Yes, Spitz / Reed n. Has rather large Kamino bodies (paler pink, ltd to DEJ, usually scalloped, will b collagen type IV+). Larger more irregular aggregates are probably clustered colloid bodies (necrotic keratinocytes dropped into papillary dermis) HMW CK would confirm.
I thought interstitial palisading granulomatous pattern & collagen necrobiosis = GA. Unusual 2C well-formed granulomas and Langhan-type giant cells!! Suspect nerve, lacks intra-neural inflammatory cells, incidental. pubmed.ncbi.nlm.nih.gov/25140662/
Looks like but was NOT a KA, see discussion thread and IHC stains: SPLUMP KA-like or FSCC Fav'd. Clue on H&E beware a lesion w actively proliferating but pushing rounded borders & no regression - more likely 2B FSCC. Proliferative KA r highly infiltrative (rounded bowl shape only in LP profile).
Well there is a nerve surrounded by tumour. I normally only report PNI when it is extending around a nerve beyond the main outlines of the tumour borders. In this case it does appear to be following a neurovascular bundle though.
I don't really have a good name. Agree benign basaloid proliferation in a naevus. Not in the textbook 😇
In my experience AFX-type cutaneous sarcoma / PDS are usually either highly aberrant null or cytoplasmic only for p16. This is an uncommon exception which is mosaic. I interpreted p53 as null. Ki67 was low in keeping with an indolent variant. Never seen a case metastasise personally.
Good thoughts: Here CK20, CD10, BerEP4, MelanA
RAC9366: IHC for "malignant spindle tumour on H-CSD skin: CD10 = 60%, S100-, a pan-keratin- & p63- not shown. I don't do other markers unless clues. Do p16, p53 & Ki67 as here when lesions are indolent as in this case. Thoughts? #Dermpath @rishiagrawal.bsky.social
Yes SPLUMP KA-like or FSCC Fav'd. KAscore (or maybe "CarrKAscore" = "uncertain" ~19% (100*6/32). Clue on H&E beware a lesion w actively proliferating but pushing rounded borders & no regression - more likely 2B FSCC. Proliferative KA r highly infiltrative (rounded bowl shape only in LP profile).
Agree but nevertheless I thought this might be a Becker given the clinical suggestions. There are rare reports of large bilateral lesions.
Interesting. Confess I was not aware of role of SLNBx in this setting. Is there not a move to treat the LN basin with DXT in any case? & Victor mentioned good responses to immune modulators so would it not make more logical sense to give neoadjuvant prophylactically - maybe the risk profile?
RAC9364: Great observations. Here is the IHC: x3 for p16 and x1 for p53.
Good thought. Clinical was ?giant congenital naevus ?Becker's naevus.
RAC9358. M40s Bilateral giant pigmented lesion. Biopsy from chest. #Dermpath @rishiagrawal.bsky.social
I thought interstitial palisading granulomatous pattern & collagen necrobiosis = GA. Unusual 2C well-formed granulomas and Langhan-type giant cells!! Suspect nerve, lacks intra-neural inflammatory cells, incidental. pubmed.ncbi.nlm.nih.gov/25140662/
I asked for follow-up. Incidentally there is a small nerve closely associated. You can see a neuritis in morphoea (that is not due to leprosy - Eduardo Calonje showed a lovely case at an Anglo-Belgium-French meeting a few years ago.
I think I might have requested alcian blue. No bug stains. History was what I had.
Positive - it's very good at staining the inner aspect of ORS at all levels up to isthmus and sebaceous duct linings.
I thought this was typical for morphoea. I've asked for follow-up. Not much literature but looks like patients with morphoea can get lesions incited by trauma or friction. PMID: 24880663. pubmed.ncbi.nlm.nih.gov/24880663/
Checked database only ~5 cases only. None wiht IHC. Expect CD34 negative usually a feature of mid-stem/lower outer ORS as in tricholemmoma although does stains about 50% of proliferating pilar tumours. Calretinin definitely. But it would be academic.
Yes well done. Not common. Usually cells pinker (isthmic). Ackerman made points - better classified as tumour of follicular isthmus part of upper ORS. Usually incidental.
RAC9356: Not my diagnosis. A few more images.
RAC9356. M60s. Re-excision of thin melanoma (7 weeks from prior excision). What's going on? @rishiagrawal.bsky.social #dermpath
Nice one Charles. I would have accepted your case as myrmecia (can you take another look - seems to have pretty substantial inclusions to me).
RAC9355 F60s. Lower back. ?BCC for opinions please. Also what type of giant cell? @rishiagrawal.bsky.social #Dermpath
Sorry for @rishiagrawal.bsky.social
