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Born LJ, Khachemoune A. Basal cell carcinosarcoma: a systematic review and reappraisal of its challenges and the role of Mohs surgery. Arch Dermatol Res 2023; 315:2195-2205. [PMID: 36790451 DOI: 10.1007/s00403-023-02551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 12/23/2022] [Accepted: 01/22/2023] [Indexed: 02/16/2023]
Abstract
Basal cell carcinosarcoma (BCCS) is a rare malignant biphasic tumor of the skin, composed of epithelial and mesenchymal components, and may be underdiagnosed. We sought to summarize the current understanding of BCCS including its reported history, clinical presentation, diagnosis, and treatment. We also reappraise and present our recommendations of histological interpretation for its diagnosis and treatment. A systematic review of PubMed and EMBASE, from inception of databases to December 1, 2022, identified all reported cases of basal cell carcinosarcoma. A total of 34 reports containing 54 patients with basal cell carcinosarcoma were included. The neoplasm was most commonly associated in areas of sun-exposed skin and primarily affected the elderly. Diagnosis was made on histology specimens using H&E. To address underdiagnosis, additional immunohistochemical markers have been proposed due to unreliable phenotypic appearance in this poorly differentiated neoplasm. Treatment consists of excision of the tumor, typically with Mohs surgery, and is curative in most cases. There are limited treatment options for metastatic disease. There were limitations to this study as various immunohistochemical stains used on suspected BCCS without providing an explanation as to why certain markers were included and others were excluded. Continued efforts in characterizing this complex neoplasm are critical in establishing reliable and accurate diagnostic tests and accompanying treatment options, especially in cases of metastatic disease.
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Affiliation(s)
- Louis J Born
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amor Khachemoune
- Department of Dermatology, Veterans Affairs Medical Center, and State University of New York, New York, NY, USA.
- Veterans Affairs Hospital and SUNY Downstate Dermatology Service, 800 Poly Place, Brooklyn, NY, 11209, USA.
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2
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Edmondson M, Lonie S, Moir D, Shukla L. Sarcomatoid transformation of a primary basal cell carcinoma of the cheek. ANZ J Surg 2022; 93:1113-1115. [PMID: 36385450 DOI: 10.1111/ans.18151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Mark Edmondson
- Department of Plastic, Hand and Faciomaxillary Surgery The Alfred Melbourne Victoria Australia
| | - Sarah Lonie
- Department of Plastic, Hand and Faciomaxillary Surgery The Alfred Melbourne Victoria Australia
| | - Diana Moir
- Department of Anatomical Pathology The Alfred Melbourne Victoria Australia
| | - Lipi Shukla
- Department of Plastic, Hand and Faciomaxillary Surgery The Alfred Melbourne Victoria Australia
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3
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Seine AJ, Aronson A, Tallon B, Mortimer NJ. A rare cutaneous tumour. Clin Exp Dermatol 2022; 47:791-794. [PMID: 34984725 DOI: 10.1111/ced.15050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
A clinicopathological correlation case of a rare cutaneous tumour, which demonstrated a very rare recurrence with uncertainty remaining over the long-term prognosis for the patient.
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Affiliation(s)
| | | | - B Tallon
- Skin Dermatology Institute, Tauranga Specialist Centre, Tauranga, New Zealand
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4
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Metastatic Basal Cell Carcinoma of the Skin: A Comprehensive Literature Review, Including Advances in Molecular Therapeutics. Adv Anat Pathol 2020; 27:331-353. [PMID: 32618586 DOI: 10.1097/pap.0000000000000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Basal cell carcinoma (BCC) of the skin is the most common type of malignant human tumor. In Europe, the incidence of BCC ranges from 44.6 to 128 cases per 100,000 inhabitants annually, whereas in the United States, the yearly incidence rate ranges between 500 and 1500. The global incidence has been calculated to be as high as 10 million cases of BCC per year. There are 2 main clinical patterns of BCC-the familial BCC in basal cell nevus syndrome and sporadic BCC. The etiology of cutaneous BCC is usually the result of the interaction between solar ultraviolet radiation and genetic factors. Somatic or germline mutations in the effector components of the hedgehog signaling pathway (ie, PTCH1, PTCH2, SMO or SUFU genes) are responsible for ∼90% of the cases of both sporadic and familial BCC, all causing a constitutive activation of the hedgehog pathway. Cutaneous BCC very rarely metastasizes, and diagnosis in metastatic sites can be very difficult. Metastatic BCC has weakly effective therapeutic options with a poor prognosis until few years ago. In 2012, small-molecule therapies, involving inactivation of the hedgehog signaling pathway, and capable of reducing tumor growth and progression have been introduced into clinical practice for advanced (locally advanced or metastatic) BCC. We performed a comprehensive literature review on metastatic BCC and found at least 915 cases reported to date. In addition, we extensively discussed the differential diagnosis of metastatic BCC, and outlined the advances in clinical therapeutics involving these small molecules.
