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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 2248 - 24 January 2019 Posted By: Raul Perret

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F80y, left axillary mass. Previous history of melanoma of the thoracic wall.


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Thinking of some CD20+ or CD30+ Ly. But also S-100- Mart1+ Melanoma.

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Alex-Ventura-Leon

Posted

With the prior history of melanoma i still favor melanoma so we need a SOX10 or MelanA.

If those markers are negatives i would think in some Sarcoma (probably related to treatment for the melanoma)

Epithelioid Sarcoma is a good possibility but also Liposarcoma.

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Raul Perret

Posted (edited)

All those markers are negative. INI1 and BRG1 are conserved

Edited by Raul Perret

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Raul Perret

Posted

MDM2 was positive but this is not a liposarcoma

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Cytokeratin??

Medullary ca of the breast, anaplastic thyroid ca, anaplastic carcinoma....

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Raul Perret

Posted (edited)

I asked for the blocks of the previous lesion to the referring center for comparison. As you see both tumors are morphologically similar/identical, share BRAF expression and interestingly, the previous lesion expressed heterogeneously SOX10 and S100. This process of "dedifferentiation" is rare but has already been described. Good lessons from this case are 1) always checking the morphology of previous tumors in patients with "multiple" neoplasms and 2) Always consider melanoma if morphology is compatible, particularly if  the mass is located deeply in the axillae or groin (frequent metastatic sites). Have a nice day

Edited by Raul Perret

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5 hours ago, Raul Perret said:

I asked for the blocks of the previous lesion to the referring center for comparison. As you see both tumors are morphologically similar/identical, share BRAF expression and interestingly, the previous lesion expressed heterogeneously SOX10 and S100. This process of "dedifferentiation" is rare but has already been described. Good lessons from this case are 1) always checking the morphology of previous tumors in patients with "multiple" neoplasms and 2) Always consider melanoma if morphology is compatible, particularly if  the mass is located deeply in the axillae or groin (frequent metastatic sites). Have a nice day

Thank you Raul! What a fantastic case!

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Dr. Richard Carr

Posted

Did you rule out Langerhan's cell sarcoma?

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Raul Perret

Posted

On 05/02/2019 at 09:52, Dr. Richard Carr said:

Did you rule out Langerhan's cell sarcoma?

CD1a negative my friend

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