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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 2989 - 21 December 2021 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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84 year old female with new right inguinal skin lesion.


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Sorry. I’m an old pathologist. Sorry again. But for me this is a Merkel cell carcinoma. Not CK20+ ? I don’t know why. But this is a MCC. 

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Eman El-Nabarawy

Posted (edited)

1 hour ago, vincenzo said:

Sorry. I’m an old pathologist. Sorry again. But for me this is a Merkel cell carcinoma. Not CK20+ ? I don’t know why. But this is a MCC. 

Could be due to,

An Unusual Immunohistochemical Profile (CK7+/CK20-) for Merkel Cell Carcinoma 

https://academic.oup.com/ajcp/article/144/suppl_2/A270/1775548

Edited by Eman El-Nabarawy

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Krishnakumar subramanian

Posted

CK7-positive/CK20-negative phenotype is seen in a wide variety of carcinomas, including carcinomas of the lung, breast, thyroid, pancreas, and female genital tract

any imaging data available

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INSM 1 positivity is a feature of neuroendocrine and neuroepithelial tumours. Search for primary is the way forward.

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Uma Sundram

Posted

An unusual and difficult. Patient has a history of Merkel ce'll carcinoma. We obtained the prior and her Merkel cell has a completely different morphology. She also has highly aggressive local SCC. Our final diagnosis=poorly differentiated carcinoma, SCC vs neuroendocrine. The latter is not favored but cannot be excluded.

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