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 1876 - 7 August - Dr Iskander Chaudhry (Invited) Posted By:

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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80 year old male - lesion on back of right ear: excision


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Anil Patki

Posted · Report

Metastatic carcinoma from a  thyroid primary ? Colloid-like material is suggestive.

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vincenzo polizzi

Posted · Report

Atypical,  mildly infiltrative growth but well circumscribed an nodular. My first spot is low grade Hydroadenocarcinoma. You can see an eccrine differentiation and a typical hyaline material around epithelial strands. 

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Raul Perret

Posted · Report

For me this looks like a low grade squamous carcinoma with ductal differentiation. IHC should be performed (EMA, berp-4, CEA, CK7) in order to better characterize it and discard a metatypical BCC. I feel that in the first picture we can see 2 in situ areas in the epidermis next to the dermal nodule arguing against a dx of hidradenocarcinoma. 

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Admin_Dermpath

Posted · Report

Some additional photos added 

DermpathPRO admin

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Raul Perret

Posted · Report

Agree with hidradenocarcinoma after new images. Well spotted on initial images Vincenzo

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Dr. Mona Abdel Halim

Posted · Report

Would like to suggest follicular SCC! Epithelial mucin, acantholytic areas and abrupt keratinization. 

Not 100% sure of true ductal differentiation. 

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vincenzo polizzi

Posted · Report

Thanks, Raul, but I'm afraid I made a bit over...diagnosis. Instead low grade adenok, maybe it could be better "atypical hidradenoma" in this case ( moreover margins are free and distant). What do you think about?

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Raul Perret

Posted · Report

Yes, I was reading the criteria for atypical and malignant hidradenoma/hidradenocarcinoma and this would fit more with atypical. I would do immunos on a case like this one, including p53.

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Robledo F. Rocha

Posted · Report

Maybe the small screen of my cell phone is playing a trick on me, but I couldn’t identify any definitive sign of sweat gland differentiation. I am not in a position to be able to distinguish the real nature of the extracellular eosinophilic material (amyloid deposits? basement membrane-like matrix?), but the tumor is a squamous cell carcinoma to me.
This whole week I’m away from home, in the lovely Cartagena, Colombia, for the XXXI Congress of the Latin American Society of Pathology.

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arti bakshi

Posted · Report

Difficult !...I can see the arguments both for hidradenocarcinoma and SCC. My impression on the 1st set of images was SCC with unusual hylaine material (worth doing amyloid stains too). The second set of images confuse the picture, but not entirely convinced of ductal differentiation. Also, cannot see the typical cellular polymorphism of hidradenomas.  Instead there are pseudoglandular areas due to acantholysis and possible mucin.

Would stick with SCC!

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urmilapandey

Posted (edited) · Report

squamoid, possibe ductal differentiation with eosinophilic material, no epidermal connection, well circumscribed. metastatic carcinoma (esp thyroid medullary carcinoma) is a possibility, if that can be excluded then would favour an atypical hidradenoma. wonder if the lymphoid collection at tumour periphery is saying something...

Edited by urmilapandey

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Admin_Dermpath

Posted · Report

Hi All 

Thanks for your comments - I have a few immunos to post which i will photograph this evening .... like the discussion! 

 

Regards

 

Iskander

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Dr. Richard Carr

Posted · Report

Favour follicular SCC. Nice acantholytic mucin pools. Would like to see connection with the infundibulum. Looks more like basement membrane-like material than keratin (amyloid) but looking forward to the IHC as this is a most unusual feature in FSCC. I would regard this circumscript lesion as "in situ" for practical purposes (pushing only borders). 

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Iskander H. Chaudhry

Posted · Report

Hi All I have added the immuno. BerEp4, CEA and CK7 were all negative. So the final diagnosis is .....

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Dr. Richard Carr

Posted · Report

As discussed apart from the unusual amorphous collagen/basement membrane like aspect its a typical follicular (infundibular-tricholemmal) SCC with central acantholytic "follicular" mucin and pushing only border, mildly pleomorphic variant. There should be attachments to the follicular infundibula that I can't appreciate in these images.

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Iskander H. Chaudhry

Posted · Report

Many thanks for your responses - the Congo red is negative. The features are those of a SCC. I welcome the different variants described. 

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