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5
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García-Souto F, Pereyra-Rodriguez JJ, Cabrera-Perez R, Durán-Romero AJ, Escudero-Ordoñez J, Conejo-Mir J. Primary cutaneous carcinosarcoma: clinical, histological, and immunohistochemical analysis of eight cases. Int J Dermatol 2020; 60:93-98. [PMID: 32530054 DOI: 10.1111/ijd.14996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cutaneous carcinosarcoma is a rare biphasic tumor comprising malignant epithelial and heterologous mesenchymal elements. Data on the clinical and histopathologic characteristics of this tumor are scarce. The objective of this study was to describe the clinicopathologic and immunohistochemical features of cutaneous carcinosarcoma. METHODS A descriptive retrospective study was conducted in a tertiary care hospital from Spain. We reviewed the records of eight patients with cutaneous carcinosarcoma who were diagnosed from 2009 to 2019. RESULTS The mean patient age at diagnosis was 72.13 years (range 44-91 years), and there was a male predilection (6 cases). The most common site of cutaneous carcinosarcoma was the head and neck (5 cases). Carcinosarcomas demonstrated variable histopathological and immunohistochemical features. Follow-up was available for 7-8 patients. There were two cases of local recurrence and one case of metastasis. Two patients died from the tumor during the entire follow-up. CONCLUSIONS Although the number of cases in this study was limited, our results provide valuable insight into the clinical, histopathologic, and immunohistochemical characteristics of primary cutaneous carcinosarcoma.
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Affiliation(s)
| | | | - Rocío Cabrera-Perez
- Department of Pathology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Julián Conejo-Mir
- Department of Dermatology, Hospital Universitario Virgen del Rocío, Seville, Spain
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6
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Bisceglia M, Panniello G, Nirchio V, Sanguedolce F, Centola M, Ben-Dor DJ. Metastatic Cutaneous Basal Cell Carcinoma: Report of 2 Cases Preceding the Hedgehog Pathway Antagonists Era. Adv Anat Pathol 2020; 27:98-111. [PMID: 31895095 DOI: 10.1097/pap.0000000000000259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Basal cell carcinoma (BCC) of the skin is the most common type of malignant human tumor. However, metastatic BCC is a very rare event with weakly effective therapeutic options and a poor prognosis, until a few years ago. In 2012, small-molecule therapies, capable of inactivating the hedgehog signaling pathway and thus reducing tumor growth and progression, were introduced into clinical practice for the treatment of patients with advanced BCC. We present retrospectively 2 personal cases of metastatic BCC of the skin, from the premolecular therapy era, from primary tumors that arose years before in the head and neck area. The former case occurred in a 45-year-old woman with a history of recurrent BCC of the retroauricular skin who eventually died due to diffuse metastatic spread. The latter case concerned a 70-year-old man also with a history of recurrent BCC of the nasal-perinasal skin who developed multiple subcutaneous and lymph node metastases in the neck. In both cases, the diagnoses were based on biopsies of the metastatic sites. The first patient died 5 months after the diagnosis of metastatic disease, while the second was alive and disease-free 2 years after neck lymph node dissection and external radiation therapy, and then lost to follow-up. We extensively discuss several tumor entities with basal or basaloid features that may enter the differential diagnosis with BCC in metastatic sites. In addition, we briefly summarize the advances in clinical therapeutics using small molecules, which are now an integral part of the treatment of such advanced BCC cases.
