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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 2459 - 5 December 2019 Posted By: Saleem Taibjee

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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“This is a routine case from last week: 75F scalp, the GP suspected sebaceous cyst”

Edited by Admin_Dermpath


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Krishnakumar subramanian

Posted

dermal round tumor cells and also intraepithelial spread

Merkel cell carcinoma

does not look like sebaceous gland carcinoma

IHC needed sir

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Dr. Mona Abdel-Halim

Posted

MCC is my first thought vs. metastasis (small cell carcinoma of the lung)

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Saleem Taibjee

Posted

Well done guys. Yes this is probably metastatic small cell carcinoma. The tumour is positive for neuroendocrine markers (CD56, chromogranin and synaptophysin), negative for CK20, and strongly positive for CK7 and TTF1 (the latter is shown below).

Of course, the patient requires imaging.

The caveat is that there are examples of CK20 negative, TTF-1 positive, Merkel cell carcinoma, in the literature. Below are links to a couple of pertinent articles.

BW Saleem

https://www.ncbi.nlm.nih.gov/pubmed/27322785

https://www.ncbi.nlm.nih.gov/pubmed/30067951

53232_10.0x TTF1.jpg

 

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