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?

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Case Number : Case 2361 - 9 July 2019 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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50 year old male with scalp lesion. The cells are CK7+ GATA3+, and negative for CK20,
TTF1, CDX2, and PSA.

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User Feedback


Anil Patki

Posted

Metastasis from carcinoma of male breast or salivary gland

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vincenzo

Posted

First spot diagnosis: BENIGN TUMOR

Second spot diagnosis: a GATA3+ cutaneous tumor could be a...monomorphic mixed tumor od the skin. Difficult case, but, benign case!!!

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Krishnakumar subramanian

Posted

benign apocrine tubular adenoma

cannot think of met looking at morphology, cannot explain the IHC

 

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Meenakshi Batrani

Posted

could it be Polymorphous sweat gland carcinoma. Not sure of IHC

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vincenzo

Posted

I haven't seen a primary cutaneous adenoid cystic carcinoma yet!  It could be a possible differential, but this one looks like a benign tumor. Waiting for the diagnosis.

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Dr. Richard Carr

Posted

I guess it's most likely a primary low grade (tubular) carcinoma eccrine ductal or apocrine is academic (although some apocrine snouts noted in the one area). I'd add p63 to look for in situ component (myoepithelial layer). I recommend complete excision with clear margin and fully body examination (for other primary) / past history? I've seen digital papillary adenocarcinomas with rather indolent scalp metastases.

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Uma Sundram

Posted

Thanks everyone, and very insightful comments.

Benign vs malignant in skin tumors with this morphology (especially with papillary or adenomatous tumors) is extremely difficult and I very much appreciate Dr Carr's comments as that is my experience as well. We did call this a low grade adenocarcinoma and recommended full excision with full clinical work up to ensure that it isn't an unusual met. We favored primary. p63 showed myoepithelial layer around some but not all glands, hence our concern that there might be subtle invasion going on. CK7+GATA3+ IHC can be seen in both primary skin and breast. Salivary gland tumors have not been excluded with this approach and we recommended clinical work up to pursue that further. 

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