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Mestre-Alagarda C, Nieto G, Terrádez L, Monteagudo C. Primary cutaneous biphasic sarcomatoid basal cell carcinoma with myoepithelial carcinoma differentiation: A new variant. J Cutan Pathol 2019; 46:949-953. [PMID: 31278765 DOI: 10.1111/cup.13543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/14/2019] [Accepted: 07/03/2019] [Indexed: 12/01/2022]
Abstract
Isolated cases of basal cell carcinoma (BCC) with partial myoepithelial component have been described. However, myoepithelial differentiation has not been described in sarcomatoid basal cell carcinomas, which usually show features resembling osteosarcoma, chondrosarcoma, or leiomyosarcoma. We report a case of an 87-year-old man with a forehead lesion that histologically showed a minor component of conventional nodular BCC in transition with a major biphasic sarcomatoid growth composed of invasive spindle-cell and epithelial-like components, the latter with a reticular pattern and scattered ductal structures. Both components showed cytological atypia and high mitotic rate (26/10HPF), with atypical mitotic figures. BER-EP4 immunostaining was exclusively found in the nodular BCC component whereas the sarcomatoid component revealed immunostaining for α-smooth muscle actin (SMA), muscle-specific actin (MSA), calponin, and p63 in both epithelial-like and spindle-cell populations. Focal immunoreactivity was observed in the epithelial component for S100 and glial fibrillary acidic protein (GFAP). Furthermore, EWSR1-PBX1 gene fusion was also detected. This is to our knowledge, the first fully documented case of biphasic sarcomatoid BCC with myoepithelial carcinoma differentiation.
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Affiliation(s)
- Claudia Mestre-Alagarda
- Department of Pathology, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Gema Nieto
- Department of Pathology, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Liria Terrádez
- Department of Pathology, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Carlos Monteagudo
- Department of Pathology, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
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Ryan MP, Woolridge KF, Sedrak M, Berlingeri-Ramos AC, Group AR. A rare variant of extraskeletal osteosarcoma presenting as a clinically benign subcutaneous neoplasm. J Cutan Pathol 2019; 46:546-549. [PMID: 30972791 DOI: 10.1111/cup.13474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/24/2019] [Accepted: 03/04/2019] [Indexed: 11/27/2022]
Abstract
Extraskeletal osteosarcoma (ESOS) is a rare variant of osteosarcoma that arises without attachment to the underlying skeleton. These cancers are typically found embedded in deeper tissues, most commonly the muscle or fascia, and are rarely found within the skin or subcutis. Most tumors are large in size upon initial presentation, and carry a poor prognosis. We discuss the case of a 48-year-old Caucasian woman who presented to a dermatology clinic with an asymptomatic, small, mobile, subcutaneous mass that appeared clinically benign. After elective removal and histopathologic examination, the patient was diagnosed with ESOS. ESOS presenting in this manner is exceedingly rare, and this case highlights the importance of sending all excised specimens, even those with a benign presentation, for pathologic examination.
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Affiliation(s)
- Michael P Ryan
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Katelyn F Woolridge
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
| | | | | | - Ashley R Group
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
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9
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Kwak HB, Park J, Kim HU, Nam KH, Yun SK. Cutaneous Carcinosarcoma: a Clinicopathologic and Immunohistochemical Analysis of 11 Korean Cases. J Korean Med Sci 2019; 34:e5. [PMID: 30618513 PMCID: PMC6318441 DOI: 10.3346/jkms.2019.34.e5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/10/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cutaneous carcinosarcoma is a rare biphasic tumor comprising malignant epithelial and heterologous mesenchymal elements. Data on the clinical and histopathologic characteristics of this tumor in Asian populations are not available. The purpose of this study was to investigate the clinicopathologic and immunohistochemical features of cutaneous carcinosarcoma in the Korean population. METHODS We retrospectively reviewed the records of 11 patients with cutaneous carcinosarcoma who were diagnosed from 2006 to 2016. RESULTS The mean patient age at diagnosis was 71.5 years (range, 43-96 years) and there was a men predilection. The most common site of cutaneous carcinosarcoma was the head and neck (8/11, 72.7%). Histopathologically, most tumors showed a characteristic morphology consisting of two types of tumor cells, varied differentiated epithelial cells (such as basal or squamous cells) and spindle cells with transition zones between the two components. These two cell types also demonstrated variable immunohistochemical characteristics. CONCLUSION Although the number of cases in this study was limited, our results provide valuable insight into the clinical and histopathologic characteristics of cutaneous carcinosarcoma in the Korean population.
