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Cazzato G, Colagrande A, Caputo V, Ingravallo G, Cascardi E, Fortarezza F, Bonoldi E, Rongioletti F. The Rarity in the Rarity: Presentation of Three Cases of Cutaneous Carcinosarcoma with Clinical and Histopathological Insights. Dermatopathology (Basel) 2024; 11:209-217. [PMID: 39051324 PMCID: PMC11270193 DOI: 10.3390/dermatopathology11030022] [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: 05/31/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Abstract
A cutaneous carcinosarcoma (cCS) is a rare and aggressive skin cancer characterized by both carcinomatous (epithelial) and sarcomatous (mesenchymal) components, making it a biphasic tumor. Despite its occurrence in various organs, a cCS is exceptionally rare in the skin, predominantly affecting older males. The etiology of a cCS is unclear, but it may originate from a single progenitor cell capable of dual differentiation or from a collision of carcinoma and sarcoma cells. Clinically, a cCS presents as a rapidly growing, painful, ulcerated nodule or plaque on sun-exposed skin, with a high risk of local invasion and metastasis. Histopathologically, a cCS includes various epithelial components, such as squamous cell carcinoma and basal cell carcinoma, along with undifferentiated sarcomatous components resembling atypical fibroxanthoma. The tumor may also exhibit heterologous differentiation like angiosarcomatous or rhabdomyosarcomatous features. We present three cases of a cCS, highlighting their clinical and histological characteristics and comparing them with previously reported cases. Understanding a cCS is complicated by its rarity and diverse presentation, emphasizing the need for further research to elucidate its pathogenesis and optimal management.
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Affiliation(s)
- Gerardo Cazzato
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (G.I.); (E.C.)
| | - Anna Colagrande
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (G.I.); (E.C.)
| | - Valentina Caputo
- U.O. Anatomia Patologica, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (V.C.); (E.B.)
| | - Giuseppe Ingravallo
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (G.I.); (E.C.)
| | - Eliano Cascardi
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (G.I.); (E.C.)
| | - Francesco Fortarezza
- Surgical Pathology and Cytopathology Unit, University Hospital of Padova, 35100 Padova, Italy;
| | - Emanuela Bonoldi
- U.O. Anatomia Patologica, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (V.C.); (E.B.)
| | - Franco Rongioletti
- Dermatology Clinic, Vita-Salute San Raffaele University, 20132 Milan, Italy;
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Toffoli L, Bazzacco G, Conforti C, Guarneri C, Giuffrida R, Zelin E, di Meo N, Zalaudek I. Pilomatrix Carcinoma: Report of Two Cases of the Head and Review of the Literature. Curr Oncol 2023; 30:1426-1438. [PMID: 36826070 PMCID: PMC9955132 DOI: 10.3390/curroncol30020109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/09/2023] [Accepted: 01/14/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pilomatrix carcinoma (PC) is a rare skin tumor arising from hair follicle matrix cells. It is locally aggressive with a high rate of local recurrence after surgical excision. Few cases in the literature have been described and the management is not well defined. OBJECTIVES The aim of this study was to present two cases of PC located on the head and review the relevant literature about epidemiology, clinical and dermoscopic evaluation, characteristics of local and distant metastases, local recurrence rate and management of this rare skin tumor. METHODS We consulted databases from PubMed, Research Gate and Google Scholar, from January 2012 to November 2022. We reviewed the literature and reported two additional cases. RESULTS We selected 52 tumors in middle-aged to older patients located mostly on the head. Dermoscopy evaluation was rarely performed in the pre-operative diagnostic setting. The most definitive treatment was wide local excision, but local recurrences were common. In total, we observed 11 cases of recurrences and 9 patients with locoregional or distant metastases. Four patients received adjuvant radiotherapy, two patients needed chemotherapy and local cancer therapy and one patient received radiochemotherapy. CONCLUSION Our reports and the review of the literature can provide a better awareness and management of this rare tumor.
