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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 2985 - 15 December 2021 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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80M Excision scalp


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msofopoulos

Posted

Looks like Spiradenoma with cylindromatous features (Spiradenocylindroma)

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Blue balls, jigsaw puzzle, thickened eosinophilic basement membrane around the lobules point towards cylindrospiradenoma. 

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Meenakshi Batrani

Posted

Agree with spiradenocylindroma. There also appears to be some sebaceosus differentiation, which can occur and labeled as sebaceous spiradenocylindroma, these composite more common in Brooke-Spiegler syndrome.  

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Eman El-Nabarawy

Posted

This case resembles very much the case number 910 of 13th December 2013.. Areas typical of hidradenoma and others of rippled sebaceoma! Still can't tell which one is favored!!

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Saleem Taibjee

Posted

Nice discussion and range of thoughts on this case.

I also favoured sebaceoma. As many of you have pointed out, the rippled pattern is a nice instant clue at low power in this case, and should be a prompt to search for sebaceous differentiation if you are aware of this uncommon but distinct architectural pattern in sebaceoma. It is a large-ish lesion with some mitosis, but relatively well-circumscribed. Furthermore, the p53 (wild-type) and Ki67 (minor hot spots only) shown below are also largely reassuring for benign.

There were areas of retraction artefact, but none have fallen into the trap of calling this a BCC. I must admit that I had not really considered hidradenoma, but I can now see that the 6th image in particular does definitely have some resemblance, but overall this seems to be a minor component. There is also some mimicry to spiradenoma, but I think the absence of lymphocytes and typical dual cell population negates this.

BW
Saleem

10595_20.0x p53 labelled.jpg10595_5.0x Ki67 labelled.jpg

 

10595_2.0x p53 labelled.jpg

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