Qap (Anatomical Pathology) 

QAP Peer Review

AP187
Case History: M/75 Scalp lesion excision
Intended diagnosis: Angiosarcoma of scalp. Contributed by:KFT
Code Diagnosis Comment Score
anonymous High grade angiosarcoma (100%) To confirm with immunstains for vascular markers such as CD31, CD34, factor 8.  100
anonymous Angiosarcoma of the scalp nil  100
anonymous Malignant spindle cell tumor. DDx malignant melanoma, epithelioid angiosarcoma. Melanoma (+ve S-100 protein and HMB45) Angiosarcoma (+ve CD31, CD34)  80
anonymous Angiosarcoma; deep resection margin involved. Immunostaining for CD31, CD34.  100
anonymous Angiosarcoma. 100% Vascular lineage to be confirmed by CD31, CD34.  100
anonymous Malignant spindle cell tumor, consistent with angiosarcoma. (100%) Do CD31 stain to confirm.  100
anonymous Scalp - Desmoplastic melanoma 100% nil  10
anonymous Spindle cell malignant neoplasm 100% Take more blocks to delineate pathognomonic morphology. Perform immunohistochemical stains to differentiate between the 2 major considerations : 1) Malignant mmelanoma (positive for S100, HMB45) 2) Angiosarcoma (positive for CD31, fVIIRA, patchy positivity for some epithelial marker e.g. EMA, CAM5.2)  80
anonymous Amelanotic spindle cell malignant melanoma nil  10
anonymous ANGIOSARCOMA (100%) nil  100
anonymous Angiosarcoma 98% Other sarcoma 2% CD31 CD34 to confirm CK, SMA, desmin, S100, HMB45 panel HHV8 to exclude Kaposi  100
anonymous Malignant spindled cell tumor Differential diagnoses are epithelioid angiosarcoma, melanoma, sarcomatoid carcinoma and metastatic malignancies. Suggest immunohistochemical study to differentiate.  70
anonymous Basal cell carcinoma, focally involving the deep margin nil  0
anonymous Epithelioid angiosarcoma. DDx: Malignant melanoma. Do CD 31 for angiosarcoma, S100, HMB45 for melanoma. Probability:100% nil  100
anonymous Malignant tumour (100%), favour angiosarcoma (90%), malignant melanoma (10%) Perform CD31 and CD34 immunostains to confirm angiosarcoma, S100 protein and HMB45 to exclude malignant melanoma  100
anonymous angiosarcoma (95%) desmoplastic melanoma (5%) Immunohistochemical staining for CD31, CD34, S-100 protein and HMB-45.  100