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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 1975 - 27 Dec 2017 Posted By: Limin Yu

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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56 Female, right cheek, previously bx with a diagnosis of BCC

Edited by Admin_Dermpath


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vincenzo polizzi

Posted

No clefts or mucin/amyloid stromal changes. A cellular, specialized peritumoral stroma with some subtle PMB-appearance...and with demarcation from the surrounding dermis. I think this lesion is in the Trichoblastoma\Trichoepithelioma spectrum. I'd like to call this superficial TB.

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Cutaneous lymphadenoma. A type of trichoblastoma.

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Dr. Richard Carr

Posted

Favour BCC. I have a personal adage that for every time you think of TE/TB on the central face in a patient of this age (>50y) it's a BCC >19 times out of 20. Obviously normal rules don't necessarily apply in dermpathpro but for me the tumour is strongly favoured to be a BCC on morphological gounds in any case. You could do CK20, CD10 - I find it quite helpful but not sure I'd have bothered on this case as the lesion appears small and out in any case (on these images). I like the little leaping dog!

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Dr. Richard Carr

Posted

I'd also be interested in the BerEP4 pattern (my cutaneous lymphadenomas have had rather distinctive peripheral staining only (unpublished), that would be very uncommon for a BCC, I demonstrated reactive Merkel cells in one cutaneous lymphadenoma but only photographed it on one case it appears). Cutaneous lymphadenomas are pretty rare so a small collection with IHC would be of interest for publication.

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Uma Sundram

Posted

I like BCC too, and probably would not have gone down any other road. I find CK20 to be helpful in difficult cases.

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msofopoulos

Posted

Looks like a Trichoepithelioma but I would also like to see a CK20

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John Zhang

Posted

I favor adamantinoid trichoblastoma based on morphology. If it is a new lesion in a 56 year old BCC is more likely, but if it is a lesion with 20 year history it can certainly be trichoblastoma. 

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At first, I apologize for overlooking this case and not providing the feedback in a timely manner. This case was posted during Christmas break and fell through the cracks.  That wasn't my excuse -- my apologies. 

Your insightful discussion reflects my debate with myself. This is a circumscribed basaloid neoplasm. My first impression was to call it BCC. Something bothered me and stopped me from signing it our as a BCC. The stromal  changes are more fibrotic than what's usually seen in BCC. I finally called it cutaneous lymphadenoma, which is type of trichoblastoma.  Your points are well-taken. And I don't believe there are reliable histologic features distinguishing BCC from TB/TE. This case underscores the hypothesis that some BCC and TE/TB are in the same spectrum. 

 

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