Jump to content
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 1800 - 21 April - Dr Richard A Carr 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: M60. Lesion upper arm ?BCC. Two other confirmed BCC excised at same time.

Case Posted by Dr Richard A Carr


  Report Record

User Feedback


vincenzo polizzi

Posted

What about a pseudoepitheliomatous induction in arthropod bite reaction?...

Share this comment


Link to comment
share_externally

Raul Perret

Posted

I thought of pseudoepitheliomatous hyperplasia with dermal granulomatous inflammation so would like to discard first skin infections fungus/mycobacteria. A PAS and ZN could help

Share this comment


Link to comment
share_externally

vincenzo polizzi

Posted

...In a patient with Chronic Lymphocytic Leukemia?

Share this comment


Link to comment
share_externally

Dr. Mona Abdel-Halim

Posted

There could be a background of CLL that explains the very dense lymphoid reaction here, as the last image shows some lymphoid atypia, to be verified by CD20,5, 43 and clinical correlation. The nature of the infiltrative epithelial growth to me is not comforting with PEH, especially with the presence of mucin (epithelial?). The granulomatous reaction is pissibly induced by keratin. I am worried about a fSCC (low grade) in a patient with CLL. I might be off track. 

Share this comment


Link to comment
share_externally

Raul Perret

Posted

I think that for LLC there is too much mixed inflammatory reaction (eosinophils, plasma cells). On the other hand the process seems multifocal and mainly centered on hair follicles, the former aspect is against fSCC. If PAS and ZN are negative then I would consider exaggerated arthropod bite reaction as Vincenzo suggested

Share this comment


Link to comment
share_externally

Arti Bakshi

Posted

I am more with Mona on this...worried about a SCC (invasive follicular) 

Share this comment


Link to comment
share_externally

Neil Catterall

Posted

The lymphocytic infiltrate is centered on the epithelial proliferation - not usual infiltrate for arthropod assault. I agree with Arti - SCC (invasive follicular)

Share this comment


Link to comment
share_externally

Nitin Khirwadkar

Posted

More for a follicular SCC. Would like to r/o CLL as well.

Share this comment


Link to comment
share_externally

Dr. Richard Carr

Posted

Good discussion and I think a difficult case. I reported it as a follicular squamous cell carcinoma, infiltrative, inflammatory variant, mild cellular atypia only. p53 was wild type and p16 only slightly up-graded (++20%). EMA diffusely positive, BerEP4-ve.

I did not originally think of CLL to be honest - I did however when looking at the image "blind" last week!  Maybe should have mentioned in my report "given the prominent lymphocytic infiltrate, any history of CLL."  Having said that I suspect it's just an inflammatory carcinoma (looks quite epitheliotropic i.e. T-cell pattern).

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...