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Carcinosarcoma Derived From Nevus Sebaceus
Type
article
Resource
Journal of Clinical Oncology. 29(25): 719-721.
Date Issued
2011-07
Author(s)
Subjects
萬芳醫院
科部：內科部
類別：期刊論文
Abstract
A 67-year-old man presented with a lesion that had been
noticed on his forehead since birth. The lesion was slowly enlarging
and had recently become ulcerated with a 3-month history of rapid
growth and spontaneous bleeding. The patient denied any history
of irradiation or trauma, and there was no family history of malignancy.
Physical examination revealed a 4-cm 3.5-cm tumor
composed of a yellowish nodule with focal ulceration and pigmentation
(Fig 1). There was no regional lymphadenopathy. The clinical
diagnosis was nevus sebaceus (NS) with malignant change, and
an incisional biopsy was performed.
Histologic findings with hematoxylin and eosin stain revealed
NS characterized by acanthosis, hyperplastic sebaceous glands
without hair follicles, and sebaceous ducts with direct opening to
the epidermis (Figs 2A and 2B). The NS was accompanied by
irregular lobules comprising an admixture of pleomorphic basaloid
cells and small numbers of differentiated sebocytes (Figs 2C
and 2D). One focus contained a large biphasic tumor (Fig 3A)
consisting of basaloid cells with peripheral palisading (Fig 3B) and
pleomorphic epithelioid and spindle cells with hyperchromatic
nuclei and numerous mitotic figures (Figs 3C and 3D). Immunohistochemical
staining showed that the epithelioid and spindle
cells (Figs 4A through 4D, asterisks) were strongly positive for
vimentin (Fig 4A) and cytokeratin 5/6 (Fig 4C), moderately positive
for cytokeratin AE1/AE3 (Fig 4B) and negative for S-100 (Fig
4D). The basaloid portion (Figs 4A through 4D, arrowheads) displayed
positive staining for cytokeratin AE1/AE3 and cytokeratin
5/6 (Figs 4B and 4C) but negative staining for vimentin and S-100
(Figs 4A and 4D). Immunostaining for mismatch repair proteins MLH-1 and MSH-2 demonstrated normal nuclear staining
throughout the specimen. Therefore, NS with carcinosarcoma and
sebaceous carcinoma (SC) was diagnosed. Thereafter, the lesion was
completely excised with safe margin. Neither recurrence nor metastasis
had been observed during 1 year of follow-up.
noticed on his forehead since birth. The lesion was slowly enlarging
and had recently become ulcerated with a 3-month history of rapid
growth and spontaneous bleeding. The patient denied any history
of irradiation or trauma, and there was no family history of malignancy.
Physical examination revealed a 4-cm 3.5-cm tumor
composed of a yellowish nodule with focal ulceration and pigmentation
(Fig 1). There was no regional lymphadenopathy. The clinical
diagnosis was nevus sebaceus (NS) with malignant change, and
an incisional biopsy was performed.
Histologic findings with hematoxylin and eosin stain revealed
NS characterized by acanthosis, hyperplastic sebaceous glands
without hair follicles, and sebaceous ducts with direct opening to
the epidermis (Figs 2A and 2B). The NS was accompanied by
irregular lobules comprising an admixture of pleomorphic basaloid
cells and small numbers of differentiated sebocytes (Figs 2C
and 2D). One focus contained a large biphasic tumor (Fig 3A)
consisting of basaloid cells with peripheral palisading (Fig 3B) and
pleomorphic epithelioid and spindle cells with hyperchromatic
nuclei and numerous mitotic figures (Figs 3C and 3D). Immunohistochemical
staining showed that the epithelioid and spindle
cells (Figs 4A through 4D, asterisks) were strongly positive for
vimentin (Fig 4A) and cytokeratin 5/6 (Fig 4C), moderately positive
for cytokeratin AE1/AE3 (Fig 4B) and negative for S-100 (Fig
4D). The basaloid portion (Figs 4A through 4D, arrowheads) displayed
positive staining for cytokeratin AE1/AE3 and cytokeratin
5/6 (Figs 4B and 4C) but negative staining for vimentin and S-100
(Figs 4A and 4D). Immunostaining for mismatch repair proteins MLH-1 and MSH-2 demonstrated normal nuclear staining
throughout the specimen. Therefore, NS with carcinosarcoma and
sebaceous carcinoma (SC) was diagnosed. Thereafter, the lesion was
completely excised with safe margin. Neither recurrence nor metastasis
had been observed during 1 year of follow-up.