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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 2662 - 18 September 2020 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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Spot Diagnosis

Edited by Admin_Dermpath


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Richard Logan

Posted

I think the immunohistochemistry was posted after the previous comments.  I am inclined to go with spiradenoma although I wouldn't say it is typical.  The possible ductal differentiation, hyaline material, EMA positivity and lymphocytic response would support this diagnosis.

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Meenakshi Batrani

Posted

IHC is supportive of basaloid trichilemmoma. 

Turnbull N, Ghumra W, Mudaliar V, et al. CD34 and BerEP4 Are Helpful to Distinguish Basaloid Tricholemmoma From Basal Cell Carcinoma. Am J Dermatopathol. 2018;40(8):561-566.

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Dr. Richard Carr

Posted

Yes well done and thanks for sharing the reference to our paper. The basaloid variant of tricholemmoma can be quite a challenge but quite easy to confirm by IHC if you think of it (BerEP4 negative / weak / focal; patchy CD34). We're going to see lots my p16/p53 profiles but this one is a nice mosaic / wild type for p53 and low wild type p53 both commensurate with a benign lesion.

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