Jump to content
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 2308 - 18 April 2019 Posted By: Raul Perret

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
   (0 reviews)

Clinical info: 85 y old male with a 7 cm scalp mass (infiltrating bone)


  Report Record

User Feedback


Meenakshi Batrani

Posted

Epithelioid angiosarcoma; Metastasis from renal cell carcinoma which may be quite vascular

Share this comment


Link to comment
share_externally

Krishnakumar subramanian

Posted

differentials

metastatic tumor-melanoma

angiosarcoma

ALCL

IHC is needed

Share this comment


Link to comment
share_externally

Victor Delgado

Posted

Metastatic Melanoma vs. Epithelioid Angiosarcoma.

Share this comment


Link to comment
share_externally

The well defined borders argues against angiosarcoma. I think this is metastatic carcinoma. Ihq are needed

Share this comment


Link to comment
share_externally

Igor's observation is excellent. Raul said the tumor infiltrates the bone but does not appear to extensively invade the dermis. Is it possible that the tumor actually originates from the bone or brain and grows into the dermis. That would explain the pseudo capsule around the tumor and a hint that the tumor actually does not grow that fast into the dermis although it looks high-grade. Don't see lymphoid tissue under the pseudo capsule to be diagnostic of angiomatoid fibrous histiocytoma. Definitely need IHC and more importantly clinicoradiologic correlation to determine the origin of this tumor. What is the past clinical history? Kind of syncytial look. Malignant meningioma?

Share this comment


Link to comment
share_externally

jaimearturo

Posted

7 cm a mass can hardly be a metastasis, however can't be ruled out on morphology. Location, age and looks favor an epithelioid angiosarcoma but the pattern is usually interconnected vessels. Melanoma and clear cell sarcoma are also plausible. 

Share this comment


Link to comment
share_externally

Alex-Ventura-Leon

Posted

First thought Metastatic Carcinoma (probably Renal), then if is a primary neoplasm, agree with the differentials, Melanoma and epitheliod Angiosarcoma.

Waiting for de IHC

Share this comment


Link to comment
share_externally

Raul Perret

Posted

CD34 was diffusely positive (not shown) 

PSX_20190415_194136.jpg

PSX_20190415_194213.jpg

Share this comment


Link to comment
share_externally

Anil Patki

Posted

Proximal type of epithelioid sarcoma - angiomatoid subtype

Share this comment


Link to comment
share_externally

Agree!  I didn’t even think about it. 

Share this comment


Link to comment
share_externally

Dr. Mona Abdel-Halim

Posted

Nice case!. Before IHC, I was thinking epithelioid angiosarcoma!

Share this comment


Link to comment
share_externally

Raul Perret

Posted

Final Dx: INI1 deficient neoplasm in keeping with  angiomatoid variant of epithelioid sarcoma. This was a really difficult case because morphology is not typical of ES. I suggested the colleague that shared the case with me to perform INI1 and CD31 because of the vesiculous nuclei that we usually see in angiosarcoma and INI1 deficient neoplasms. I thought CD31 would come positive and INI1 retained but to my surprise it was the opposite.  Hope you liked the case

Share this comment


Link to comment
share_externally



Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Add a comment...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...