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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 1878 - 09 August - Dr Uma Sundram 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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60 year old woman with papule on left lateral leg.


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Dr. Richard Carr

Posted

I'm struggling. I find this sort of spindle cell lesion tricky and invariably end up doing a few immunos. My differential including: perineurioma, neurofibroma, hypopigmented blue n., desmoplastic naevus.

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Dr. Mona Abdel-Halim

Posted

Looks neural to me too, perinurioma?

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Nitin Khirwadkar

Posted

Agree with the differentials proposed by Richard. Favour a neural tumour ? Perineurioma

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vincenzo polizzi

Posted

I was thinking of mutinucleated cell angiohistiocytoma, but I'm afraid I'm wrong, if no other thought of this lesion...

I looked for alternative diagnosis ( as perineurioma or some  smooth muscle proliferation ), but this lesion has a typical plaque-like silhouette, and typical angulated multinucleate cells, so favour MCA.

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Some of the cells looks like mast cells.

Just to widen the differentials , the following are added with different priorities;Giant cell collagenoma (GCC) ,multinucleate cell angiohistiocytoma , circumscribed storiform collagenoma, pleomorphic fibroma/lipoma, regressive forms of dermatofibroma, solitary myofibroma,  giant cell fibroblastoma , neurofibroma, giant cell angiofibroma .

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Arti Bakshi

Posted

pleomorphic fibroma if other d/d (as above) excluded by immunos.

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Uma Sundram

Posted

My apologies for the late post. We did call this an unusual neurofibroma. Sox10 and s100 were positive but other melanocytic markers were negative. 

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