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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: 2526 - 12 March 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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34F, Non-healing lesion left side of nose/ala, non-specific clinical features.


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Intradermal thin basaloid strands, without lumina, and horn cysts with abrupt keratinization, embedded in a sclerotic stroma,   point to a Desmoplastic Trichoepithelioma.

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7 hours ago, vincenzo said:

Intradermal thin basaloid strands, without lumina, and horn cysts with abrupt keratinization, embedded in a sclerotic stroma,   point to a Desmoplastic Trichoepithelioma.

Agree!

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Saleem Taibjee

Posted

Yes, desmoplastic trichoepithelioma. The initial levels which I encountered showed unusually prominent keratocysts, obscuring the basaloid cords. Below I show one of the additional levels in which the basaloid element becomes more pronounced. There is also CK20 shown, which highlights numerous Merkel cells, as often seen in DTE.

It was helpful to have a good deep biopsy here, which rules out deeper extension into subcutis. The pitfall in a superficial biopsy is the differential of microcystic adnexal carcinoma which can be a great mimic.

11559_10.0x level 5.jpg

11559_40.0x level 5.jpg

11559_20.0x CK20 labelled.jpg

 

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