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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 2247 - 23 January 2019 Posted By: Dr. Hafeez Diwan

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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6 year-old male with right forearm mass


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Krishnakumar subramanian

Posted

can we have  INI1 protein status

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Tough one favor Angiomatoid fibrohistiocytoma over epithelioid sarcoma

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Alex-Ventura-Leon

Posted

Difficult case but i favor Epithelioid Sarcoma.

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This is a bad lesion, I'm afraid! A large. multinodular, kaposiform and infantile hemangioma-like tumor, with trombones and hemorrhage. I'm afraid this is a kaposiform hemangioendothelioma, with Kasabach-Merrit syndrome associated.

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Dr. Hafeez Diwan

Posted

There is an area of necrobiosis with increased mucin and palisaded histiocytes.  INI-1 was negative. I called this deep granuloma annulare.

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Krishnakumar subramanian

Posted

there is some atypia and mitosis in fig 5, can ga present as a mass 

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Krishnakumar subramanian

Posted

sir, normal cells nuclei ini is conserved in this case ini is lost, is it a cause for concern, can you please clarify

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Dr. Hafeez Diwan

Posted

Sorry my mistake. INI-1 was positive.  I wrote incorrectly previously.  I interpreted the epithelioid cells as palisaded histiocytes.

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Dr. Hafeez Diwan

Posted

And therefore I called this lesion deep GA/rheumatoid nodule.

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Krishnakumar subramanian

Posted

Thanks sir

any history of connective tissue disease or IDDM in the child

Thanks a lot

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Dr. Richard Carr

Posted

Great case. With the necrosis-like area and mucin my first thought was early phase of deep GA (pseudorhematoid nodule).

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