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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 3076 - 21 April 2022 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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11F left arm ?pyogenic granuloma.


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Eman El-Nabarawy

Posted

BAP1-inactivated melanocytic tumor.

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Shawn

Posted

Spitzoid morphology, BAPoma is a good thought. No atypical junctional component, more or less symmetrical on low power, no significant mitotic activity or atypia from the pictures. 

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Meenakshi Batrani

Posted

Agree with BAPOMA

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msofopoulos

Posted

Looks like Spitz nevus. I cannot distinguish any type of combined nevus. Do you know if it is a RET fusion?

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vincenzo

Posted

I don’t see bapoma-like cells, but it’s a my impression of course. There are spitzoid features, (NTRK3?). If BRAFV600E neg favor a SN. I know many pathologists prefer the AST label for these cases.  But it looks like benign  for me. 

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Saleem Taibjee

Posted

The additional relevant IHC is shown below. ALK showed some positive staining which might suggest an underlying driver ALK fusion, p16 appears lost, Ki67 low. Not shown, but BAP-1 was preserved, ROS-1 and NTRK negative.

This type of IHC is constituting my 'Spitz' IHC panel in these difficult sorts of lesions.

In this case, with the loss of p16, I erred towards 'atypical Spitz tumour', and advised MDT discussion + aiming for re-excision. One could also consider ancillary investigations such as FISH.

BW
Saleem

71595_20.0x ALK labelled.jpg

211_A_1_P_10.0x p16 labelled.jpgDigitalSlide_B6M_6S_1_20.0x Ki67 labelled.jpg

 

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