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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 1930 - 23 Oct - 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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72 F neck mass

Edited by Admin_Dermpath


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THOMASPAULO

Posted

I think this is a DERMATOFIBROSSARCOMA PROTUBERANS.

Thomas Paulo MD

Natal RN, Brazil

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vincenzo polizzi

Posted (edited)

Reactive! Fibromatosis-like hypertrophic scar ( ?secundary to inflamed branchial cyst)

 

Edited by vincenzo polizzi

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I am not getting the lay of the land here. Is that normal epidermis or cyst?

Dermal process is banal and myofibroblastic in high power images, so I favor scar (with retraction of the overlying epidermis). If that doesn't fit clinically, other considerations are fibromatosis and hemorrhagic dermatomyofibroma. In a younger person with a rapidly growing nodule, I would favor nodular fasciitis. If suspected in this case, USP6 FISH should be considered.

LGFMS (alternating myxoid and fibrous areas) and myxofibrosarcoma (myxoid stroma and curvilinear vessels) are unlikely from these images. DFSP and KS should cross mind, but myofibroblasts here look solid.

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This is a deep fibromatosis (desmoid tumor).  beta-catenin shows nuclear positivity. 

 

All the discussions are insightful and I highly appreciated them!

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