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 1962 - 6 Dec 2017 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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Clinical Details: F80. ?BCC ?TE. Biopsy 4 years ago favouring desmoplastic trichoepithelioma.


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Iskander H. Chaudhry

Posted · Report

Interesting ... I would consider a MAC - site not given and would take into consideration

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Dr. Richard Carr

Posted · Report

I thought this was a fairly typical case of microcystic adnexal carcinoma. I tend to regard low grade squamoid eccrine ductal and syringoid (+/- sclerosing) sweat gland carcinomas as a group with similar implications i.e. locally infiltrative but without significant metastatic potential. This is provided they are cytologically only relatively mildly atypical and with low mitotic activity (e.g. <1/mm2 or 1 or 2 per 10 hpf). Obviously Moh's or other margin control surgery may be required because despite their rather indolent features they may have grown quite extensively over many years and be difficult to extirpate especially when there is growth along the nerves.  Fortutantely this was a relatively small lesion that lacked perineural spread. I must emphasise the diagnosis can be perilous on small and superficial biopsies.

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Uma Sundram

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Hi Richard, I agree with your interpretation but was under the impression that MACs were usually very bland. This has fairly distinctive cytologic atypia.

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Dr. Richard Carr

Posted · Report

Agree this case does have atypia (I thought mild) and also some mitotic figures but I'd still put in the "neglible" risk for metastasis group.  Eduardo Calonje's group presented a series in Delhi, they labelled squamoid eccrine ductal carcinoma that included cases with quite marked atypia I suppose you might consider this case on the lower grade end of that spectrum.  Personally for higher grade lesions I prefer to label as "adenosquamous carcinoma" rather than use SEDC that originally were described as "low grade" lesions.

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