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 1899 - 07 Sept - 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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F75. Few months history of vascular appearing but very firm lesion on the neck. ?Pyogenic granuloma ?Other


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Admin_Dermpath

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Dear All Many thanks for your posts. IT are looking at the elusive 'like' button as we did a recent upgrade on the platform. Will hope to have it back soon :). Admin DermpathPRO

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Raul Perret

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I would perform some immunos in this case. To be honest It made me think of that case we saw in Kazakov's collection that looked like Détombes-Rosai-Dorfman disease but was actually a melanoma. Could this be a reticulohistiocytoma/Détombes-Rosai-Dorfman like melanoma? The other important differential is AFX of course

Edited by Raul Perret

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vincenzo polizzi

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It looks like a balloon cells Melanoma for me too. Thanks for your comment Raul. I’m looking for this RDD-like Melanoma online. 

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Raul Perret

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25 minutes ago, vincenzo polizzi said:

It looks like a balloon cells Melanoma for me too. Thanks for your comment Raul. I’m looking for this RDD-like Melanoma online. 

You are welcome Vincenzo, if you find a reference let me know please because I could not find one. I think that if this is a melanoma it deserves to be published.

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vincenzo polizzi

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5 hours ago, Raul Perret said:

You are welcome Vincenzo, if you find a reference let me know please because I could not find one. I think that if this is a melanoma it deserves to be published.

My first thought was of a balloon cell variant of MM because of nuclear inclusions and nested pattern, but agree with you: AFX is a great ddx, since it is located on a sun exposed region and looks like to a pyogenic granuloma.

I didn't find anything relevant about RD-like MM...

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Robledo F. Rocha

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I go along with melanoma for the same reasons listed above. Cells are bizarre, with cytoplasmic variations, including peripheral vacuolization, rhabdoid features and reticulohistiocytoma-like features.

As our colleague Ed Friedlander wrote in his web site: “Celebrate democracy! Today is Brazil’s Independence Day.”

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Agree. Most likely malignant melanoma. Can't rule out a metastasis. History might help.

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Dr. Richard Carr

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I'm awaiting x4 additional IHC images but this is the immuno:

Positive: Pan-keratin, Vimentin, PAX8, CD10var.

Negative: CK7, CK20, p63, S100, GCDFP15, TTF1, RCC, WT1

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Raul Perret

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The immunophenotype is consistent with a metastasis of renal cell carcinoma as some of our colleagues suspected

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The immunostaining pattern definitely supports a metastatic renal cell carcinoma, although it doesn't look like any typical RCC subtype in the new WHO classification of RCC. So I would like to know what kind of RCC the patient has.  PAX-8 is also positive for thyroid carcinoma (TTF-1 is negative but anaplastic carcinoma may be negative for TTF-1) and carcinoma of the gynecological tract. So still need the history.

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Raul Perret

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5 hours ago, anh said:

The immunostaining pattern definitely supports a metastatic renal cell carcinoma, although it doesn't look like any typical RCC subtype in the new WHO classification of RCC. So I would like to know what kind of RCC the patient has.  PAX-8 is also positive for thyroid carcinoma (TTF-1 is negative but anaplastic carcinoma may be negative for TTF-1) and carcinoma of the gynecological tract. So still need the history.

Ck7 and Ck20 neg with a co-expression of pan ck and vimentin points strongly to kidney (in addition to pax-8). It must be a high grade CCRCC with rhabdoid features

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Arash Daryakar

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Metastatic RCC. Honostly,before seeing IHC results i thought this is a balloon cell melanoma

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Dr. Richard Carr

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Originally my DDx was AFX etc. After seeing the pan-keratin I went for metastatic carcinoma but was still quite perplexed.

Scanning revealed a renal mass in addition to widespread metastases. The additional immunostains performed by colleagues supported a renal primary as discussed eloquently above. 

Thank you for your excellent contributions on the case.

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Dr. Mona Abdel Halim

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Amazing case. I have just now seen the immunos! Marvelous!. Well done for those who thought of RCC on H&E level!

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