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Affiliation(s)
- Hyun-Bin Kwak
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea
| | - Jin Park
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Han-Uk Kim
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Kyung-Hwa Nam
- Department of Dermatology, Presbyterian Medical Center, Jeonju, Korea
| | - Seok-Kweon Yun
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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10
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Rieger UM, Schlecker C, Pierer G, Haug M. Spontaneous Regression of Two Giant Basal Cell Carcinomas in a Single Patient after Incomplete Excision. TUMORI JOURNAL 2018; 95:258-63. [DOI: 10.1177/030089160909500223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Spontaneous regression of small basal cell carcinoma has been reported. For giant basal cell carcinoma, however, no spontaneous regression has been described to date. Case report We present a patient with two independent giant basal cell carcinomas over the left clavicle and the lower back, measuring 7 × 12 cm and 18 × 20 cm, respectively. Both tumors were excised incompletely (R2) and the patient refused follow-up resections. After 52 and 16 months, respectively, no signs of recurrence were observed. Conclusion Incompletely excised giant basal cell carcinomas can regress spontaneously. A watch-and-wait approach after incomplete resection may be pragmatic to avoid mutilating follow-up resections in patients refusing further surgery.
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Affiliation(s)
- Ulrich M Rieger
- Department of Plastic and Reconstructive Surgery, A.ö. Landeskrankenhaus Innsbruck, Innsbruck Medical University, Austria
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Christina Schlecker
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Gerhard Pierer
- Department of Plastic and Reconstructive Surgery, A.ö. Landeskrankenhaus Innsbruck, Innsbruck Medical University, Austria
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Martin Haug
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland
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Cutaneous Metaplastic Carcinoma: Report of a Case With Sebaceous Differentiation. Am J Dermatopathol 2018; 40:e100-e103. [PMID: 29293124 DOI: 10.1097/dad.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this study, a case of a 56-year-old woman with cutaneous metaplastic carcinoma in the neck is reported. It harbored basal cell carcinoma, squamous cell carcinoma, and sebaceous carcinoma, as well as osteosarcoma (with fibroblastic, osteoblastic, aneurysmal bone cyst-like, and chondroblastic patterns). To our knowledge, the literature does not mention sebaceous carcinoma in cutaneous metaplastic carcinoma. Epidemiology and intact mismatch repair proteins of this case support sporadic pathogenesis for this neoplasm. The patient has been followed up for 3 years after surgery with free margins, and no local recurrence or distant metastases have been observed.
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12
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Vulvar Carcinosarcoma Composed of Intestinal-type Mucinous Adenocarcinoma Associated With Anaplastic Pleomorphic and Spindle Cell Carcinoma and Heterologous Chondrosarcomatous and Osteosarcomatous Elements. Int J Gynecol Pathol 2018; 37:93-100. [DOI: 10.1097/pgp.0000000000000385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Xu C, Ibbetson J, Yeoh TM, Harries RHC. Aggressive growth of an incompletely excised primary cutaneous basal cell carcinosarcoma on the scalp: a case report. ANZ J Surg 2016; 86:1065-1066. [PMID: 27910277 DOI: 10.1111/ans.13620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/28/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Chris Xu
- Department of Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Jan Ibbetson
- Department of Surgical Pathology, SA Pathology, Adelaide, South Australia, Australia
| | - Tze Ming Yeoh
- Department of Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Richard H C Harries
- Department of Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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14
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Clark JJ, Bowen AR, Bowen GM, Hyngstrom JR, Hadley ML, Duffy K, Florell SR, Wada DA. Cutaneous carcinosarcoma: a series of six cases and a review of the literature. J Cutan Pathol 2016; 44:34-44. [DOI: 10.1111/cup.12843] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Joshua J. Clark
