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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 4064 - 18 August 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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9-year-old girl: Shave excision right neck ?pyogenic granuloma


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Eman El-Nabarawy

Posted

Lymphoepithelioma-like carcinoma..

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sfwenson

Posted

Low power I considered epithelioid hemangioma (ALHE), but I don't see any eos. Seems young for carcinoma. Some type of Spitz nevus? I'd do some stains including keratins, and vascular and melanocytic markers.

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This could be TRAPP (t cell rich angiomatoid polyploid pseudolymphoma) vs APACHE

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Meenakshi Batrani

Posted

Could it be cutaneous epithelioid angiomatous nodule. Don't see eosinophils, but I think in contrast to ALHE, eosinophils are not prominent in cutaneous epithelioid angiomatous  nodule. 

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Saleem Taibjee

Posted

Interesting to see the various differential diagnosis proposed.

This was in fact a Spitz, ALK-positive (see below). Arguably it is atypical given the inflammatory reaction, but I suspected that this is secondary to trauma, and with an overall likely benign course.

These days I tend to request a panel including ALK, ROS-1 and NTRK (and sometimes BAP-1) to help classify such lesions.

BW

Saleem

1M01_27.05.2022_13.42.31_2.0x ALK labelled.jpgimage.jpeg

 

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