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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 2376 - 2 August 2019 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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F85. 10 x 10 mm area of pearly skin with telangiectasia overlying a cystic lump of 20 x 30 mm – could be a seb cyst DD: ?BCC overlying seb cyst

Edited by Admin_Dermpath


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Meenakshi Batrani

Posted

The tumor in lower dermis-subcutis appears to be hidradenoma, not sure of the superficial islands and lobules in image 3 - but could be dermal duct tumor. The composite tumors with a combined silhouette of both hidradenoma and dermal duct tumor displaying either poroid or apocrine differentiation can occur. 

 

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BCC overlying a hidradenoma...diff with an odd bcc with apocrine and ductal differentiation.

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Krishnakumar subramanian

Posted

BER EP4 positive diffuse and EMA negative suggests BCC may be over a poroid tumor

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Meenakshi Batrani

Posted

Interesting. BCC overlying hidradenoma 

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Dr. Richard Carr

Posted

Thanks. This is a BCC. BCC can very closely mimic hidradenoma. The signature of diffuse strong BerEP4 highlighting the peripheral palisade and completely negative EMA in the basaloid cells is practically pathognomic of a BCC. You must always run EMA in combination with BerEP4 (which I fear, from memory, the Afshar paper did not do and therefore one could question their findings). Most of the apparent ductal / glandular differentiation here is pseudo (stromal, note the small blood vessels in the spaces in some areas). There is a duct-like space centrally but remember BCC can show ductal differentiation. Remember calcification is rather typical of follicular neoplasms. I have made the error of reporting hidradenoma as BCC and vice versa in the past till I paid attention to these details. Also I've noted in this sub-type of BCC one can find the BerEP4 only strong in the peripheral basaloid areas and may be markedly reduced in the more squamoid component. Make sure your BerEP4 has strong internal controls.

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Thanks Richard. Good learning points.

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Krishnakumar subramanian

Posted

Thanks sir, very useful points

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