- Department of Dermatology; University of Utah; Salt Lake City UT USA
| | - Anneli R. Bowen
- Department of Dermatology; University of Utah; Salt Lake City UT USA
| | - Glen M. Bowen
- Department of Dermatology; University of Utah; Salt Lake City UT USA
- Department of Dermatology; Huntsman Cancer Institute; Salt Lake City UT USA
| | - John R. Hyngstrom
- Department of Surgery; University of Utah and Huntsman Cancer Institute; Salt Lake City UT USA
| | - Michael L. Hadley
- Department of Dermatology; University of Utah; Salt Lake City UT USA
| | - Keith Duffy
- Department of Dermatology; University of Utah; Salt Lake City UT USA
| | - Scott R. Florell
- Department of Dermatology; University of Utah; Salt Lake City UT USA
| | - David A. Wada
- Department of Dermatology; University of Utah; Salt Lake City UT USA
- Department of Dermatology; Huntsman Cancer Institute; Salt Lake City UT USA
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15
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High Relative Expression of Pannexin 3 (PANX3) in an Axillary Sweat Gland Carcinoma With Osteosarcomatous Transformation. Am J Dermatopathol 2016; 38:846-851. [DOI: 10.1097/dad.0000000000000583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cutaneous Osteoblastic Osteosarcoma: Report of 2 New Cases Integrated With SATB2 Immunohistochemistry and Review of the Literature. Am J Dermatopathol 2016; 38:824-831. [DOI: 10.1097/dad.0000000000000555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ghannem L, Debbi K, Kerdraon R, Michenet P, Lecointre C. [Bone in skin]. Ann Pathol 2016; 36:155-8. [PMID: 26996973 DOI: 10.1016/j.annpat.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 12/10/2015] [Accepted: 01/15/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Lila Ghannem
- Service de pathologie, hôpital La Source, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France.
| | - Kamel Debbi
- Service de pathologie, hôpital La Source, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France
| | - Rémy Kerdraon
- Service de pathologie, hôpital La Source, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France
| | - Patrick Michenet
- Service de pathologie, hôpital La Source, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France
| | - Claire Lecointre
- Service de pathologie, hôpital La Source, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France
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18
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Zbacnik AP, Rawal A, Lee B, Werling R, Knapp D, Mesa H. Cutaneous basal cell carcinosarcoma: case report and literature review. J Cutan Pathol 2015; 42:903-10. [DOI: 10.1111/cup.12578] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 10/17/2011] [Accepted: 12/15/2011] [Indexed: 12/01/2022]
Affiliation(s)
| | - Ajay Rawal
- Department of Pathology; Minneapolis VA Health Care System; Minneapolis MN USA
| | - Bailey Lee
- Department of Dermatology; University of Minnesota; Minneapolis MN USA
| | - Robert Werling
- Department of Dermatology; University of Minnesota; Minneapolis MN USA
| | - Dennis Knapp
- Department of Pathology; Minneapolis VA Health Care System; Minneapolis MN USA
| | - Hector Mesa
- Department of Pathology; Minneapolis VA Health Care System; Minneapolis MN USA
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Bourgeault E, Alain J, Gagné E. Primary Cutaneous Carcinosarcoma of the Basal Cell Subtype Should Be Treated as a High-Risk Basal Cell Carcinoma. J Cutan Med Surg 2015; 19:407-11. [PMID: 25775619 DOI: 10.1177/1203475415575233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cutaneous carcinosarcoma is a rare primary tumor of the skin, characterized by biphasic epithelial and mesenchymal differentiation. OBJECTIVE Due to the limited number of cases reported, there is no consensus regarding treatment and prognosis. Some authors suggest that cutaneous carcinosarcomas should be viewed as aggressive tumors, with ancillary imaging used to evaluate potential metastatic disease. Other reports demonstrate an indolent disease course, especially with epidermal-type cutaneous carcinosarcomas. METHODS We report a case of cutaneous carcinosarcoma, which we treated with electrodessication and curettage following a shave biopsy. The tumor had an epithelial component resembling a basal cell carcinoma and a fibrosarcomatous stroma. RESULTS At 1-year follow-up, our patient did not show evidence of recurrence or metastasis. CONCLUSIONS Our case suggests that a cutaneous carcinosarcoma with an epithelial component composed of basal cell carcinoma can be regarded as a high-risk nonmelanoma skin cancer.
