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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 2516 - 27 February 2020 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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44F, swelling left shin


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My question is: a perineurioma or a mixed perineurioma and neurofibroma? 

There are two types of spindle cells: a) more slender with tapered nuclei b) more plump...so I think this is a hybrid neural tumor.

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I have seen a very similar case, but the patient was known to have neurofibromatosis NF1. Usual neurofibromas are not encapsulated. So I've called it plexiform neurofibroma, despite only one nodule was present. 

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Let me correct my mistake: not a perineurioma and neurofibroma, but perineurioma and Schwannoma. I see an intimate admixture of Schwann cells and perineurial cells, in a well circumscribed and unencapsulated proliferation, with a distinctive whirling pattern. So favor a hybrid Schwannoma and perineurioma.

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Eman El-Nabarawy

Posted

Agree with Vincenzo. Hybrid perineurioma and schwannoma.

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Dr. Mona Abdel-Halim

Posted

S100, EMA and CD34 will be nice to c. I favor hybrid perineurioma/shwannoma lesion

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Saleem Taibjee

Posted

The immunos follow below. EMA and CD34 positive, but S100 negative. Hence I favoured a 'pure' perineurioma. We don't have Claudin in our lab, but that would be another potentially useful stain. BW Saleem

06633_5.0x EMA labelled.jpg

06633_5.0x CD34 labelled.jpg

06633_10.0x S100 labelled.jpg

 

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