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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 2233 - 3 January 2019 Posted By: Raul Perret

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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Extraskeletal myxoid chondrosarcoma. The tumor cells are arranged in classic strings, cords, and lace-like structures with prominent myxoid stroma.

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vincenzo

Posted (edited)

It looks like a bone biopsy with permeative growth of chondroid (atypical) tissue...agre with chondrosarcoma ( low/intermediate grade ).

Edited by vincenzo

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Alex-Ventura-Leon

Posted

Not and easy one for me. But, after read the comments, i agree that the morphology is consistent whit a Extraskeletal Myxoid Chondrosarcoma as Henry proposed.

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vincenzo

Posted (edited)

Ok! Myoepithelioma could be a viable alternative, but S100 is almost always positive in myxoid ch. and a faint EMA-positivity shouldn't rule out this diagnosis...Sincerly this EMA positivity is more then faint, but nevertheless I still favor Chondrosarcoma.

...a vague, unclear nested pattern fit well ME, but...too vague!

Edited by vincenzo

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Raul Perret

Posted

Great comments! Indeed, this was a textbook example of extraeskeletal myxoid chondrosarcoma. RT-PCR showed an EWSR1-NR4A3 fusion transcript confirming the diagnosis. Despite the deceiving morphology  with delicate cells lacking atypia, these tumors are highly aggressive sarcomas. The disposition in small cords and circular patterns is very suggestive of this entity. In addition, the presence of hemorrhage with hemosiderin deposition is another good clue. Necrotic areas are also frequent. As you guys suggested, the main differential is myoepithelioma which can show morphological and immunophenotypic overlap. In this setting sox10 is a good marker as it tends to be positive in most myoepitheliomas and negative in EMC. Have a wonderful day

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