradictory.

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Arti Bakshi

Posted

Yes, acantholytic SCC. p63 was diffusely positive.

A very valid comment from Robledo regarding the prognosis of this group of tumours. I agree the literature is not conclusive and although this has been included as a high risk group, there do not appear to be large studies/series supporting this. In routine practice, I find  this to be a particular problem when dealing with small diameter, relatively well to moderately differentiated (and often fairly superficial) lesions which show focal areas of acantholysis. The guidelines do not indicate how extensive the acantholysis should be to categorsie a lesion as an 'acantholytic' and hence a 'high risk' subtype. It does seem an overcall to label these lesions as high risk. Would be good to hear other people's experiences.....

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Neil Catterall

Posted

An article on acantholytic SCC in J Cutaneous Pathol is the topic for the first Dermpath Journal club on Twitter. Some of Arti's questions are raised in this article.

Acantholytic invasive squamous cell carcinoma: tumour diameter, invasion depth, grade of differentiation, surgical margins, perineural invasion, recurrence and death rate. J Cutan Pathol 2017: 44: 320-327 

J H Pyne, E Myint et al

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Dr. Richard Carr

Posted

I'm a strong advocate of the type of invasive border. If cohesive and pushing - virtually no risk (many follicular SCC are for practical purposes in situ lesions). If an acantholytic SCC invades the dermis it will by definition be pretty infiltrative and poorly differentiated. Difficult to tell in this biopsy how much invasion there is, could be the tip of the ice-berg. But beware the pseudocircumscript poorly differentiated SCC running through the collagen and elastic unimpeded (these I exclude from "pushing" borders). The ENT bods have been using this system for sometime and it was reported as useful on SCC's of the ear.

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Robledo F. Rocha

Posted

Thank you all for your kind comments on my query. I was not aware about Dr. Pyne's article, so I gonna read it right now.

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