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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 1834 - 8 June - Dr Arti Bakshi 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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Clinical History: 37/M Axillary lymph node biopsy. Previous history of partial nephrectomy for Renal Cell carcinoma and skin excision for benign adnexal tumour.

Case Posted by Dr Arti Bakshi


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Admin_Dermpath

Posted

It is never too early to see a case from Dr Arti Bakshi.

Geoff Cross - DermpathPRO Projects

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Raul Perret

Posted

This is really interesting, and beautiful, I have only seen this once during my residency. This is lymph node compromise by nodular hidradenoma, probably just a deposit and therefore the patient has a great prognosis. Here a nice article by Dr. Calonje describing the phenomenon

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Dr. Mona Abdel-Halim

Posted

Yes, I also perceived it as nodular hidradenoma in a LN !!! 

Beautiful :-) 

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Dr. Mona Abdel-Halim

Posted

Thanks for the reference Raul 

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vincenzo polizzi

Posted

Completely agree with Raul! Ductal differentiation and myoepithelial/basal layer support a primary axillary nature of the lesion, and there aren't worrisome features (maybe something stromal fibroplasia in fig, but not invasive desmoplastic changes ).

My spot is primary axillary clear cell adenoma, with nodal involvement. 

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Arash Daryakar

Posted

agree with colleagues.the lesion is  looks like a nodular hidradenoma to me,too. interesting case!

I came back after a long absence!

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Arif Usmani

Posted

Agree. Thanks for the diagnosis and reference Raul.

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Raul Perret

Posted

It is my pleasure to share with colleagues and friends

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Robledo F. Rocha

Posted

Kudos for Raul! Fully agree.

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Arti Bakshi

Posted

Brilliant Raul!....yes this is a lymph node deposit of nodular hidradenoma.

The patient had a nodular hidradenoma excised from the axilla a few years back. The tumour was present at the margin, but no re-excision was done at the time. The lesion recurred a year later and was completely excised this time. Following the LN deposit, I reviewed the previous histology worried that I might have missed a malignancy. Even with the benefit of hindsight, I could not see any overtly concerning features. The tumour was well circumscribed, cytologically banal with very ocassional mitoses. I came across the same article which Raul has referenced and sent the case to Dr Calonje for a second opinion. He agreed that the case was in the same spectrum as the cases in their series. None of the cases from that series have had an aggressive course and since then he has seen 2 more such cases, also with a benign outcome. I do think this is a novel example of 'benign metastasis', and hopefully this patient will follow an indolent course as well. Nevertheless, I think all nodular hidradenomas should be completely excised in the first instance and one needs to be aware that a small subset with benign histology can show regional LN involvement.

Thanks for all your comments!

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