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Affiliation(s)
- Ludovica Toffoli
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, 34100 Trieste, Italy
| | - Giulia Bazzacco
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, 34100 Trieste, Italy
- Correspondence: (G.B.); (R.G.)
| | - Claudio Conforti
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, 34100 Trieste, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, 98124 Messina, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, 98124 Messina, Italy
- Correspondence: (G.B.); (R.G.)
| | - Enrico Zelin
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, 34100 Trieste, Italy
| | - Nicola di Meo
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, 34100 Trieste, Italy
| | - Iris Zalaudek
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, 34100 Trieste, Italy
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Reymundo-Jiménez A, Martos-Cabrera L, Muñoz-Hernández P, Llamas-Velasco M. [Translated article] Usefulness of LEF-1 Immunostaining for the Diagnosis of Matricoma. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Suemune K, Adachi Y, Takagi M, Tokuriki T, Akiyama H, Ikehara S. Pilomatrical carcinosarcoma in the very elderly: A case report. Mol Clin Oncol 2021; 15:264. [PMID: 34777800 PMCID: PMC8581733 DOI: 10.3892/mco.2021.2426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/21/2021] [Indexed: 11/06/2022] Open
Abstract
Pilomatrical carcinosarcomas are very rare tumors. To the best of our knowledge, only nine cases diagnosed with pilomatrical carcinosarcomas have been reported. The present study reported on a case of pilomatrical carcinosarcoma in the posterior part of the left auricle of a 100-year-old male patient. The tumor histologically comprised the following two components: Pilomatrical carcinoma and undifferentiated spindle cell sarcoma. The pilomatrical carcinoma comprised atypical basaloid cells and shadow cells. The basaloid cells had basophilic cytoplasm, clear nucleoli and deeply stained nuclear chromatin. The undifferentiated spindle cell sarcoma comprised atypical spindle cells. Both components contained numerous mitotic cells. The boundary area between the carcinoma and sarcoma smoothly transitioned into each other. The carcinoma cells and a portion of the sarcoma cells were positive for β-catenin in the cytoplasm with or without the nuclei. These results suggested that the two components developed from the same origin.
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Affiliation(s)
- Kazuki Suemune
- Department of Diagnostic Pathology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Yasushi Adachi
- Department of Diagnostic Pathology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan.,Department of Pediatrics, Kansai Medical University, Hirakata, Osaka 573-1010, Japan.,Medical Department, Keishinkai Ayabe Sakura Home, Ayabe, Kyoto 623-0045, Japan
| | - Masayuki Takagi
- Department of Laboratory Medicine, Shizuoka Medical Center, Shimizu-Cho, Shizuoka 411-8611, Japan
| | - Toshiharu Tokuriki
- Department of Plastic and Reconstructive Surgery, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Hajime Akiyama
- Department of Dermatology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan
| | - Susumu Ikehara
- Department of Stem Cell Disorders, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
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Utilidad de la inmunotinción con LEF-1 para el diagnóstico de matricoma. ACTAS DERMO-SIFILIOGRAFICAS 2021; 113:907-910. [DOI: 10.1016/j.ad.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/19/2020] [Accepted: 01/18/2021] [Indexed: 11/21/2022] Open
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Abstract
Cutaneous adenosquamous carcinoma is a mixed, squamous and glandular, rare malignant tumor of the skin characterized by a mixed, squamous, and glandular differentiation. Few cases of this tumor have been so far reported, and even fewer have been thoroughly studied by immunohistochemistry. We report here an exceptional case of cutaneous adenosquamous carcinoma which showed immunohistochemically features of intestinal differentiation, namely because of the expression of keratin 20 and CDX2, a marker of gastrointestinal tumors.
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Abstract
We present a case report of the exceptionally rare pilomatrical carcinosarcoma in an even rarer pediatric age group, a 9-year-old female patient. The tumor showed biphasic pilomatrical carcinoma and malignant sarcomatous transformation. To date, the patient is healing well without signs of recurrence. Although limited clinical follow-up is available due to the recent diagnosis, this case may provide a rare look at the clinical outcome of this very rare tumor.
