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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 1948 - 16 Nov 2017 Posted By: Iskander H. Chaudhry

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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65 year old, female: C+C right third toe.
?P.G. ?Malignancy. 12 year history.

Edited by Admin_Dermpath


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Dr. Mona Abdel-Halim

Posted

Thinking epithelioid hemangioendothelioma?

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vincenzo polizzi

Posted

Atypical glomus tumor is my first thought. Second one is epithelioid perineurioma.

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Dr. Richard Carr

Posted

Tricky. I wondered about epithelioid cell histiocytoma, PECOMA, epithelioid angiomatous nodule or epithelioid H.E. Like suggestion of glomus - I was wondering about a perivascular type tumour and it also crossed my mind. Needs IHC!

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Don't really appreciate cytoplasmic lumen or red blood cells commonly in vascular lesions. Epithelioid histiocytoma?

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Admin_Dermpath

Posted

Dr Chaudhry's response: 

 

The tumour is negative for S100, p63, EMA, Desmin and AE1AE3. Before I disclose the final immuno results what is your preferred diagnosis? 

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Raul Perret

Posted

I was wondering about ALK-1 in this case too. Before answering I would have liked to see H-caldesmon, CD34, ERG, and ki67. For me this is not the expected morphology of Glomus tumor. Without any immunos my first hypothesis would have been epithelioid fibrous hystiocytoma.

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Arti Bakshi

Posted

Epithelioid fibrous histiocytoma vs epithelioid angiomatous nodule, favouring latter.

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Just wonder how much controversy such tumours must have created in the pre- immunostaining days! 

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vincenzo polizzi

Posted

In the preimmunoAge many entities as CEAN ECH PECOMA didn’t exist...:-))

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Even usual conditions created controversy. Remember"The Final Diagnosis" by Arthur Hailey?

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vincenzo polizzi

Posted

Yes off course...pathology is the Controversy Science...and the disputes have not been settled by new Ancillary technologies as 

Immuno and Molecular but, if possible, incremented.

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Nitin Khirwadkar

Posted

Epithelioid fibrous histiocytoma vs epithelioid CEAN vs glomus. ALK, SMA, ERG.

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Admin_Dermpath

Posted

Dr Chaudhry's comments:

Please see the additional immuno!  The tumour is negative for CD10, CD31, Scattered CD68 + cells and low proliferation index for Ki67. 

So the final diagnosis is ........

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Very difficult to make sense of the immunohistochemical staining pattern. Most glomus tumors are negative for CD34. But rarely glomus tumors can be positive for CD34 (CD34-positive glomus tumor). That's my best interpretation of this case. But I have never seen one before.

CD34-positive glomus tumor: clinicopathologic and immunohistochemical analysis of six cases with myxoid stromal changes.

Mentzel T, Hügel H, Kutzner H.

J Cutan Pathol. 2002 Aug;29(7):421-5

 

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vincenzo polizzi

Posted

Expression of CD34 in glomus tumors.

Hatori M, et al. Tohoku J Exp Med. 1997.

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Dr. Mona Abdel-Halim

Posted

CD34 positive Glomus sounds good idea!

 

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Admin_Dermpath

Posted

Dr Chaudhry : Final diagnosis

CD34-positive glomus tumour

Many thanks for the excellent discussion points 

 

 

 

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