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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 1979 - 04 Jan 2018 Posted By: Iskander H. Chaudhry

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92 year old male

Left forehead excision. BCC/SCC.

Edited by Admin_Dermpath


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John Zhang

Posted

If a melanoma (Mart 1, S100+), spindle cell squamous cell carcinoma (Keratin+), leimyosarcoma (SMA+, Desmin+) can be ruled out, then dermal pleomorphic sarcoma is favored over AFX because of the deep infiltrate into the subcutis.

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Dr. Richard Carr

Posted

AFX type cutaneous sarcoma (I'm not a supporter of the term pleomorphic dermal sarcoma for such lesions - think I've given my diatribe on it previously!) with low metastatic risk (<10% probably).

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vincenzo polizzi

Posted

Agree with J Zang and Mona! If melanoma/SCC/LMS markers neg-->Dermal Pleomorphic Sarcoma is favored over AFX because of deep subcutaneous tissue infiltration. CD10 positivity is uninfluent in this case...

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Uma Sundram

Posted

We have often called these AFX/MFH overlaps with the caveat about metastatic potential due to extension into fat. Having said that, I've also been surprised when the case is stained and it turns out to be melanoma or spindled SCC! Will wait for immunos.

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Admin_Dermpath

Posted

Hi Everybody,

 

Doctor Chaudhry has said that the final diagnosis is Cutaneous Leiomyosarcoma.

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Dr. Richard Carr

Posted

Perhaps controversially I'd still call it AFX-type sarcoma (with myomatous differentiation) particularly as it lacks clear-cut cigar-shaped nuclei. ! I'm sure it's academic. I don't bother doing desmin or SMA on AFX-type cutaneous sarcomas as management is same as far as I'm aware. I'd be interested in the CD10 as they are almost always strongly diffuse in AFX & AFX-type cutaneous sarcomas.

 

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