Smith-Zagone Megan J, Prieto Victor G, Hayes Ruth A, Timperman Walter W, Diwan A Hafeez
Department of Pathology, M. D. Anderson Cancer Center, Houston, TX 77030, USA.
J Cutan Pathol. 2004 Mar;31(3):284-6. doi: 10.1111/j.0303-6987.2004.00173.x.
Atypical fibroxanthoma (AFX) is a cutaneous tumor that primarily occurs in the sun-damaged skin of the head and neck of adults. It is often a rapidly growing, solitary lesion that may clinically resemble squamous cell carcinoma, malignant melanoma, or lobular hemangioma. The histologic differential diagnosis primarily includes spindle cell squamous carcinoma and spindle cell melanoma, and immunohistochemical studies are often needed to establish the diagnosis.
We report an unusual case of an AFX with aberrant HMB-45 and MART-1 (melanoma antigen recognized by T cells-1) immunohistochemical expression. Clinical information was obtained. Histologic examination and immunohistochemical studies were performed.
A 54-year-old woman presented with a 1.5 cm posterior scalp lesion, which was excised. Microscopic examination revealed a dermal tumor composed of pleomorphic and spindled cells with numerous giant cells. The tumor cells expressed CD68 but did not express either keratin or S-100. In addition, there was focal gp100 (with HMB-45) and MART-1 expression limited to the large, multinucleated cells with vacuolated cytoplasm. A diagnosis of AFX was subsequently made.
This is the first reported case of an AFX with HMB-45 and MART-1 reactivity.
非典型纤维黄色瘤（AFX）是一种皮肤肿瘤，主要发生于成年人头颈部受阳光损伤的皮肤。它通常是一种生长迅速的孤立性病变，临床上可能类似于鳞状细胞癌、恶性黑色素瘤或小叶状血管瘤。组织学鉴别诊断主要包括梭形细胞鳞状癌和梭形细胞黑色素瘤，通常需要进行免疫组织化学研究以明确诊断。
我们报告了一例非典型纤维黄色瘤，其HMB-45和MART-1（T细胞识别的黑色素瘤抗原-1）免疫组织化学表达异常。获取了临床信息。进行了组织学检查和免疫组织化学研究。
一名54岁女性后头皮出现一个1.5厘米的病变，已切除。显微镜检查显示真皮肿瘤由多形性和梭形细胞组成，伴有大量巨细胞。肿瘤细胞表达CD68，但不表达角蛋白或S-100。此外，有局灶性gp100（与HMB-45一起）和MART-1表达，仅限于具有空泡状细胞质的大的多核细胞。随后诊断为非典型纤维黄色瘤。
这是首例报道的具有HMB-45和MART-1反应性的非典型纤维黄色瘤病例。
