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?

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Case Number : Case 2048 - 12 April 2018 Posted By: Raul Perret

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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Case 14: 54 y old male with a 15 mm superficial tumor located in the toe

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Anil Patki

Posted · Report

Acanthotic epidermis and proliferation of spindle cells in a fibrous stroma. I think this is a cellular digital fibroma

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vincenzo polizzi

Posted · Report

Agree with Anil...

Here there’s an interstitial(not vascular) fibroblastic/myofibroblastic proliferation, with a prominent vascular network, reminiscent of superficial acral fibromyxoma. Why not a monophasic(fibrous) SAF?

CD34? 

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That's the beauty of pathology. To some of us, the vessels are judged to be more relevant, hence microvenular hemangioma. To others, the spindle cell proliferation is more relevant, hence cellular digital fibroma / SAF. Would  CD34 really be helpful and change one' s opinion? 

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Anil Patki

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Nice comment , anh. Would you add one more diagnosis to enhance the beauty ? :--)

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Dr. Richard Carr

Posted · Report

Nice thoughts above. I have little to add except who's that handsome devil posting tricky soft tissues?

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Raul Perret

Posted · Report

Thanks for the for the comments. This is indeed cellular digital fibroma (as suggested by some authors) or a cellular variant of superficial acral fibromyxoma. There was a diffuse expression of cd34 in the spindle cells located in the dermis. CD99 is supposed to be positive in SAF and negative in CDF but I think performing this technique is waste of time and money. This tumor may recur if incompletely excised and an important differential diagnosis is DFSP which has a similar phenotype but is generally more cellular, infiltrates the hypodermis and is rarely/never located on acral sites. On the other hand, the presence of abudant capillaries is frequently seen in SAF/CDF, so considering a vascular neoplasm in the differential is not aberrant.

I am sorry for the pale slides but hope you guys liked the case. Thanks again for your comments.

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Raul Perret

Posted · Report

14 hours ago, Dr. Richard Carr said:

Nice thoughts above. I have little to add except who's that handsome devil posting tricky soft tissues?

Haha, just trying to contribute a bit in this site that helped me learn so much and make good friends!

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