UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Case Authors: Peggy Lin MD, Michael Y. Zhang MD PhD, Drazen Jukic MD PhD
MAY 2004 CASE OF THE MONTH
CLINICAL FINDINGS
CLINICAL HISTORY:An outside dermatologist sent a skin specimen to the UPMC Department of Dermatopathology for a second opinion/consultation. The specimen was removed from the left forehead of an 88-year-old male and a request was made to rule out squamous cell carcinoma. Although no clinical history was submitted with the case, the gross specimen contained an approximately 2.1 cm by 1.6 cm well-demarcated, ulcerated lesion.
Hematoxylin-eosin (H&E) Staining:
H&E sections reveal a poorly demarcated invasive tumor extending from the epidermis to deep dermis. The surface is ulcerated (Figure A). The tumor shows marked acantholysis with cells arranged predominantly in glandular pattern (Fig B-D). There is moderate lymphoplasmacytic infiltrate within the tumor. Most of the tumor cells are cuboidal in shape with significant nuclear pleomorphism. Mitoses are frequent. In one of multiple tissue sections, there is one area that exhibits distinct features of typical squamous cell carcinoma (Figure E).
Immunohistochemistry:
The following immunostains were performed:
Immunohistochemistry studies demonstrate that the tumor cells are posistive for pancytokeratin (Figure F) and high molecular weight cytokeratin (CK903, Figure G), but negative for CEA (Figure H). The histological features and special studies confirmed the diagnosis of squamous cell carcinoma, acantholytic type. .
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