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Clear Cell Proliferations of the Skin: A Histopathologic Review. Am J Dermatopathol 2021; 43:607-636. [PMID: 34411018 DOI: 10.1097/dad.0000000000001881] [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
ABSTRACT Cutaneous clear cell proliferations encompass a heterogenous group of several primary cutaneous neoplasms and metastatic tumors with different histogenesis. Many of these clear cell proliferations may seem strikingly similar under the microscope resulting in challenging diagnosis. In many of these clear cell lesions, the reason for the clear or pale appearance of proliferating cells is unknown, whereas in other ones, this clear cell appearance is due to intracytoplasmic accumulation of glycogen, mucin, or lipid. Artifacts of tissue processing and degenerative phenomenon may also be responsible for the clear cell appearance of proliferating cells. Awareness of the histopathologic findings as well as histochemical and immunohistochemical techniques are crucial to the accurate diagnosis. This review details the histopathologic features of clear cell cutaneous proliferations, classifying them according their type of differentiation and paying special attention to the histopathologic differential diagnosis among them.
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Berg SH, Massoud CM, Jackson-Cook C, Boikos SA, Smith SC, Mochel MC. A Reappraisal of Superficial Pleomorphic Liposarcoma. Am J Clin Pathol 2020; 154:353-361. [PMID: 32525520 DOI: 10.1093/ajcp/aqaa045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Superficial pleomorphic liposarcoma (PL) has a favorable prognosis compared to deeply seated PL. Given developments in the classification of lipomatous neoplasms, we reappraised a series of cases. METHODS Retrospective clinicopathologic evaluation and genome-wide single-nucleotide polymorphism (SNP) microarray studies were performed for cases previously designated superficial PL. RESULTS Four cases were identified (age, 48-70 years). Two were dermally confined, whereas two were superficial subcutaneous; no recurrences or metastases were reported. Tumors demonstrated pleomorphic spindled morphology with variable cellularity. Multivacuolated atypical lipoblasts were focal in 3 and abundant in 1. Dermal tumors demonstrated atypical cells within sclerotic collagen. Genome-wide SNP microarray studies revealed consistent gains and losses, including losses at the 13q14.2 locus encompassing RB1 and DLEU2 and deletion/disruption of the TP53 locus. Although subcutaneous examples showed genomic changes similar to deep PL, the dermal examples showed fewer genetic alterations, including changes reported in the spectrum of atypical spindle cell/pleomorphic lipomatous tumors (ASPLT). All lacked MDM2 amplification. CONCLUSIONS Careful integration of histologic and genetic features may improve classification of lipomatous neoplasms with atypia, allowing reclassification of some superficial PL as ASPLT.
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Affiliation(s)
| | | | - Colleen Jackson-Cook
- Department of Pathology, Virginia Commonwealth University Health System, Richmond
- Department of Human and Molecular Genetics, Virginia Commonwealth University Health System, Richmond
| | - Sosipatros Alexander Boikos
- Department of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University Health System, Richmond
| | | | - Mark Cameron Mochel
- Department of Pathology, Virginia Commonwealth University Health System, Richmond
- Department of Dermatology, Virginia Commonwealth University Health System, Richmond
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Chambers M, Badin DJ, Sriharan AA, Linos KD. Expanding the differential of cutaneous epithelioid tumors: A case of dedifferentiated liposarcoma with epithelioid features involving the skin, with review of the literature. J Cutan Pathol 2020; 47:554-560. [PMID: 31995237 DOI: 10.1111/cup.13650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/30/2022]
Abstract
Liposarcomas are categorized into four distinct histopathological subtypes: atypical lipomatous tumors (ALT)/well-differentiated liposarcoma (WDL), dedifferentiated, myxoid, and pleomorphic. Dedifferentiated liposarcomas account for approximately 18% of all liposarcomas, characteristically arising in the deep soft tissue. They are reported to have lower rates of metastasis compared to other pleomorphic sarcomas.1 -3 The classic histopathologic appearance is ALT/WDL admixed or juxtaposed with a predominantly nonlipogenic sarcoma. Epithelioid features are rare, appearing in as few as 3% of tumors, and have not previously been reported in a superficial location. Herein, we present a 57-year-old male with intradermal and subcutaneous metastasis of his known deep dedifferentiated liposarcoma with epithelioid features. By H&E the tumor featured cords and sheets of crowded, plump, epithelioid cells with thick nuclear membranes and prominent nucleoli, which raised a broad differential including carcinoma and melanoma. By immunohistochemistry the tumor was diffusely positive for MDM2 and CDK4, on the other hand stains for Sox10, Melan A, MITF, CKAE1/3, desmin, and S100 protein were negative. This case serves as an opportunity to raise awareness of this rare morphological subtype, which can involve the skin and mimic epithelial and melanocytic malignancies. It can be a potential diagnostic pitfall, especially if metastases are the first presentation.
