Case Number : Case 2261 - 12 February 2019 Posted By: Uma Sundram

squamous cell carcinoma p40positive

Agree. Sarcomatoid acantholytic SqCC

Agree, Sarcomatoid SCC, very difficult without IHC.

Sarcomatoid SCC after seen the IHC

Poorly differentiated SCC.

SCC

Yes, poorly differentiated SCC. The key is 'very difficult without IHC'. This case was sent to me, r/o angiosarcoma. Angiosarcoma is actually quite rare outside these parameters 1) Head and neck of the elderly 2) post radiation therapy, typically the breast 3) post stewart/treves syndrome 4) arteriovenous fistula.

The patient is the same one from 2 weeks ago with differentiated VIN. A large excision of this lesion shows differentiated VIN next to this fungating malignant tumor.

d-VIN is easy to miss and the subsequent invasive SCC is very aggressive, more aggressive than those that are HPV driven. This is a cautionary tale to be vigilant when you see lesions that look like LSC/hypertrophic LS/hypertrophic LP on the vulva.

Apologies for the late post! I'm moving offices this week and I feel that I'm moving my brain at the same time!!!