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Saggini A, Bang N, Hantschke M, Held L, Kempter W, Schärer L. Bowen disease with matrical differentiation: Report of an exceptional histopathologic presentation. J Cutan Pathol 2020; 47:840-844. [PMID: 32301151 DOI: 10.1111/cup.13714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/09/2020] [Accepted: 04/12/2020] [Indexed: 11/26/2022]
Abstract
Matrical differentiation is the distinctive feature of pilomatricoma and other purely matrical adnexal neoplasms; additionally, foci of matrical differentiation have been also described in hybrid cysts of Gardner syndrome, as well as in a wide variety of benign and malignant cutaneous tumors, including basal cell carcinoma. We report an exceptional case of Bowen disease exhibiting multiple foci of matrical differentiation, as confirmed by means of immunohistochemical studies. Several types of divergent, non-squamous differentiation have been exceptionally reported in cutaneous squamous cell carcinoma in situ (cSCCIS), including sebaceous, mucinous/glandular, poroid, tricholemmal, and neuroendocrine differentiation; matrical differentiation may be added to this list. Our findings further emphasize the undifferentiated nature of neoplastic cells in cSCCIS.
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Affiliation(s)
| | - Nicole Bang
- Südharz Klinikum Nordhausen, Nordhausen, Germany
| | | | - Laura Held
- Dermatopathology Bodensee, Friedrichshafen, Germany
| | | | - Leo Schärer
- Dermatopathology Bodensee, Friedrichshafen, Germany
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Eckhoff MD, Tadlock J, Kafchinski LA. Pilomatrix Carcinoma of the Antecubitum. Cureus 2020; 12:e6821. [PMID: 32190433 PMCID: PMC7054892 DOI: 10.7759/cureus.6821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We present the case of a 46-year-old male with atypically large left elbow pilomatrix carcinoma present for 10 years with emergent excision after developing life-threatening hemorrhage. Pilomatrix carcinoma is a dermal-based malignant tumor typically of the head and neck region. Histopathology shows islands of basaloid cells, shadow cells, and fibromyxoid fibroma. Reoccurrence is seen in 23% of cases on an average of six months after primary excision. The current standard of care is wide excision with close follow-up.
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Affiliation(s)
- Michael D Eckhoff
- Orthopedics, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, USA
| | - Joshua Tadlock
- Orthopedics, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, USA
| | - Lisa A Kafchinski
- Orthopedics, Texas Tech University Health Sciences Center El Paso, El Paso, USA
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Mori D. Pilomatrical carcinosarcoma of the temple: A case report. J Cutan Pathol 2019; 46:267-270. [PMID: 30582193 DOI: 10.1111/cup.13407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/02/2018] [Accepted: 12/17/2018] [Indexed: 11/29/2022]
Abstract
Pilomatrical carcinosarcoma is a very rare entity, with only six cases reported until now. This report describes the case of a 100-year-old woman with a mass on the left temple that had existed for several decades but had recently grown in size. Histology showed an asymmetric lesion composed of basaloid cells, spindle cells, and "shadow" or "ghost" cells. Cells had atypical hyperchromatic nuclei with prominent nucleoli, high mitotic activity, and atypical mitosis. In the central area, an epidermal cyst-like structure was seen. The diagnosis of pilomatrical carcinosarcoma was rendered. This case appeared to have arisen from malignant transformation of a pilomatricoma because of the long clinical history and existence of a benign epidermal cyst-like structure. In addition, the observation that the basaloid cells and spindle cells showed a gradual transition from one to the other and that both types were positive for β-catenin would seem to support a common clonal origin for the carcinomatous and sarcomatous components.
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Affiliation(s)
- Daisuke Mori
- Department of Pathology, Saga-ken Medical Centre Koseikan, Saga, Japan
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