History A 89 year old gentleman presenting with a scalp/forehead nodule. Patient had squamous cell carcinoma 18 m at same site, excised. Outside diagn
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- Ethelbert Brown
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1 Case III
2 History A 89 year old gentleman presenting with a scalp/forehead nodule. Patient had squamous cell carcinoma 18 m at same site, excised. Outside diagnoses: Squamous cell carcinoma. R/O: SCC, Melanoma, others.
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7 What is your Diagnosis? A. Atypical fibroxanthoma. B. Sarcomatoid carcinoma (SCC) C. Pleomorphic sarcoma (MFH). D. Spindle cell melanoma. E. Scar and granulation tissue.
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9 What is your Diagnosis? A. Atypical fibroxanthoma. B. Sarcomatoid carcinoma (SCC) C. Pleomorphic sarcoma (MFH). D. Spindle cell melanoma. E. Scar and granulation tissue.
10 Pleomorphic Sarcoma Spindle Cell Melanoma
11 Pleomorphic sarcoma (MFH)
12 Pleomorphic sarcoma Cutaneous PS is very rare years Etiology: - Idiopathic - Rarely post-radiotherapy, scar, chronic ulcer >5cm 5-year survival: 15-30% Superficial and angiomatoid: Better prognosis. Angiomatoid, myxoid, giant-cell & inflammatory.
13 Which of the following is the LEAST accurate statement in describing this entity? A. Usually involves the deep soft tissue and striated muscles. B. Usually involves the proximal part of the ext., particularly the lower. C. Skin is a common site. D. Adults between y are often affected. E. Multiple variants have been described including myxoid, inflammatory, angiomatoid, giant cell, etc.
14 Which of the following is the LEAST accurate statement in describing this entity? A. Usually involves the deep soft tissue and striated muscles. B. Usually involves the proximal part of the ext., particularly the lower. C. Skin is a common site. D. Adults between y are often affected. E. Multiple variants have been described including myxoid, inflammatory, angiomatoid, giant cell, etc.
15 Which of the following is the BEST IHC panel to confirm diagnosis? A. Vimentin +, CD68 + & CKAE1/3 ± B. HMWCK +, CK5/6 +, P63+ & Melan-A - C. S100+, Melan-A + & CKAE1/3- D. CD31 +, CD34 + & S100- E. Desmin +, SMA+, S100+ & CD31-
16 Which of the following is the BEST IHC panel to confirm diagnosis? A. Vimentin +, CD68 + & CKAE1/3 ± B. HMWCK +, CK5/6 +, P63+ & Melan-A - C. S100+, Melan-A + & CKAE1/3- D. CD31 +, CD34 + & S100- E. Desmin +, SMA+, S100+ & CD31-
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18 Dr. Roger Moukarbil
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22 Case IV
23 History A 71 year old gentleman presenting with erythematous plaque over nose. Rule out: SCC vs. Melanoma.
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26 What is your Diagnosis? A. Squamous Cell Carcinoma. B. Nevoid Melanoma. C. Basal cell carcinoma, Metatypical type. D. Eccrine Carcinoma. E. Sebaceous Carcinoma.
27 What is your Diagnosis? A. Squamous Cell Carcinoma. B. Nevoid Melanoma. C. Basal Cell Carcinoma, Metatypical type. D. Eccrine Carcinoma. E. Sebaceous Carcinoma.
28 Nevoid Melanoma
29 Metatypical BCC Nevoid Melanoma
30 Metatypical BCC Basosquamous Carcinoma??? Rare variant of BCC: 1.2% to 2.7%. Recurrence rates: 12-50%. Incidence of metastasis: 5-10% Central face
31 Basal cell carcinoma PCNA: G1-S phases KI-67: G2-M phases Basal layer expression: KI-67>PCNA In BCC: - P53 is negative to focal <10%). - PCNA Ki-67 - Ber-EP4: Positive, diffuse - CK7 & CK18: Positive, diffuse EMA: Negative.
32 Metatypical BCC P53: intense and diffuse staining. Ber-EP4: Positive. PCNA>KI-67. Less expression of CK7 & CK18 EMA: Negative.
33 Which of the following is the LEAST accurate statement in describing this entity? A. It has same prognosis as other variants of this entity. B. Surgery is the main treatment. C. It affects more males than females. D. The most affected site is cervicofacial area. E. Recurrence occurred 10% of cases and metastasis in 5%.
34 Which of the following is the LEAST accurate statement in describing this entity? A. It has same prognosis as other variants of this entity. B. Surgery is the main treatment. C. It affects more males than females. D. The most affected site is cervicofacial area. E. Recurrence occurred 10% of cases and metastasis in 5%.
35 Which of the following is the LEAST accurate statement in describing this entity? A. In comparison to other variants there is less expression of CK17 & CK8. B. It shows diffuse and intense P53 labeling. C. In this tumor, PCNA staining is greater than that of Ki-67 D. The tumor cells express Ber EP4. E. The tumor cells express EMA diffusely.
36 Which of the following is the LEAST accurate statement in describing this entity? A. In comparison to other variants there is less expression of CK17 & CK8. B. It shows diffuse and intense P53 labeling. C. In this tumor, PCNA staining is greater than that of Ki-67 D. The tumor cells express Ber EP4. E. The tumor cells express EMA diffusely.
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