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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 1993 - 25 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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54M, Large skin lesion lower abdomen/groin region


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Admin_Dermpath

Posted

Dear All 

Good morning!

Dr Shenjere's has posted his diagnosis on the case below:

 

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vincenzo polizzi

Posted

Difficult. It looks like a myxoid variant of DFSP in myxoid areas, and Desmoid in solid areas. My spot in virtual slide is Fibromatosis.

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Pablo Gonzalvo

Posted

Myxofibrosarcoma (vs nodular fascitis, low grade fibromyxoid sarcoma, myxoid liposarcoma...)

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Lobulated myxoid spindle and stellate cell lesion, quite cellular for a myxoid lesion, with arcuate blood vessels

Do not really appreciate lipoblasts in the periphery, so I don't think it's myxoid liposarcoma.

Definitely a low grade sarcoma so don't think it's nodular fasciitis.

Don't see the swirling pattern of spindle cells as commonly seen in low grade fibromyxoid sarcoma. But I would do MUC4 to rule it out.

Just based on morphology, I would agree with dr. Gonzalvo: Low grade myxofibrosarcoma.,

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this being a lesion in the groin, would add aggressive angiomyxoma to the above mentioned differentials

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Nice example of Evan's tumor (low-grade fibromyxoid sarcoma).

Monomorphic spindle cells featuring hyper- and hypocellular areas in myxoid to hyalinized backgrounds.  Prominent arcades of blood vessels, bland tumor nuclei coming off the BV resemle dribbling candle, there are also halinized collagen balls reminiscent of hyalinizing spindle cell tumor with giant rosettes (in the same disease spectrum, the other one is sclerosing epithelioid fibrosarcoma)

The monotony of the nuclei suggests a translocation (FUS-CREB3L2, or EWSR1-CREB3L1) driven tumor, which essentially rule out another differential diagnosis, myxofibrosarcoma. Myxofibrosarcoma is most seen in limbs of older population (>50yo) and nuclear pleomorphism is usually present. 

Other DDXs I can think of are angiofibroma of soft tissue and perineurioma, which I do not think the current case is.

Like to do MUC4 IHC or FISH to confirm the diagnosis.

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vincenzo polizzi

Posted

I was wrong. LGFMS is a better spot. 

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Dr. Mona Abdel-Halim

Posted

I was thinking myxoid DFSP, but I agree with chugol: low grade fibromyxoid sarcoma

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Admin_Dermpath

Posted

Dear All 

Dr Shenjere's final diagnosis was a myxoid DFSP

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Is there IHC and FISH (PDGFB Tx) to support the diagnosis of myxoid DFSP?

DFSP is just a locally aggressive disease. But LGFMS has a metastatic potential and need a long-term follow-up. 

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Patrick Shenjere

Posted (edited)

My diagnosis was myxoid DFSP.

The tumour was diffusely positive for CD34 and FISH studies (performed on a biopsy sample from the same tumour) confirmed the presence of COL1A1-PDGFB gene rearrangement. In most cases of myxoid DFSP, one can find more cellular areas with classical DFSP morphology. The lack of storiform architecture in myxoid DFSP can cause diagnostic difficulties in small biopsy material and it is in such cases that one may have to do FISH studies.

Edited by Patrick Shenjere

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Uma Sundram

Posted

Amazing case. DFSP is not common in this location so am glad FISH was done. Somewhat cellular for myxofibrosarcoma. These are really super hypocellular lesion with atypia noted at fairly low power. That being said, much variability in histologic presentation.

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