Case Number : Case 2063 - 3 May 2018 Posted By: Raul Perret

I'm struggling with this case... but no features enough convincing for a comfortable spot diagnosis..there are two an entity more convincing for me: EED-like Granuloma Faciale, late stage...and amelanotic cellular blue nevus...

Was just wondering about the hair follicles in a lip biopsy. Fibrous histiocytoma ?

Apologies but I have now finally posted my last two Friday cases.  I had problems logging in during my hols.

Challenging indeed. Couple of quick thoughts. Cellular neurothekeoma an epithelioid angiomatous nodule or a haemangioendothelioma variant. Likely to be some soft tissue teaser I suspect. I'd throw in PECOMA. Even histioid leprosy! Brown stains needed.

I like epithelioid angiomatous nodule

Yeahh. Histioid Leprosy is a good spot. I was completely off road. 

This should help

Crypto??

This is a case of a poorly differentiated adenocarcinoma, of probable metastatic origin. CKAE1-AE3 was diffusely positivite and the tumor cells also coexpressed CK7, CK20 and CDX2. I suggested ruling out a primitive from the GI tract (particularly from the stomach) pancreatic or eventually a cholangiocarcinoma. P63, GATA3, Glypican 3 were all negative.

I thought this case was particularly challenging due to the overall architecture of the lesion (simulating a dermatofibroma) and the moderate atypia of the cells. The giveaway were the isolated intracytoplasmic mucin vacuoles (hard to see on HE but beautifully demonstrated by alcian blue).

The case was sent to our institute as a probable "atypical dermatofibroma". As a rule I always perform an initial small pannel including a pan-keratin, a couple of muscle markers, CD34 and s-100/sox-10 in cutaneous tumors sent as atypical variants of DF.

Thanks for the comments and enjoy your sunday!

Nice case dear Raul.

Actually i thought of epithelioid angiomatous nodule and Epithelioid histiocytoma.

Although,in this case IHC study solved our dilemma.

and nice image quality!

2 hours ago, Arash Daryakar said:

Nice case dear Raul.

Actually i thought of epithelioid angiomatous nodule and Epithelioid histiocytoma.

Although,in this case IHC study solved our dilemma.

and nice image quality!

Thank you Arash, nice to see you posting at the site again

Great fooler!