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Rishi Agrawal @rishiagrawal.bsky.social · 1d

...and p53 and take it from there.

Rishi Agrawal @rishiagrawal.bsky.social · 1d

....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...

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Rishi Agrawal @rishiagrawal.bsky.social · 1d

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.....

Rishi Agrawal @rishiagrawal.bsky.social · 3d

Great case 👍
What does the 'R' stand for in your tables under p16? Reactive pattern i.e mosaic?

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Rishi Agrawal @rishiagrawal.bsky.social · 3d

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 🙏

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Rishi Agrawal @rishiagrawal.bsky.social · 4d

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

Rishi Agrawal @rishiagrawal.bsky.social · 22d

I think the faint nuclear p53 staining in the 4th pic are the inflammatory cells in the background and not the lesional cells

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Rishi Agrawal @rishiagrawal.bsky.social · 22d

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

Rishi Agrawal @rishiagrawal.bsky.social · 22d

P16 and p53 please 🙏

Rishi Agrawal @rishiagrawal.bsky.social · 22d

Exo endophytic. Trichilemmal type keratinisation. Thickened basaloid peripheries, nuclear atypia, plenty of mitoses. 4th pic shows intraepithelial mucin.
fSCC

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Rishi Agrawal @rishiagrawal.bsky.social · 26d

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 🙏

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Rishi Agrawal @rishiagrawal.bsky.social · Sep 26

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.

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Rishi Agrawal @rishiagrawal.bsky.social · Sep 25

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 🙏

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Rishi Agrawal @rishiagrawal.bsky.social · Sep 25

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.

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Rishi Agrawal @rishiagrawal.bsky.social · Sep 23

I'm going to need some clinical details

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Rishi Agrawal @rishiagrawal.bsky.social · Sep 20

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

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Rishi Agrawal @rishiagrawal.bsky.social · Sep 17

The tumour shows an aberrant cytoplasmic blush pattern of staining. If they want positive control tissue then they should probably pick another case

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Rishi Agrawal @rishiagrawal.bsky.social · Sep 17

Correlate with location but this could be a median raphe cyst

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Rishi Agrawal @rishiagrawal.bsky.social · Sep 16

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

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Rishi Agrawal @rishiagrawal.bsky.social · Sep 16

Superficial angiomyxoma?

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Rishi Agrawal @rishiagrawal.bsky.social · Sep 12

A superficial microvenular haemangioma. Looks like acral site. Can't explain all the dermal oedema...an affect of the topical steroids?

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Rishi Agrawal @rishiagrawal.bsky.social · Sep 12

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

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Rishi Agrawal @rishiagrawal.bsky.social · Sep 12

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?)

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Rishi Agrawal @rishiagrawal.bsky.social · Aug 20

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

Rishi Agrawal @rishiagrawal.bsky.social · Aug 20

Paisley tie differential....
Desmoplastic trichoepithelioma
Residual Ck20 positive Merkel cells should be present Vs a BCC

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