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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 2747 - 15 January 2021 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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F50 Calf. 3/12. ?DF Case c/o Dr Paul Geddy


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Dr. Mona Abdel-Halim

Posted

PECOMA?

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Alex-Ventura-Leon

Posted

My differentials are: DFSP ("clear cell variant"), Clear Cell Sarcoma and (lest likely) metastasic Renal Cell Carcinoma 

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vincenzo

Posted

Distinctive Dermal Clear Cell Mesenchymal Neoplasm.

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Dr. Mona Abdel-Halim

Posted

3 minutes ago, vincenzo said:

Distinctive Dermal Clear Cell Mesenchymal Neoplasm.

First time to know about this entity! but I think it fits well! Well done Vincenzo! 

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vincenzo

Posted

Thanks, Mona. So, in two, we may get it right. 

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tyelaine

Posted

Skin tumour involving mainly the reticular dermis and extending to the subcutis. Composed of sheets/packets of tumour cells with distinct cell border, abundant clear cytoplasm and vesicular nuclei with prominent nucleoli (although not much nuclear pleomorphism or mitoses). Quite vascularized. Some entrapment of collagenous fibres.

If considered primary, then I think Distinctive Dermal Clear Cell Mesenchymal Neoplasm would be a nice fit as suggested already. It seems to be mesenchymal as the name suggests but the line of differentiation is unknown. Seems in McKee's newest edition it is put under 'Clear cell fibrous histiocytoma' but mentions 'The overall architecture and morphological features are not usually typical of a fibrous histiocytoma and thus may represent an altogether unrelated tumor.'

Also agree with others that we need to exclude metastatic clear cell tumours (e.g. clear cell RCC) and other soft tissue lesions (as those listed above).

Looking forward to Richard's comment.

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Eman El-Nabarawy

Posted

Balloon cell/clear cell dermatofibroma.

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Dr. Richard Carr

Posted

Great discussion. I was not sure what to call it but sent it to Chris Fletcher with the differential diagnosis of distinctive clear cell mesenchymal tumour (it's similar morphologically to the cases illustrated in the paper) and PECOMA. Chris confirmed that based on the IHC and morphological features this was completely typical of PECOMA (I guess this case fits in to the category of clear cell myomelanocytic tumour). Tumour was diffusely NKIC3+ve (a relatively non-specific marker). I've always had a bit of a blind spot for this diagnosis so I think it's nice to see an apparently typical case! Glad some of you found it similarly challenging to myself!

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Dr. Mona Abdel-Halim

Posted

11 hours ago, Dr. Richard Carr said:

Great discussion. I was not sure what to call it but sent it to Chris Fletcher with the differential diagnosis of distinctive clear cell mesenchymal tumour (it's similar morphologically to the cases illustrated in the paper) and PECOMA. Chris confirmed that based on the IHC and morphological features this was completely typical of PECOMA (I guess this case fits in to the category of clear cell myomelanocytic tumour). Tumour was diffusely NKIC3+ve (a relatively non-specific marker). I've always had a bit of a blind spot for this diagnosis so I think it's nice to see an apparently typical case! Glad some of you found it similarly challenging to myself!

Thanks for sharing such a beautiful case!

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Dr. Richard Carr

Posted

Thanks Elaine, cutaneous primary. Thanks for you recent comments.

R

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