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 2146 - 30 August 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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Foot tumor of a 42 year old female.

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AmerSM

Posted (edited)

Shwanoma with ancient changes

My another thought is PHAT

Edited by AmerSM

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I'm thinking of a myoepithelioma. My second thought is a melanocytic nevus, myxoid variant.

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Myxoid variant is sometimes found in melanoma, rarely in nevus.

Sox10 is usually expressed in melanocytic lesions, but, often,  in cutaneous myoepitheliomas too.

So myoepithelioma remains my first choice.

 

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Raul Perret

Posted

These are the rest of immunos: (AE1/AE3): neg,
CD34 : neg, smooth muscle actin: neg, desmin : neg, SMARCB1 (INI1)positive (conserved), Ki67 : 3 %. Final diagnosis was epithelioid schwannoma with focal atypia (ref: https://www.ncbi.nlm.nih.gov/m/pubmed/26752543/). Myoepithelioma and spitz nevi are good differentials but hyalinized blood vessels and a thick capsule (as seen in this case) are not typical of those entities.

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