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Affiliation(s)
| | - Jimmy Alain
- Department of Dermatology, Université Laval, Québec City, Canada
| | - Eric Gagné
- Department of Pathology, Université Laval, Québec City, Canada
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20
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Merkel Cell Carcinoma With Glandular Differentiation Admixed With Sweat Gland Carcinoma and Spindle Cell Carcinoma. Am J Dermatopathol 2015; 37:e31-6. [DOI: 10.1097/dad.0000000000000064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Harms PW, Fullen DR, Patel RM, Chang D, Shalin SC, Ma L, Wood B, Beer TW, Siddiqui J, Carskadon S, Wang M, Palanisamy N, Fisher GJ, Andea A. Cutaneous basal cell carcinosarcomas: evidence of clonality and recurrent chromosomal losses. Hum Pathol 2015; 46:690-7. [PMID: 25704628 DOI: 10.1016/j.humpath.2015.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
Abstract
Cutaneous carcinosarcomas are heterogeneous group of tumors composed of malignant epithelial and mesenchymal components. Although mutation analyses have identified clonal changes between these morphologically disparate components in some subtypes of cutaneous carcinosarcoma, few cases have been analyzed thus far. To our knowledge, copy number variations (CNVs) and copy-neutral loss of heterozygosity (CN-LOH) have not been investigated in cutaneous carcinosarcomas. We analyzed 4 carcinosarcomas with basal cell carcinoma and osteosarcomatous components for CNVs/CN-LOH by comparative genomic hybridization/single-nucleotide polymorphism array, TP53 hot spot mutations by polymerase chain reaction and Sanger sequencing, and TP53 genomic rearrangements by fluorescence in situ hybridization. All tumors displayed multiple CNV/CN-LOH events (median, 7.5 per tumor). Three of 4 tumors displayed similar CNV/CN-LOH patterns between the epithelial and mesenchymal components within each tumor, supporting a common clonal origin. Recurrent changes included allelic loss at 9p21 (CDKN2A), 9q (PTCH1), and 17p (TP53). Allelic losses of chromosome 16 including CDH1 (E-cadherin) were present in 2 tumors and were restricted to the sarcomatous component. TP53 mutation analysis revealed an R248L mutation in both epithelial and mesenchymal components of 1 tumor. No TP53 rearrangements were identified. Our findings indicate that basal cell carcinosarcomas harbor CNV/CN-LOH changes similar to conventional basal cell carcinoma, with additional changes including recurrent 9p21 losses and a relatively high burden of copy number changes. In addition, most cutaneous carcinosarcomas show evidence of clonality between epithelial and mesenchymal components.
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Affiliation(s)
- Paul W Harms
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109; Department of Dermatology, University of Michigan Health System, Ann Arbor MI 48109; Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor MI 48109.
| | - Douglas R Fullen
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109; Department of Dermatology, University of Michigan Health System, Ann Arbor MI 48109
| | - Rajiv M Patel
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109; Department of Dermatology, University of Michigan Health System, Ann Arbor MI 48109
| | - Dannie Chang
- Department of Dermatology, University of Michigan Health System, Ann Arbor MI 48109
| | - Sara C Shalin
- Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Linglei Ma
- Miraca Life Sciences, Glen Burnie, MD 21061
| | - Benjamin Wood
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA 6009, Australia
| | - Trevor W Beer
- CliniPath Pathology, Osborne Park, WA 6017, Australia
| | - Javed Siddiqui
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109; Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor MI 48109
| | | | - Min Wang
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109
| | - Nallasivam Palanisamy
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109; Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor MI 48109; Department of Urology, Henry Ford Health System, Detroit, MI 48202; King Saud University, Riyadh, Saudi Arabia 11362
| | - Gary J Fisher
- Department of Dermatology, University of Michigan Health System, Ann Arbor MI 48109
| | - Aleodor Andea
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109; Department of Dermatology, University of Michigan Health System, Ann Arbor MI 48109
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Cutaneous carcinosarcoma with metastasis to the parotid gland. Case Rep Otolaryngol 2014; 2014:173235. [PMID: 25328737 PMCID: PMC4190691 DOI: 10.1155/2014/173235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/17/2014] [Indexed: 11/17/2022] Open
Abstract
Cutaneous carcinosarcoma is a rare malignancy that exhibits both mesenchymal and epithelial components. It is similar to nonmelanoma skin cancers in terms of risk and prognostic factors. However, these malignancies are known to have a propensity for local recurrence and metastasis, even with adequate resection margins. Here we report a case of metastatic cutaneous carcinosarcoma to the parotid gland and review the relevant literature.
