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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 1860 - 14 July - Dr Richard Carr 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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M80. Three scalp lesions. ?All actinic keratoses, ?lichenoid keratoses, ?actinic granuloma. Representative images from 2 of the biopsies but all showed similar features.

Edited by Admin_Dermpath


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Dr. Mona Abdel-Halim

Posted

Worried about blue nevus like met melanoma. At some point I was thinking early angiosarc but the pigmented spindled and dendritic cells made me favor a melanocytic lesion.

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urmilapandey

Posted

wondered if this could be a desmoplastic melanoma with stromal myxoid change

 

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vincenzo polizzi

Posted

Desmoplastic Melanoma was my first thought on my iPhone, too...but after read the Mona's comment I deferred the diagnosis to the study with the computer, and now Angiosarcoma is my favorite spot.

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Dr. Mona Abdel-Halim

Posted

1 hour ago, vincenzo polizzi said:

Desmoplastic Melanoma was my first thought on my iPhone, too...but after read the Mona's comment I deferred the diagnosis to the study with the computer, and now Angiosarcoma is my favorite spot.

But why the pigmented spindled and dendritic cells Vincenzo?

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vincenzo polizzi

Posted

I can’t answer to this question, Mona. I’m thinking of angipsarcoma because of many hypercromatic cells stuck to collagen bands, reminiscent of a dissecans pattern...but this is a difficult case...of course!!!

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Nitin Khirwadkar

Posted

Difficult case. Agree with the differentials. Favour an angiosarcoma ( a rather sneaky one) especially with the last two images. Case requires IHC.

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Raul Perret

Posted

To be honest the picture that struck me the most was the first picture of the second biopsy (the one at low power) there are many suspicious empty spaces/clefts something that we usually see en angiosarc, are those spaces real or artefactual?

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Raul Perret

Posted

P.S. For me the pigment is hemosiderin due to haemorrhage

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vincenzo polizzi

Posted

Yes, agree. Hemosiderin. I’d like to see other images of this intriguing case...

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Dr. Mona Abdel-Halim

Posted

So the first impression was correct!

One should stick to his first impression!

Angiosarc it is!

Very nice case Dr Carr, Thanks for sharing..

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urmilapandey

Posted

just as well we don't report (at least some) cases without immunohistochemistry! Great case Richard, thanks for sharing

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vincenzo polizzi

Posted

Great case. Thanks Richard. And kudos to Mona. 

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Dr. Richard Carr

Posted

I think this is a very sneaky case but I gave you fully representative images and the clinical information exactly as provided. I don't think we definitely have the neoplastic vessels in these biopsies. I think however you have to look at the clinical and if there is any suspicion for angiosarcoma request larger biopsies. The clinical in fact was suspicious for angiosarcoma (when reviewed but that suspicion had not be stated on the request form) and only one of 3 repeat generous incision biopsies included clear-cut, well differentiated, rather superficial, vasoformative angiosarcoma. Also in the intervening few months the lesions had become much more purple and concerning clinically for angiosarcoma.

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