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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 2606 - 02 July 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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27F, Soft tissue mass right foot.


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vincenzo

Posted

Clear Cell Sarcoma of Soft Parts. Nice fibrovascular septal organization. And nice nucleolar prominence. 

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Richard Logan

Posted

Cellular blue naevus?

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Dr. Mona Abdel-Halim

Posted

Agree with clear cell sarcoma

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Meenakshi Batrani

Posted

Clear cell sarcoma

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Krishnakumar subramanian

Posted

Clear cell sarcoma

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Saleem Taibjee

Posted

Sorry for the delay on this case.

Yes this is indeed Clear Cell sarcoma.

As Vincenzo points out, the prominent fibrous septae are a good clue, as well prominent nucleoli. I could not identify wreath like giant cells (an additional clue) despite careful scrutiny.

As you probably all know, immunohistochemistry isn't so helpful in such cases, because clear cell sarcoma is often positive for melanocytic markers.

EWSR1 rearrangement was confirmed in this case, supporting the diagnosis.

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Richard Logan

Posted

Saleem, are the cells dissecting the collagen in the upper dermis also part of the tumour, as they look so different?

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Saleem Taibjee

Posted

I think these are tumour cells also. I was reading that occasionally clear cell sarcoma can include a superficial component, and even a junctional/pseudo-junctional component, adding to the potential for misdiagnosis as melanocytic.

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