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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 2193 - 5 November 2018 Posted By: Limin Yu

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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78F, lesion on right arm


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Sarcomatoid carcinoma plus porocarcinoma in situ

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Alex-Ventura-Leon

Posted

Porocarcinoma in situ.

I have to recognize that I didn't see the sarcomatoid component. But agree with Amer. 

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Agree with porocarcinoma, with a widely in situ growth, and a dedifferentiated invasive component.

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What are the criteria for porocarcinoma in situ?

Poroma proliferates in the dermis and form nodules of poroid cells. So just because there are nodules of poroid cells in the dermis , it does not mean it is invasive. So when is a tumor invasive? I remember Dr. Ackerman said that the silhouette of the tumor is very important to render the diagnosis of porocarcinoma. Is the silhouette of this tumor justified it as invasive?

 

I do not see cytologic atypia. Necrosis does not count because necrosis en masse is actually a typical feature of  poroma. I think it is a very a difficult case and would be a little bit conservative before calling this right out porocarcinoma.

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very interesting remarks! Indeed not easy to decide if its invasive or not @anh

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After all these years working with the microscope i learned there aren’t abosolute criteria to decide about the malignancy and infiltration of a tumor. The General pathology is a beautiful and useful scientific reference point... but it’s an abstraction. As a hands-on pathologist I made an invasive Porocarcinoma diagnosis following these criteria: 1) this a cancer because of cytoarchitctural atypia. 2) this is a poroid cancer because of ductal eccrine differentiation. 3) there are dedifferentiared invasive ( desmoplasia and epithelial strands) components in fig 1 2 7 8 13.   But this is a subjective assessment of course. 

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Dr. Richard Carr

Posted

Agree in favouring a porocarcinoma in situ and a presumed invasive more spindle pattern (not shown at high power). I'd be interested in the pattern of Ki67, p16 & p53 in the lesion. It looks rather basaloid / neuroendocrine (although may just be the thick sections photographed). I'd run CD56, synaptophysin, neurofilament, chromogranin for interest.  We're doing this in basaloid bowen's and picking up some cases with NED that I suspect are independent of Merkel (virus).

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