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The actual H&E slide will be presented as virtual microscopy.

An 80-year-old female presented with an ulcerated nodule on the left cheek. An excision was performed. The actual H&E slide will be presented as virtual microscopy. The following images are representative of the virtual image.

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The actual H&E slide will be presented as virtual microscopy.

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  1. An 80-year-old female presented with an ulcerated nodule on the left cheek. An excision was performed.

  2. The actual H&E slide will be presented as virtual microscopy. The following images are representative of the virtual image.

  3. Based on the H&E findings on the skin excision, what is your differential diagnosis? List your 5 top choices. Once you have finished this section, you may not return to it

  4. Atypical fibroxanthoma • Basal cell carcinoma • Large cell lymphoma • Leiomyosarcoma • Melanoma • Metastatic carcinoma • Metastatic sarcoma • Pleomorphic fibroma • Primary undifferentiated pleomorphic sarcoma • Squamous cell carcinoma

  5. Answers for Diff Dx • Atypical fibroxanthoma • Leiomyosarcoma • Melanoma • Primary undifferentiated pleomorphic sarcoma • Squamous cell carcinoma

  6. Based on the clinical history and your differential diagnosis, which immunostains would most likely be helpful in arriving at a definitive diagnosis? Please choose 3 stains. Once you have chosen, you cannot choose an additional panel of immunostains.

  7. CD3 • CD45 • CD117 • Cytokeratin • CK7 • CK20 • Desmin • Factor XIIIa • GATA-3 • MOC31 • PAX5 • PAX8 • S-100 protein • Vimentin

  8. Answers for Stains • Cytokeratin • Desmin • S-100

  9. The following immunostains were performed

  10. S-100 protein

  11. Desmin

  12. Cytokeratin

  13. What is the best diagnosis? • Squamous cell carcinoma

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