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Paniz-Mondolfi A, Singh R, Jour G, Mahmoodi M, Diwan AH, Barkoh BA, Cason R, Huttenbach Y, Benaim G, Galbincea J, Luthra R. Cutaneous carcinosarcoma: further insights into its mutational landscape through massive parallel genome sequencing. Virchows Arch 2014; 465:339-50. [DOI: 10.1007/s00428-014-1628-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/17/2014] [Accepted: 07/02/2014] [Indexed: 01/06/2023]
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An unusual infiltrative basal cell carcinoma with osteoclastic stromal changes mimicking carcinosarcoma: a case report. Am J Dermatopathol 2014; 37:26-30. [PMID: 24786580 DOI: 10.1097/dad.0000000000000131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 91-year-old man presented with an ulcerated nodule on his left lower eyelid. The tumor showed an epithelial component composed of basaloid and clear cells and a stroma that contained many osteoclastic giant cells. Strong, diffuse expression for cytokeratin 17 and p63 was noted in the epithelial component, whereas no staining was present in the sarcomatoid stroma, suggesting that the osteoclast-rich stromal component represented an unusual benign stromal reaction to the carcinoma rather than a manifestation of carcinosarcoma. Further supporting this interpretation was the absence of mitotic figures and low Ki-67 proliferation index (of approximately 1%) in the stromal cells. We herein reported a case of unusual infiltrative basal cell carcinoma, accompanied by a clear cell carcinomatous features and concurrent benign osteoclastic stromal changes.
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Elwood H, Gardner J, Galloway W, Shalin SC. A case of a giant sarcomatoid basal cell carcinoma with heterologous osteosarcomatous elements. J Cutan Pathol 2014; 41:550-1. [DOI: 10.1111/cup.12308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/12/2014] [Accepted: 01/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Jerad Gardner
- University of Arkansas for Medical Sciences; Department of Pathology; Little Rock AR USA
| | | | - Sara C. Shalin
- University of Arkansas for Medical Sciences; Department of Pathology; Little Rock AR USA
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Trichoblastic sarcoma with osteosarcomatous differentiation: evolution of one lesion with 3 histologic appearances over a 3-year period. Am J Dermatopathol 2013; 34:658-62. [PMID: 22688391 DOI: 10.1097/dad.0b013e3182491d52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Only one description of trichoblastic sarcoma exists in the literature. Here, we present the first case of trichoblastic sarcoma with heterologous osteosarcomatous differentiation. Biospy 1 demonstrated an intermediate-grade trichoblastic sarcoma with pleomorphic cells and atypical mitotic figures observed only in the stroma. The epithelium contained no malignant cells. The histologic morphology was reminiscent of an intermediate-grade phyllodes tumor of the breast. Biopsy 2, an excisional biopsy taken 7 months later, showed a high-grade sarcoma with osteosarcomatous differentiation. Immunohistochemistry performed on both specimens showed positive CD10 and bcl-2 staining in the sarcomatous component; p63 was positive in the benign epithelium only. p53 was negative in both the benign epithelium and the malignant stroma. Ki-67 labeling was approximately 10% in both components. Specimen 3, a complete rhinectomy performed 3 months later, showed a poorly differentiated sarcoma. Six months following his rhinectomy procedure, multiple pulmonary nodules consistent with metastatic disease were detected on chest computed tomography. This is the first case report documenting the evolution of an intermediate-grade trichoblastic sarcoma to a high-grade lesion with osteosarcomatous differentiation, to a poorly differentiated sarcoma. The tumor morphologically resembles malignant phyllodes tumor of the breast. Our case is the first to show negative p53 and positive bcl-2 staining in a trichoblastic sarcoma. We propose that cutaneous trichoblastic sarcoma is pathogenetically analogous to phyllodes tumors of the breast, adenosarcoma of the uterus, or ameloblastoma of the oral cavity.
