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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 2668 - 28 September 2020 Posted By: Iskander H. Chaudhry

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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50M, 3-4mm indurated lesion right cheek , Punch biopsy. ?BCC


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Richard Logan

Posted

I don't know what this is, and it seems no-one else is sufficiently confident about the diagnosis to venture a comment, so I'll start the ball rolling.  This lesion shows a sclerotic stromal reaction around islands of basophilic cells, some of which are originating from the epidermis.  In places there are cells which look trichilemmal, suggesting a desmoplastic trichilemmoma.  However, I see also areas where the cytology looks more poroma-like.  I'm not sure what to make of the elastic tissue alteration which is highlighted in figures 4,6 and 8.  I look forward to seeing what others make of this.

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solid carcinoma / solid variant of microcystic adnexal carcinoma.

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Meenakshi Batrani

Posted (edited)

?Desmoplastic trichoepithelioma

Edited by Meenakshi Batrani

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Please Dr Iskander: what’s the 2658 and 2664 dx?

Agree with ?DTE. 

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Eman El-Nabarawy

Posted

Solid variant of microcystic adnexal carcinoma.

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Admin_Dermpath

Posted

Thank you all - on this biopsy with the crust artefact the two main differentials are desmoplastic trichoepithelioma versus a micronodular basal cell carcinoma. We gave the differential but requested a complete excision. Microcystic adnexal carcinoma would typically show the BM thickening and cribriform architecture and is very rare in the skin. 

Iskander H. Chaudhry 

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Admin_Dermpath

Posted

On 30/09/2020 at 18:46, vincenzo said:

Please Dr Iskander: what’s the 2658 and 2664 dx?

Agree with ?DTE. 

These now have comments attached thanks 

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Dr. Richard Carr

Posted

IHC can be quite useful for this sort of thing. I was wondering about a low grade carcinoma like MAC (not ducts in the images). It looks low grade and indolent. 

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