Jump to content
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 1780 - 24 March - 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.
Submitted Date :
   (0 reviews)

Clinical History: F25 10mm dermal lump on palm of hand.

Case Posted by Dr Richard A Carr

Edited by Admin_Dermpath


  Report Record

User Feedback


Admin_Dermpath

Posted

Round off your week with another great set of images from Dr Richard A Carr - more to follow in 8 hours  :-)

Don't forget to follow the ACP on Twitter https://twitter.com/ACP_Pathologist

Don't forget to check out and Like our Facebook page https://www.facebook.com/DermPathPro/ plus follow our Twitter feed https://twitter.com/DermPathPro

COMING SOON... The New York Dermatopathology Review Course 

Geoff Cross - DermpathPRO Projects

Share this comment


Link to comment
share_externally

vincenzo polizzi

Posted

Distal type of Epithelioid Sarcoma is my first spot!

Share this comment


Link to comment
share_externally

Victor Delgado

Posted

This is a neoplastic lesion with lobular growth pattern, compossed by spindle and epithelioid cells, mitotic figures and geographic necrosis with fibrinoid degeneration, central hyalinization. I´m going to buy your Epithelioid Sarcoma Vincenzo Polizzi.

Share this comment


Link to comment
share_externally

Sasi Attili

Posted

2 hours ago, vincenzo polizzi said:

Distal type of Epithelioid Sarcoma is my first spot!

agree...

Share this comment


Link to comment
share_externally

Dr. Richard Carr

Posted

Hmm! Full house. Immunos might change your minds (hopefully for me!).

Share this comment


Link to comment
share_externally

Robledo F. Rocha

Posted

I was going to agree with my colleagues. After Dr. Carr’s allert, maybe immunos might change my mind...

Share this comment


Link to comment
share_externally

Nitin Khirwadkar

Posted

I was going to agree too for an ES. Waiting for the IHC.

Share this comment


Link to comment
share_externally

vincenzo polizzi

Posted

If we are fighting against some pathological dark knight like pseudomyogenic hemangioendothelioma I give up immediately...I don't know this new entries in soft tissues tumors...but I'm here for learning!!!

Share this comment


Link to comment
share_externally

vincenzo polizzi

Posted

Ok   I'm checking now the IHC. Actin reaction is positive in 30% of ES.  I don't know about Desmin but I think this is an Epithelioid Sarcoma that didn't study immunohistochemistry.  

What about Cytokeratins and EMA?

Share this comment


Link to comment
share_externally

Robledo F. Rocha

Posted

Epithelioid sarcoma is usually negative for desmin, but reactivity for SMA have been described in the literature. In the absence of the most used immunohistochemical markers (keratin, EMA, vimentin), and considering the clinical history and the microscopic features, I keep my suggestion of epithelioid sarcoma.

Share this comment


Link to comment
share_externally

vincenzo polizzi

Posted

If keratin, Ema neg I would think of an odd new entry, like Low Grade Myofibroblastic Sarcoma, but I have never seen it before...I still hope about keratin positivity..

Share this comment


Link to comment
share_externally

Mariantonieta Tirado

Posted

I agree with low grade myofibroblastic sarcoma 

Share this comment


Link to comment
share_externally

Dr. Mona Abdel-Halim

Posted

IHC fits with low grade myofibroblastic sarcoma as vincenzo suggested..

Share this comment


Link to comment
share_externally

Dr. Richard Carr

Posted

I might have to send some more images on Monday. There is not really any necrosis in this case, more hyalinisation. Might I draw attention to the vascular pattern. I don't think the tumour was mitotic to any degree.

Regarding IHC these are my notes: Strong SMA sparing more cellular areas, desmin exact reverse. CD34 highlighting the delicate and branching vessels only. Weak EMA staining in 20% (very capricious stain).

 

Share this comment


Link to comment
share_externally

Dr. Mona Abdel-Halim

Posted

With the recent hint from Dr Carr, shifting to solitary myofibroma?

Share this comment


Link to comment
share_externally

vincenzo polizzi

Posted

Yes...why not?! The vascular pattern of half lesion isn't hemangiopericytomatous but could fit well the same...

Share this comment


Link to comment
share_externally

Neil Catterall

Posted

? sclerotic epithelioid dermatofibroma

Share this comment


Link to comment
share_externally

Hi, my name is Anh, Dermatopathologist in Orlando, FL. I'm new and this is a great website.

Just a simple question: why can it be just a simple  leiomyosarcoma?

Share this comment


Link to comment
share_externally

amiratawdy

Posted

my first thought was solitary myofibroma

Share this comment


Link to comment
share_externally

Arti Bakshi

Posted

Difficult case!...following the immunos, like Mona's suggestion of myofibroma. Biphasic pattern is not particularly prominent but the solitary adult variants may not show this. The other thought which comes to mind is a cutaneous myoepithelioma. The epithelioid cells and hyalinised matrix (? chondroid in last H&E image) along with immunos would fit.  But the vascular pattern noted in this case is not a feature of myoepithelioma.....S100, pankeratins??

Share this comment


Link to comment
share_externally

Dr. Richard Carr

Posted

Well clearly this case has caused some difficulty!  I should point out that I do not claim myself to be anything other than reasonably adequate at soft tissue lesions but I interpreted this lesion as being in the spectrum of myofibroma/myopericytoma. Clues including the highly cellular areas of rounded / plump epithelioid cells and the more bland spindle cells areas with hyalinised stroma. I think we can see cuffing of the vessels at the periphery of the lesion (highlighted by SMA). Very nice branching vascular pattern fitting with the perivascular (pericytomatous) group. It was also a nicely circumscribed rounded lesion. I had shared the case with Raul Perret previously who thought this lesion could fit with myopericytoma / myofibroma (provided PECOMA, i.e. negative HMB45, excluded). My notes stated S100 and HMB45 was negative. I did not note the keratin staining but presume it was either not done or negative. A well differentiated leiomyosarcoma would really look more like bundles of erector pili (red/pink cytoplasm and longer, cigar shaped, nuclei) with scattered mitotic figures, usually more irregular horizontal permeation (rather than rounded) in outline. Regarding myofibroma I think it can also be one of those pathological dark knights, or perhaps a sheep in wolves clothing, (I had placed a case in the RCPath diploma exam a few years ago and we had to exclude the case from the marking!). I would like to sincerely thank Dr Kathleen Romain for sharing this interesting case with me.

Share this comment


Link to comment
share_externally



Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Add a comment...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...