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 2027 - 11 March 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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55 year old woman with long standing lesion on back.

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Anil Patki

Posted

Islands of squamoid cells with variable clear cell change set in a hyalinized stroma. Eosinophilic droplets of basement membrane material are seen in tumour islands and stroma. This seems to me a desmoplastic trichilemmoma. CD 34 stain for confirmation.

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urmila1

Posted (edited)

amyloid like hyaline material, would do stains for that. otherwise thinking of hidradenoma

Edited by urmila1

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Raul Perret

Posted

Agree with hidradenoma, im worried about infiltrating borders, I would be cautious.

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agree with at least clear cell hidradenoma. But i also worried  about  the infiltrative pattern . Could be a more ominous process.

The tumor definitely shows some morphologic  features reminiscent of a hyalinizing clear cell carcinoma of salivary glands, particularly in the abscence of  definitive duct formation.ThAt salivary gland tumor has a very specific rearrangement EWRS1-ATF1. Sometimes I wonder if we do FISH studies on these skin tumors, how many would have that gene fusion?

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Uma Sundram

Posted

I was pretty cautious too. The lesion also had centralized necrosis. As hidradenocarcinomas can be very bland, I asked for a second opinion. We both thought of the same thing: low grade hidradenocarcinoma. The tip off is the presence of infiltrating small islands and centralized comedo-style necrosis (seen in the second image). A desmoplastic response was also present, unusual for a straight forward hidradenoma. Congo Red negative. Good question about FISH studies! Would be very interesting to find out.

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IgorSC

Posted

Nodular hidradenoma with some areas containing clear cells

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vincenzo polizzi

Posted

Sincerely I was thinking of a hidradenoma...but Uma’s comments are stringent. 

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LR123

Posted

I agree with hidradenocarcinoma Infiltrative lesion with necrosis !

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