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?

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Case Number : Case 1919 - 06 Oct 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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History: 45/F, lesion left antecubital fossa

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vincenzo polizzi

Posted · Report

Multinodular growth pattern. Slit like vessels separating nodules. There aren’t cellular and sclerotic alternating areas, but I think this is a paucicellular hyalinized variant ( or stage ) of Fibroma of tendon sheath. 

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urmilapandey

Posted · Report

would add desmoplastic fibroblastoma to the differentials mentioned above

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I like the idea of desmoplastic fibroblastoma. What about beta-catenin immunostain?

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Anil Patki

Posted · Report

Desmoplastic fibroblastoma shows thick, hyalinized bands of collagen like in a keloid which are not seen here

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Dr. Richard Carr

Posted · Report

Where's Raul et al when we need them!  I was thinking nodular fasciitis so glad to see Mona on same ticket!

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Dr. Richard Carr

Posted · Report

Actually think it might prove to be neurofibroma - plexiform/myxoid and last image shows somewhat distinctive collagen tracts - almost can imagine the axons. S100 please (if negative stick with first spot).

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Raul Perret

Posted · Report

rather difficult based only on these images. Thought of neurofibroma mainly but all the differentials are valid. s-100, EMA, SMA, Desmin, CD34?

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vincenzo polizzi

Posted · Report

I’m still thinking of a TSF. But it could be also a hyalinized variant/stage of myofibroma ( without hemangiopericytomatous areas).  

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arti bakshi

Posted · Report

I am no expert on soft tissue tumours, but i can tell you the immunohistochemical panel. S100, SMA, desmin, CD34 and EMA were all completely negative. So that ruled out neurofibroma and myofibroma. I would have expected some SMA positivity in nodular fasciitis, so did not go for that either. 

I actually left it as a differential of Fibroma of Tendon Sheath and Desmoplastic Fibroblastoma.

I dont think the lesion fits neatly into either, but that's often the frustration with soft tissue lesions! Thanks for all your comments and any further suggestions given the IHC are welcome.

 

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