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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 2261 - 12 February 2019 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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75 year old woman with large fungating vulvar mass. Unknown prior history of radiation. Figure 5=CD34; Figure 6=cytokeratin AE1; Figure 7=p40


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Krishnakumar subramanian

Posted

squamous cell carcinoma p40positive

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Victor Delgado

Posted

Agree, Sarcomatoid SCC, very difficult without IHC.

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Uma Sundram

Posted

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.

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Uma Sundram

Posted

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

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