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Affiliation(s)
- Meagan Chambers
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Dylan J Badin
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Aravindhan A Sriharan
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Konstantinos D Linos
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Tashakori M, Pimentel J, Howitt BE, Sanchez J, Michalowski S, Chitale D, Ormsby AH, Williamson SR. Pleomorphic fibroma of the skin with MDM2 immunoreactivity: A potential diagnostic pitfall. J Cutan Pathol 2017; 45:59-62. [PMID: 28981153 DOI: 10.1111/cup.13052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/06/2017] [Accepted: 09/29/2017] [Indexed: 01/01/2023]
Abstract
Pleomorphic fibroma is a rare benign cutaneous neoplasm characterized by spindle-shaped cells and multinucleated giant cells scattered throughout collagenous stroma. These morphologic features can lead to diagnostic confusion, including atypical lipomatous tumor as one consideration. In contrast to atypical lipomatous tumor, previous studies have found pleomorphic fibroma to be negative for MDM2 immunohistochemical staining and MDM2 gene amplification. Here, we present a case of pleomorphic fibroma of skin with nuclear MDM2 immunoreactivity in the absence of MDM2 gene amplification, underscoring the superiority of fluorescence in situ hybridization as a diagnostic test in this differential diagnosis. The RB1 locus is also explored for differential diagnosis with pleomorphic/spindle cell lipoma and related entities.
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Affiliation(s)
- Mehrnoosh Tashakori
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan
| | - Jason Pimentel
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jessica Sanchez
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan
| | - Susan Michalowski
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan
| | - Dhananjay Chitale
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan.,Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan
| | - Adrian H Ormsby
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan
| | - Sean R Williamson
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan.,Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan
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Martelosso A, Bitencourt P, Lima RB, D'Acri AM, Martins C, Lupi O, Basilio-de-Oliveira RP. Giant primary pleomorphic dermal liposarcoma. J Cutan Pathol 2017; 44:724-725. [DOI: 10.1111/cup.12963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 04/19/2017] [Accepted: 05/08/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Andresa Martelosso
- Gaffree & Guinle University Hospital; Federal University of the State of Rio de Janeiro (UNIRIO); Rio de Janeiro Brazil
| | - Priscila Bitencourt
- Gaffree & Guinle University Hospital; Federal University of the State of Rio de Janeiro (UNIRIO); Rio de Janeiro Brazil
| | - Ricardo Barbosa Lima
- Gaffree & Guinle University Hospital; Federal University of the State of Rio de Janeiro (UNIRIO); Rio de Janeiro Brazil
| | - Antonio Macedo D'Acri
- Gaffree & Guinle University Hospital; Federal University of the State of Rio de Janeiro (UNIRIO); Rio de Janeiro Brazil
| | - Carlos Martins
- Gaffree & Guinle University Hospital; Federal University of the State of Rio de Janeiro (UNIRIO); Rio de Janeiro Brazil
| | - Omar Lupi
- Gaffree & Guinle University Hospital; Federal University of the State of Rio de Janeiro (UNIRIO); Rio de Janeiro Brazil
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Ramírez-Bellver JL, López J, Macías E, Alegría-Landa V, Gimeno I, Pérez-Plaza A, Kutzner H, Requena L. Primary dermal pleomorphic liposarcoma: utility of adipophilin and MDM2/CDK4 immunostainings. J Cutan Pathol 2016; 44:283-288. [PMID: 27778364 DOI: 10.1111/cup.12850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 10/06/2016] [Accepted: 10/18/2016] [Indexed: 11/28/2022]
