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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 2040 - 30 March 2018 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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Large erosive painful plaque of vulva, perineum, pubis, inguinal folds. Posted with kind permission of Dr Benedicte Cavelier-Balloy.


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John Zhang

Posted

Can't tell if there are dermal lesional nests or not.

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Anil Patki

Posted

There is a lot of acantholysis. Also, in the last pic, the nest of malignant cells lies directly on the basement membrane whereas Paget's cells are supposed to lie above the basal keratinocytes and 'crush' them.These two points raise the possibility of Pagetoid SCC and melanoma. CK7 and S100 should clarify. EMPD of course remains the third differential diagnosis.

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John Zhang

Posted

The multiple locations of these lesions do not favor SCC or melanoma.

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vincenzo polizzi

Posted

Syringocystadenocarcinoma papilliferum with a predominant in situ component, pagetoid. 

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Raul Perret

Posted

My first impression was also extramammary Paget's. What about ck7, ck20 and p63?

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I like Vincenzo diagnosis of syringocystadenocarcinoma papilliferum in situ with pagetoid spread. The differential diagnosis would be extramammary Paget's disease with syringocystadenocarcinoma papilliferum in situ-like changes. I think it's definitely very difficult to differentiate the two entities from each other. But considering the history of "large erosive painful plaque of vulva, perineum, pubis, inguinal folds", I have to say this is most likely extramammary Paget's disease with syringocystadenocarcinoma papilliferum in situ-like changes.

A reference is included:

Syringocystadenocarcinoma Papilliferum In Situ-Like Changes in Extramammary Paget Disease: A Report of 11 Cases.

Konstantinova AM, Kacerovska D, Stewart CJ, Szepe P, Pitha J, Sulc M, Bencik V, Michal M, Shideler B, Kerl K, Kazakov DV.

Am J Dermatopathol. 2016 Dec;38(12):882-886.

 

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Anil Patki

Posted

The report quoted above says that the native basal cell layer was intact. But here, the malignant cells seem to lie directly on the basement membrane.

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Dr. Richard Carr

Posted

This was a nice example of acantholytic extra-mammary Paget's. Nice discussion. Thanks.

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