This case report provides the first description of‘‘FGC-like’’ carcinoma of the skin. Based on the results of immuno-histochemistry and histochemis try, we suggest that this FGC-likecarcinomaaccompaniessebaceous differentiation.A74-year-oldmanwithagraduallygrowingyellow,flatnoduleinthe right upper eyelid visited a lo cal dermatologist, and the lesionwas histopathologically diag nosed as xanthoma. Because thepatient wanted complete resection of the tumor, a local plastic sur-geon removed the tumor with a 1-mm margin. The tumor was closeto the lateral margin of excision, and a recurrence was noted2monthsfollowingsurgery.Eventhoughthepatienthadthesec-ond operation, thetumor was histop athologicallydiagnosed as xan-thoma and recurred 6 months later. The patient left the tumor for10 months, resulting in it having extended all over the right eyelidwhen the patient visited our hospital. The clinical picture from theoriginal dermatologist was of a yellow or pale-reddish, hard, ill-demarcatedsubcutaneoustumorintheuppereyelid(Fig.1a).Histo-pathological examination showed the infiltrative mass of tumor cellswith hyperchromatic nuclei and g ranular to foamy cytoplasm in themid-dermis to subcutaneous tissue. Cellular pleomorphism, nuclearpleomorphism and atypism were rare as the previous reports ofFGChave documented(Fig. 1b–d).Magnetic resonance imaging revealed that tumors had growndiffusely in both upper and lower right eyelids, extending aroundthe superior rectus muscle and optic foramen (Fig. 1e). Computedtomography (CT) revealed no metastasis and no suspicious pri-mary tumor except for the right eyelid; therefore, we performedextended excision of the tumor wi th 3-cm margins along with totalorbital exenteration of the right e ye. However, the positive marginswere confirmed at the deepest end around the optic foramen,and further tumor cells were iden tified in the sentinel lymph nodeof the right submandible. The defect of the right eye was recon-structed by using a free rectus abdominis flap. One year after sur-gery, the patient suffered an abdominal incisional hernia at thedonor site of the free flap. Despite emergency surgical treatment,the patient died of severe acute respiratory distress syndromeafter the operation. It was confirmed that there was no primarytumor by autopsy.In histochemical studies, many Sudan-III-positive droplets wereidentified in the cytoplasm, resembling xanthoma (Fig. 2a). Tumorcells were periodic acid Schiff-positive and diastase-resistant(Fig. 2b). In immunohistochemical studies, tumor cells wereimmunoreactive for AE1 ⁄AE3, CAM 5.2, epithelial membraneantigen (EMA), carcinoembryoni cantigen(CEA),GCDFP-15andadipophilin (Fig. 2c–h, respectively). In contrast, tumor cellsshowed no staining for prostate-specific antigen, cytokeratin(CK)20, S-100, HMB-45 and CD68 (data not shown). The exis-tence of Sudan-III-positive droplets and the reactivity with adipo-philin and EMA strongly suggested sebaceous carcinoma orsebaceous differentiation.
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Jan 1, 2015
Tsutomu Nomura + 3
Open Access