Abstract
Liposarcoma, usually arises in deep soft tissues and pleomorphic liposarcoma (PL), is the rarest histopathologic variant. However, 15 cases of entirely dermal PL have been reported. We describe a case of a 79-year-old man who developed a rapidly growing nodule on his thorax. Excisional biopsy was performed and immunohistochemical studies were carried. The lesion was a well-circumscribed dermal nodule composed of multivacuolated pleomorphic lipoblasts and atypical mitotic figures. Neoplastic cells expressed CD10 and resulted negative S100 protein, Melan-A, MITF-1, AE1/AE3, CD4, CD68 (PGM1), retinoblastoma gene family protein, pericentrine and lysozyme. Adipophilin stain showed the lipid contents in the cytoplasm of the neoplastic cells. MDM2 and CDK4 resulted both negative. A diagnosis of primary dermal PL was made. This case shows the utility of adipophilin immunostaining to prove the lipid contents in neoplastic cells, which has the advantage of using formalin-fixed paraffin-embedded tissue and making needless frozen sections and ultrastructural studies to show these findings. Negative MDM2/CDK4 staining in our case argues against the possibility of dedifferentiated liposarcoma and further supports the diagnosis of true PL.
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Affiliation(s)
| | - Joaquín López
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Elena Macías
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Ignacio Gimeno
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Alejandra Pérez-Plaza
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Heinz Kutzner
- Department of Dermatology, Dermatopathologie Friedrichshafen, Friedrichshafen, Germany
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Yu J, Sokumbi O. Cutaneous metastasis of pleomorphic liposarcoma to the scalp: an elusive diagnosis. J Cutan Pathol 2016; 43:526-530. [PMID: 26968423 DOI: 10.1111/cup.12692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/24/2015] [Accepted: 11/02/2015] [Indexed: 12/17/2022]
Abstract
Liposarcomas are one of the most common sarcomas arising in the extremities of the elderly. Various subtypes of liposarcomas include well-differentiated liposarcomas, dedifferentiated liposarcomas, myxoid liposarcomas and pleomorphic liposarcomas. Pleomorphic liposarcomas are the rarest subtype and have the highest malignant potential compared with the other subtypes of liposarcomas. Metastases to internal organs are common but cutaneous metastasis is very rare with only few cases in the literature. We present a patient with a known diagnosis of stage IV metastatic liposarcoma who presented to our clinic with a rapidly growing nodule on the scalp. A biopsy showed a high-grade poorly differentiated spindled cell neoplasm sparing the epidermis with scattered lipoblasts. Immunostaining for S100, SOX10, and MNF-116 were negative. To further characterize the neoplasm, immunostaining with MDM-2 was performed and was also found to be negative. The histologic appearance, immunohistochemical staining, and clinical history support a diagnosis of metastatic pleomorphic liposarcoma to the scalp. The diagnosis of pleomorphic liposarcoma is challenging. It is often difficult to differentiate from myxofibrosarcoma or other high-grade pleomorphic sarcomas based on histology alone. However, the presence of bizarre lipoblasts and negative MDM-2 staining can be helpful clues to differentiate this neoplasm from histologic mimics.
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Affiliation(s)
- JiaDe Yu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Olayemi Sokumbi
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
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