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 2572 - 15 May 2020 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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M65. Left lower leg.


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John Zhang

Posted

I am thinking about epithelioid fibrous histiocytoma. But of course, I'd like to run keratin and S100 stains to rule out a carcinoma, a melanoma, etc. 

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Cem Leblebici

Posted

My first impression is epithelioid fibrous histiocytoma. The other possibilities are spitzoid melanocytic lesion and myoepithelioma. IHC required. 

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Dr. Richard Carr

Posted

Good suggestions. On blind H&E I was going down the Spitz naevus route and was somewhat surprised to see the tumour negative for S100, melanA, HMB45 so took another look. I noticed the lack of nesting and the presence of those typical binucleate cells, nice collarette etc so the final diagnosis is epithelioid cell histiocytoma with strong ALK expression (doing a very good impression of a Spitz naevus). Well done John and Cem.

Thanks to Dr Brinder Chohan for sharing this case.

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