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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 2117 - 18 July 2018 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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75 year old man with lesion on scalp.

Edited by Admin_Dermpath


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Primary cutaneous cribriform carcinoma

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John Zhang

Posted

I'd first like to rule out metastatic colorectal carcinoma because of the dirty necrosis and focally palisading glands. If cdx2, CK20 and history are negative then consider adnexal carcinoma with sweat gland differentiation, such as cribriform carcinoma. Sweat gland carcinomas are usually CK5/6 and p63 positive, and p63 highlights myoepithelial layers.  

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Anil Patki

Posted

Metastasis adenocarcinoma. Primary may be in the colon, rectum, prostate or thyroid. In addition to CK 5/6 and p63, PSA ,thyroglobulin, TTF1 stains needed.

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Metastatic adenocarcinoma ( lung? ).  CK7 CK20 TTF1 CDX2 could be useful. 

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Admin_Dermpath

Posted

Thank you all for the great comments. Yes following immuno' and careful analysis the final diagnosis is:  Lymphoepithelioma-like carcinoma

Dr Iskander Chaudhry

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Uma Sundram

Posted

Sorry, there was a slight confusion- I think Iskander meant to post his answer to the next case!

This gentleman did indeed have gastric carcinoma, and this is a metastatic deposit. Kudos to those who recommended a metastatic work up! CK7, CK20, and CDX2 were all positive. TTF1 was negative.

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