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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 2240 - 14 January 2019 Posted By: Limin Yu

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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78M, lesion on right lower eyelid


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Sebaceous Carcinoma or BCC with sebaceous differentiation? No dermal mucin around basaloid infiltrating epithelial aggregates. No stromal-epithelial clefts. Only focal palisading, and atypia that exceeds the expected degree on a BCC. But there isn't the in situ Pagetoid spreading expected in Sebaceous Carcinoma, so I find this case difficult.

Favor Sebaceous Carcinoma. 

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Ductal differentiation makes me think of porocarcinoma.

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Alex-Ventura-Leon

Posted

Sebaceous Carcinoma (not a easy case i think)

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Krishnakumar subramanian

Posted

The tumor cells are arising from basal layer, basaloid pattern. There are areas showing clear cell changes, but SGC usually shows severe atypia. second SGC in lower lid is uncommon

BAsal cell carcinoma

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Dr. Richard Carr

Posted

High powers are not great but looks to have the squared of nuclei sign, and focally the applique sign (peritumoural subnecrosis), published by Kazakov's group for sebaceous carcinoma.

Site & other morphology obviously good for the diagnosis too.

 

Am J Dermatopathol. 2017 Apr;39(4):275-278. doi: 10.1097/DAD.0000000000000651.

Squared-Off Nuclei and "Appliqué" Pattern as a Histopathological Clue to Periocular Sebaceous Carcinoma: A Clinicopathological Study of 50 Neoplasms From 46 Patients.

 

Abstract

The histopathological diagnosis of periocular sebaceous carcinoma can be difficult in poorly differentiated cases showing few mature sebocytes. The authors examined 50 periocular sebaceous carcinomas from 46 patients to determine the frequency of 2 features seen in this neoplasm, namely cells with squared-off nuclei and so-called "appliqué" pattern (peritumoral subnecrosis of peripherally located neoplastic cells). Neoplastic cells with squared-off nuclei were found in varying numbers in both the intraepithelial and dermal (invasive) components in all neoplasms, whereas the appliqué pattern was observed in a third of the cases. It is concluded that these features, taken together, may serve as a clue for the diagnosis of periocular sebaceous carcinoma.

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vincenzo

Posted (edited)

THANKS for this comment, Richard. 

Edited by vincenzo

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This is a sebaceous carcinoma. Thank everyone for the insightful discussion. Dr. Carr, thank you for the reference!

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