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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 2298 - 4 April 2019 Posted By: Raul Perret

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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Dr. Mona Abdel-Halim

Posted

Epithelioid hemangioma

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Alex-Ventura-Leon

Posted

I'm not sure if those are vascular spaces.

What about Langerhans Cell Histiocytosis

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Meenakshi Batrani

Posted

Cutaneous epithelioid angiomatous nodule- which has more solid areas of epithelioid endothelial cells and less conspicuous vessels. CEAN is considered a distinct lesion or related lesion in the spectrum of epithelioid hemangioma/ALHE

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vincenzo

Posted (edited)

Oops something was wrong.  See below.

Edited by vincenzo

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vincenzo

Posted (edited)

12 hours ago, Alex-Ventura-Leon said:

I'm not sure if those are vascular spaces.

What about Langerhans Cell Histiocytosis

Agree...it could be a pulmonary lesion, we don't know CPC. So my first spot is LCH.

Edited by vincenzo

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Alex-Ventura-Leon

Posted

Really interesting. So is a Pseudomyogenic Hemangioendothelioma.

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I am envious of Raul. He has all the good immunos.

This lesion clearly show vascular formation, even highlighted by CD31. I think pseudomyogenic hemangioendothelioma, despite the name, usually does not really form vascular channels. I think a subset of epithelioid hemangioma harbors a translocation involving FOSB gene, although with a different partner. I can't keep track with all these translocations but I have learned a lot from Raul. 

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vincenzo

Posted (edited)

I'm learning a lot from Raul, too, about these new entry in molecular diagnostic tools. So, if FOSB positivity is in keeping also with epithelioid hemangioma, I favor this one. 

Found this interesting art : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229947/

Edited by vincenzo

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Raul Perret

Posted

Dear all, 

As most of you proposed, I signed this case out as Epithelioid Hemangioma. Although most histological features were typical, this case also showed necrosis (not shown) and an unusually large size (5 cm). Taking into account these facts, I performed FOSb in order to confirm the diagnosis (diffuse and strong staining is seen in around 50-60% of EH based on some series) and rule out other mimickers like epithelioid angiosarcoma and epithelioid hemangioendothelioma that are FOSb negative. It is important to note that even though I favoured the dx on microbiopsy, I suggested a surgical excision due to the atypical features aforementioned.

 

Ps. Pseudomyogenic hemangioendothelioma is also positive for FOSb but morphology is completely different.

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