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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 1840 - 16 June - Dr Richard A 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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Clinical History: F50. 6/12 growing lesion below right nostril. c/o Dr S. Mahalingham and Dr Abbie Pugh.

Case Posted by Dr Richard A Carr

Edited by Admin_Dermpath


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Admin_Dermpath

Posted

Wrap up your week with a bumper spot diagnosis case from Dr Richard A Carr.

Geoff Cross - DermpathPRO Projects

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Raul Perret

Posted

Seems like another primary cutaneous mucinous carcinoma (after cpc). How many have we seen this year? Like 3 or something like that? This is great. I think we can morphologically see the natural history of the disease, from the in situ ductal lesions to the inasive neoplasm.

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vincenzo polizzi

Posted

I’m thinking of a malignant ( low grade ) mixed tumor of the skin/malignant chondroid syringoma. 

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Dr. Mona Abdel-Halim

Posted

Primary cut mucinous carc is my first thought

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nick turnbull

Posted

primary cutaneous mucinous carcinoma.

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vincenzo polizzi

Posted

S100+ myoepithelial cells are more in keeping with mixed tumor. Anyway I think morphology supports MT diagnosis, also, if I’m not fully off the track...

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Raul Perret

Posted

Is not infrequent for PCMC to show prominent myoepithelial cells, and s-100 is a capricious staining (in the literature I have seen conflictive results regarding this marker). I do agree that mixed tumor could come to the differential but I dont see chondroid and stromal components that we usually see in eccrine mixed tumor

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vincenzo polizzi

Posted

Found this interesting article

 Malignant chondroid syringoma: Report of a case with lymph node metastasis 12 years after local excision
Akira Watarai MD, Yasuyuki Amoh MD, Ryoichi Aki MD, Hiroshi Takasu MD, Kensei Katsuoka
Dermatology Online Journal 17 (9): 5 

Kitasato University School Of Medicine, Sagamihara, Kanagawa, Japan

 

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Pablo Gonzalvo

Posted

primary cutaneous ductal myoepithelial carcinoma

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Dr. Richard Carr

Posted

A very challenging case it appears! I reported this as a benign mixed tumour of skin (chondroid syringoma). I was a bit concerned by the degree of mitotic activity in the myoepithelial component but re-assured by the nice circumscription and lack of cellular pleomorphism. I indicated that if the lesion were to recur locally it should be excised completely. To my eye this is "stromal" type mucin in the setting of mixed tumour rather than epithelial type mucin seen in mucinous carcinoma. Also the range of cells from well formed central ducts in places, intermediate or slightly squamoid cells and rather striking myoepithelial differentiation are not typical for a mucinous carcinoma. We know even benign looking mixed tumours and hidradenomas can show so-called benign metastasis and I think Kazakov has also reported on a number of otherwise benign mixed tumours with an intra-lymphatic component. Sadly we no longer appear to stock hyaluronidase in order to confirm the nature of the mucin in this case but I was satisfied with the diagnosis based on the features above.

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Abbie Pugh

Posted

Thank you Richard and everyone else for your opinions. Interesting case, we will follow it up.

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