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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 2648 - 31 August 2020 Posted By: Iskander H. Chaudhry

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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39M, Back excision. 1cm pink, hyperkeratotic lesion ?Viral wart ?KA ?SCC.

Edited by Admin_Dermpath


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Krishnakumar subramanian

Posted

can we have alk 

could it be epithelioid  dermatofibroma

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Dr. Mona Abdel-Halim

Posted

I think EMA is weakly positive? Perineurioma? 

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Richard Logan

Posted

I must say I was stumped by the low-power architecture of this lesion, where a spindle cell neoplasm with storiform pattern seemed to be lying almost wholly within the epidermis.  Obviously this must be an attempt at transepidermal elimination of a dermal tumour, which has been almost completely nipped off by the epidermis.  I looked back at Richard Carr's case 1521 of perineurioma posted on 22.4.16 which shows the same phenomenon to a less pronounced degree.

I would therefore agree with Mona that with the EMA positivity, perineurioma is the likely diagnosis.  Factor 13a would be interesting.

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Admin_Dermpath

Posted

Dr Chaudhry:

Well done - the final diagnosis was a perineurioma ! 

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Saleem Taibjee

Posted

yes, I did also wonder if ALK (as well as claudin) might help with the differential diagnosis in this case. I have seen a spindle cell variant of epithelioid fibrous histiocytoma.

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