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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 1871 - 31 July - Dr Limin Yu 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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51 M, right thigh lesion


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Raul Perret

Posted

probable AFX for excision and complete evaluation. IHC should be performed also to discard the differentials

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urmilapandey

Posted (edited)

given the location, AFX will be lower on my list of differentials for a malignant spindle cell neoplasm but agree, IHC needed to assess the usual suspects. favour fibro/fibrohistiocytic on morphology.

Edited by urmilapandey

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vincenzo polizzi

Posted

urmilapandey:"given the location, AFX will be lower on my list of differentials for a malignant spindle cell neoplasm but agree, IHC needed to assess the usual suspects. favour fibro/fibrohistiocytic on morphology."

Agree, and my first spot is Epithelioid Cell Histiocytoma. Unusual epidermal ulceration, but it has been described in this dermatofibroma variant.

 

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urmilapandey

Posted

42 minutes ago, vincenzo polizzi said:

urmilapandey:"given the location, AFX will be lower on my list of differentials for a malignant spindle cell neoplasm but agree, IHC needed to assess the usual suspects. favour fibro/fibrohistiocytic on morphology."

Agree, and my first spot is Epithelioid Cell Histiocytoma. Unusual epidermal ulceration, but it has been described in this dermatofibroma variant.

 

haven't seen many. so not much experience. can epithelioid histiocytoma show diffuse atypia with mitoses..?

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vincenzo polizzi

Posted

In "Cutaneous Soft Tissue Tumors" of Requena/Kutzner, pg 21, epithelioid cell dermatofibroma is reported with (sometimes) scattered mitosis and, in general, with the architecture and cytology of a Spitz Nevus...

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urmilapandey

Posted

33 minutes ago, vincenzo polizzi said:

In "Cutaneous Soft Tissue Tumors" of Requena/Kutzner, pg 21, epithelioid cell dermatofibroma is reported with (sometimes) scattered mitosis and, in general, with the architecture and cytology of a Spitz Nevus...

thanks for that information Vincenzo

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Arti Bakshi

Posted

Agree, cellular DF most likely. These tumours can be quite mitotically active and atypia is well described as well (including 'monster cell' variants).

Ulceration is unusual...so would do the usual panel of immunos to exclude other differentials. 

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Dr. Mona Abdel-Halim

Posted

Yes, cellular fibrous histiocytoma

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Robledo F. Rocha

Posted

I got some alarming features, including ulceration, increased cellularity, and brisk mitotic activity, but the incomplete excision does not allow microscopic analysis of the whole lesion. Considering the site and the not-so-elderly patient, this tumor has low cellular pleomorphism and fascicular growth pattern with admixed lymphocytes, so I tend to favor a more common benign cutaneous mesenchymal tumor like some variant of fibrous histiocytoma.

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Nitin Khirwadkar

Posted

Cellular DF. Ulceration unusual indeed.

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Limin Yu

Posted

This is a cellular fibrohistiocytoma. I have learned a lot for your discussion. Thank you!

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