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 1880 - 11 August - Dr Arti Bakshi

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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36/M, ?squamous papilloma, right shoulder


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vincenzo polizzi

Posted · Report

This is a well circumscribed, dermal based, syncytial growth of histiocytoid cells, with pale eosinophilic cytoplasm, reminiscent of something myoid. It's an intriguing case, and I'm thinking of a recently described lesion on the myoepithelial spectrum: Cutaneous Syncytial Myoepithelioma.

S100 and EMA could be useful in DD pathway.

 

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Raul Perret

Posted · Report

I agree completely with Vincenzo, there seems to be some initial chondroid metaplasia in the last image. A similar case was published at the ASDP website recently, I find the perivascular lymphocytic infiltrates to be quite helpful for suspecting the entity.

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Dr. Mona Abdel Halim

Posted · Report

Agree with Vincenzo! 

Marvelous case... I did not know about this entity before but I read the case refered to by Raul and it is typical... Thanks Arti... educating case :-)

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Anil Patki

Posted · Report

The presence of vessels and vacuoles in the cells is suggestive of cutaneous epithelioid angiomatous nodule

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Robledo F. Rocha

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I couldn’t find those irregular vascular spaces lined by epithelioid endothelial cells, and extravasated erythrocytes, for epithelioid angiomatous nodule, maybe a variant of epithelioid hemangioma according to Omar Sangüeza. So, I agree with Vincenzo, this is a syncytial myoepithelioma.
Talking about Dr. Sangüeza, he is now presenting his lecture on novel immunohistochemical markers in Dermatopathology during SLAP Congress.

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arti bakshi

Posted · Report

Yes, this is a syncytial myopeithelioma. The tumour was EMA and S100 positive. The sheet like growth with syncytial eosinophilic cytoplasm is characteristic of this variant of myoepithelioma. In the largest series of this variant (see link https://www.ncbi.nlm.nih.gov/pubmed/23588365 ), all cases behaved in a benign fashion (as opposed to greater risk of recurrence/mets in other variants of myopeitheioma).

A spirited defence of cutaneous angiomatous nodule by Anil! But it is not this entity due to the reasons outlined by Robledo and the immunos help to rule it out. A good differential nevertheless!

Thanks to Raul for the link to the case on ASDP. Enjoy your conference, Robledo, and keep sharing what u learn with us too!

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