Case Number : Case 2492 - 23 January 2020 Posted By: Saleem Taibjee

Difficult case. It seems that tissue inclusion is not so correct, so it looks an "hamartoma" at the beginning. I see some dermal cells with brown pigment, but it doesn´t look dermal melanocytes, I think it could have some relation with medication. Maybe minocycline-induced hyperpigmentation, Type-II. I would do Perls and Fontana Masson stains.

Difficult. Ideas: Sclerosing mucinous blue nevus, angiomatoid cellular blue nevus, melanotic plexiform mucinous schwannoma.

30 minutes ago, Eman El-Nabarawy said:

Difficult. Ideas: Sclerosing mucinous blue nevus, angiomatoid cellular blue nevus, melanotic plexiform mucinous schwannoma.

 

Like the last : melanotic mucinous schwannoma. 

like to add superficial angiomyxoma , may be co-existing with post-inflammatory hyperpigmentation.

Or melanocytic myxoid spindle cell tumor with ALK rearrangement?? Difficult and interesting lesion!

CD34 please myxoid DFSP

OK, so no-one has got it yet, difficult case. Clue: The pigment is Perl's positive, Masson-Fontana negative.

Superficial angiomyxoma

So with the clue given: hemosiderotic fibrohistiocytic lipomatous lesion???

9 minutes ago, Dr. Mona Abdel-Halim said:

So with the clue given: hemosiderotic fibrohistiocytic lipomatous lesion???

Yes you are right, Mona. But it's very difficult for me. Superficial angiomyxoma is a my spot hypotheses because of the silhouette and the vascular and myxoid mix in a superficial site. However this is a predominant hemosiderotic lesion. I don't know. Waiting for the diagnosis.

20 hours ago, Dr. Mona Abdel-Halim said:

So with the clue given: hemosiderotic fibrohistiocytic lipomatous lesion???

Fits well!

Hi Guys.

Yes you are quire right, the working diagnosis at the moment (suggested by Richard Carr and Raul Perrett) is haemosiderotic fibrolipomatous tumour. It does seem to have the various components including prominent haemosiderin, spindle cell and fatty components. I have indicated this possibility in my original report, and suggested consideration of complete excision given the uncertain biological potential. I have since heard back from the local histopathologist (patient is from another hospital) after MDT discussion that the lesion is clinically a flat pigmented lesion, with no obvious lump. The clinical team plan to arrange an ultrasound scan in the first instance. Will keep you posted if I hear more.

BW
Saleem