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Nanguzgambo AB, Razack R, Louw M, Bolliger CT. Immunochemistry and lung cancer: application in diagnosis, prognosis and targeted therapy. Oncology 2011; 80:247-56. [PMID: 21734416 DOI: 10.1159/000329064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 04/19/2011] [Indexed: 12/25/2022]
Abstract
Immunochemistry is now an established ancillary technique in lung cancer diagnosis. Not only does it help in supporting the morphological diagnosis of malignancy, but its role now extends to the determination of cell lineage, ascertaining the primary site of tumour origin and contributing to decisions on prognosis and treatment. Early detection and confirmation of lung cancer facilitate early treatment decisions. Lung cancer management now has a multidisciplinary approach which includes cytopathologists and clinicians. Some clinicians may not understand what immunochemistry is and what its role is in lung cancer diagnosis, prognosis and therapy. The purpose of this paper is to define immunochemistry, on the background of basic respiratory airway epithelial structure and cancer biology, and discuss its application in the diagnosis, treatment and determination of prognosis of lung cancer.
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Affiliation(s)
- Aldoph B Nanguzgambo
- Division of Pulmonology, Department of Medicine, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa.
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31
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Study of D2-40 immunoexpression of the spindle cell areas of a metaplastic basal cell carcinoma (sarcomatoid basal cell carcinoma). Appl Immunohistochem Mol Morphol 2011; 20:518-22. [PMID: 21602664 DOI: 10.1097/pai.0b013e31821acdf5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sarcomatoid basal cell carcinoma (BCC) is rare. In the literature, data on the prognosis of such a variant is somewhat contradictory. D2-40 immunoexpression has been shown to have prognostic connotations in carcinomas of organs other than the skin. However, although D2-40 immunoexpression has been investigated in "common" (nonsarcomatoid) BCC, it has not yet been studied in the spindle cell component of a sarcomatoid BCC. We present a sarcomatoid BCC on the neck of an 87-year-old man that has grown rapidly over the last few months. The sarcomatoid component of the tumor expressed several types of cytokeratins, such as AE1/AE3, CK 5/6, 34betaE12, and CAM 5.2. It was also positive for p63 and for D2-40 in a diffuse pattern.
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Abstract
BACKGROUND Osteosarcoma is a common malignancy, although skin metastasis is rare. We sought to review the incidence, epidemiology, risk factors, and prognosis of osteosarcoma with skin involvement. METHODS We conducted a retrospective chart review that covered 30 years and involved clinic patients younger than 18 years who had cutaneous metastases of osteosarcoma. The main outcome measure was histologic documentation of both primary tumor and metastatic lesion in the skin. RESULTS Two patients were found to have osteosarcoma with skin involvement. No unifying factors were identified. CONCLUSIONS Although osteosarcoma is a common malignancy with frequent metastases, involvement of the skin is rare. Further studies to identify risk factors and subsequent prognosis are necessary. Nevertheless, unidentifiable skin lesions in a patient with a history of osteosarcoma should be investigated to rule out tumor metastasis, regardless of cancer status.
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Affiliation(s)
- Sangeetha Larsen
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA
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Basal cell carcinoma with a sarcomatous component (carcinosarcoma): A series of 5 cases and a review of the literature. J Am Acad Dermatol 2008; 59:627-32. [DOI: 10.1016/j.jaad.2008.05.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 05/28/2008] [Accepted: 05/30/2008] [Indexed: 11/24/2022]
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Cutaneous sarcomatoid carcinoma with features of giant cell tumor of soft parts--a case report. Am J Dermatopathol 2008; 30:395-7. [PMID: 18645315 DOI: 10.1097/dad.0b013e3181716e95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report here a previously undescribed tumor in a 72-year-old patient who had a nasal cutaneous sarcomatoid carcinoma. The epithelial component resembles a skin adnexal tumor, and the sarcomatous component resembles a giant cell tumor of soft parts.
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Poblet E, Pascual A, Godínez JM, Pariente-Martín M, Escario E, García-Olmo DC. Human papillomavirus-associated penile sarcomatoid carcinoma. J Cutan Pathol 2008; 35:559-65. [DOI: 10.1111/j.1600-0560.2007.00867.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brasanac D, Boricic I, Todorovic V, Tomanovic N. Primary cutaneous carcinosarcoma: case report with expanded immunohistochemical analysis. Int J Dermatol 2008; 47:496-501. [DOI: 10.1111/j.1365-4632.2008.03427.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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