Rishi Agrawal
rishiagrawal.bsky.social
Rishi Agrawal
@rishiagrawal.bsky.social
3 followers 3 following 38 posts
Histopathology resident/trainee
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...and p53 and take it from there.
....however there is no parakeratosis and the cells don't look too bad (preserved NC ratio).
Other thought was some areas have the blue grey cytoplasm resembling EDV, so fleeting thought was an acquired EDV acanthoma.
Either way EDV patients have high risk of developing dysplasia, so I'd do p16...
Acanthotic and sharply demarcated hyperkeratotic lesion from the adjacent epidermis. A few raised mitotic figures off the basal layer. Severe underlying solar elastosis.
Favouring a clonal lesion, some type of AK (possibly hypertrophic variant) purely based on the raised mitoses and sun damage.....
Great case 👍
What does the 'R' stand for in your tables under p16? Reactive pattern i.e mosaic?
P16 is aberrant (low), p53 looks weak wild type. Ki67 is too high (~90%).
So the IHC helps support it being malignant.
But from h&e I'm still going for seb carcinoma 🙏
Exophytic tumour. Basaloid with vesicular nuclei. Lipid vacuoles focally scalloping the nuclei. Squared off nuclei also present. Not sure I appreciate applique pattern.
Going for sebaceous carcinoma
I think the faint nuclear p53 staining in the 4th pic are the inflammatory cells in the background and not the lesional cells
1st two pics are p16, which are patchy mosaic in the lesion (normal pattern of staining)
However p53 is aberrant (null) in the lesion.
So supports my h&e impression of fSCC
Exo endophytic. Trichilemmal type keratinisation. Thickened basaloid peripheries, nuclear atypia, plenty of mitoses. 4th pic shows intraepithelial mucin.
fSCC
Epithelial tumour, ulcerated, very basaloid with deep dermal LVI. I see adjacent Bowens, hence favouring poorly diff SCC nos. EMA and BerEP4 for hand holding 🙏
p16 is not mosaic, looks aberrant (null). P53 is not wild type, looks aberrant strong basal and parabasal pattern
Given the disconcordant IHC (favouring malignant) with the H&E (favouring benign), I think this would be a good candidate for SPLUMP.
Infiltrative architecture, but benign cytology (no thickened basaloid peripheries, no mitoses in the pics, no increased NC ratios). Focal lichenoid reaction. Favour benign verrucous keratosis. Considering KA. P16 &p53 please 🙏
Thanks. The clinical changes everything.
I see features of LSC flanking acanthotic epidermis. The keratinocytes look ok. Can see focal papillary dermal fibrinoid collagen degeneration. Underlying granulation tissue. I think this is CDNH. Can't see the ulcer but it could be out the plane of section.
I'm going to need some clinical details
I'm thinking acral site with a clinically red/purple patch. Vasoformative tumour. Extravasated RBCs. I think I see promontory sign. So going for Kaposi sarcoma. ?HHV8
The tumour shows an aberrant cytoplasmic blush pattern of staining. If they want positive control tissue then they should probably pick another case
Correlate with location but this could be a median raphe cyst
Transepidermal elimination disorder vs
? Molluscum bodies ?tinea nigra
Masons trichrome, EVG, DPAS
Not really sure why it's pigmented, no obvious melanocytic pathology. Sox10 to exclude
Superficial angiomyxoma?
A superficial microvenular haemangioma. Looks like acral site. Can't explain all the dermal oedema...an affect of the topical steroids?
Images 1 and 3 are p16 (can see mosaic cyto and nuclear staining in adjacent epidermis). Lesion has aberrant nuclear only staining. Images 2 and 4 are p53, which are aberrant null in the lesion
Circumscript borders, thickened basaloid peripheries with high NC ratios and plenty of mitoses.
I'm going for warty Bowens disease with adexotropsim.
(Some foci of keratinization at the deep aspect near the stromal interface?)
Cytoplasmic vacuoles in places indenting the nucleus?
Sebaceoma vs sebaceous carcinoma. I think I favour the latter due to the pagetoid extension onto the epidermis
Paisley tie differential....
Desmoplastic trichoepithelioma
Residual Ck20 positive Merkel cells should be present Vs a BCC