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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 2449 - 21 November 2019 Posted By: Saleem Taibjee

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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87M, diffuse swelling left side of face for several months


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Rhabdomyosarc/melanoma/ Triton tumor are among the differentials.

Need IHC tests.

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Meenakshi Batrani

Posted

I will add epithelioid angiosarcoma to the differentials. 

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Saleem Taibjee

Posted

A couple more images to help you perhaps. The immuno is MNF116 (pankeratin)06968_40.0xf.jpg06968_2.0x MNF116.jpg

 

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Krishnakumar subramanian

Posted

there is a grenz zone with signet ring cells CK positive, is it secondary deposits

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Agree with signet ring-like neoplastic cells. Given the location of the lesion, I would favor a primary signet-ring cell / histiocytoid carcinoma of the eyelid.

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Saleem Taibjee

Posted

Yes, well done, this is primary cutaneous signet-ring cell / histiocytoid carcinoma. The eyelid involvement is characteristic, and this is the reason this is often called the 'monocle' tumour. This often present late due to the insidious thickening/infiltration of the skin. Of course, it is still imperative rule out metastatic adenocarcinoma (breast, GI tract (gastric, large intestine, pancreas), rarely endocervix and gallbladder.

From a morphology point of view, in addition to the signet-ring cells, other features include the 'stack of pennies' arrangement (see image annotation below).

As a dermatopathologist, it is useful to have a list of differentials of tumours presenting in the skin which may show signet-ring cell morphology i.e. large pale or eosinophilic cytoplasm with inclusion or vacuole which compresses the nucleus to the edge of the cell. This includes:

Adenocarcinoma (primary vs metastatic as above)

Apocrine carcinoma (axilla)

Melanocytic lesions (melanoma, naevi)

Squamous cell carcinoma

Basal cell carcinoma

LymphomaSignet ring cell (histiocytoid) carcinoma (H&E x200) annotated.jpg

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Today I learned something I didn't know. Thanks for sharing.

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Dr. Richard Carr

Posted

Wonderful case Saleem. Very rare but it's a fashionable at meetings!

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