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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 2332 - 24 May 2019 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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F80. Lower lid. ?Sebaceous cyst, ?Naevus, ?Seborrhoeic keratosis


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John Zhang

Posted

what an interesting lesion! I don't know what it is. But the presence of multiple round lumen, especially in fig 3, makes me think of a sweat gland neoplasm. Also it's the eyelid, I would run neuroendocrine markers chromogranin, synaptophysin to rule out EMPSGC. If these stains are negative, I would run CEA, if the lumen is positive then I will consider hidradenoma or tubular adenoma. But because I am not sure if the periphery is infiltrative, I would recommend excision in case it is a sweat gland carcinoma. If CEA is negative, I will consider metastatic renal cell carcinoma (RCC and PAX8 to confirm).

I feel like that I am firing a shotgun towards the other direction of the target. But hey this forum is so pleasant I dare to have a chit chat...

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John Zhang

Posted

I don't think it is sebaceous carcinoma. But would run adipophilin if the neuroendocrine markers are negative.

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IgorSC

Posted

On picture 3 we can see better the true nature of this proliferation. I think this is a syringoma presenting a huge clear cell differentiantion in the cytoplasm (seen better in the other pictures). So, this is a clear cell syringoma.

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vincenzo

Posted

Tricky and intriguing case! The differentiation seems follicular-trichilemmal. I see something reminiscent of trichoadenoma and something reminiscent of desmoplastic trichilemmoma. ?Mixed clear cell trichoadenoma-trichilemmoma?

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Krishnakumar subramanian

Posted

looks like a benign tumor more for trichelemmoma like 

do not know

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Completely agree with Igor's observation. Clear cell syringoma.

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Neil Catterall

Posted

Would also agree with Igor based on site and obvious syringoma in 3rd pic.

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Krishnakumar subramanian

Posted

agree, looks like clear cell syringoma

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Dr. Richard Carr

Posted

I think there are two main possibilites i.e. Syringoma, clear cells with unusually expansile solid lobules or dermal duct tumour, clear cell variant. I guess it is academic. Certainly the lack of typical poroid elements and location favour the former.

https://www.ncbi.nlm.nih.gov/pubmed/18042069

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Krishnakumar subramanian

Posted

Thanks a lot sir, for interesting case to learn pattern diagnosis

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Dr. Mona Abdel-Halim

Posted

What a beautiful case!

 

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