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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 1988 - 18 Jan 2018 Posted By: Patrick Shenjere

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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16F, Lump left chest wall ?sebaceous cyst ? fibroma


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Plexiform lesion. Plexiform fibrohistiocytic tumor?

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Cellular neurothekeoma or plexiform fibrohistiocytic tumor. 

Do not know how to reliably distinguish these two entities.

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Arif Usmani

Posted

Agree with plexiform fibrohistiocytic tumor. Young age and a few multinucleated cells.

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Dr. King-Chung Lee

Posted

Agree with plexiform fibrohistiocytic tumor. Would do MiTF immunostaining, though (-ve in plexiform fibrohistiocytic tumor, positive in cellular neurothekeoma).

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Dr. Mona Abdel-Halim

Posted

Plexiform fibrohistiocytic tumor

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Admin_Dermpath

Posted

Dear All 

Dr Shenjere's final diagnosis was: Cellular neurothekeoma with atypia (atypical cellular neurothekeoma)

 

Differentials he considered are: Melanoma; Atypical Spitz naevus/Spitz tumour of uncertain malignant potential; Myxofibrosarcoma; Epithelioid sarcoma

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Admin_Dermpath

Posted

From Dr Shenjere:

The main differential diagnosis in this case is between a plexiform fibrohistiocytic tumour and a cellular neurothekeoma. These entities have significant histologic overlap, and in rare cases one is unable to make a confident distinction between them, leading some authors to suggest that they may be the same entity or parts of a spectrum of lesions . The morphological involvement of the upper dermis and presence of nuclear variability, with some areas showing significant pleomorphism and atypical mitoses – not apparent in the pictures provided) seen in this case are more in keeping with a cellular neurothekeoma with atypia(atypical cellular neurothekeoma). The tumour is positive for MiTF. The other differentials one might consider include melanoma; Atypical Spitz naevus/Spitz tumour of uncertain malignant potential; Myxofibrosarcoma; Epithelioid sarcoma, depending on the cellular morphology and degree of nuclear pleomorphism.

 

 

 

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