Case Number : Case 1979 - 04 Jan 2018 Posted By: Iskander H. Chaudhry

Pleomorphic dermal sarcoma.

If a melanoma (Mart 1, S100+), spindle cell squamous cell carcinoma (Keratin+), leimyosarcoma (SMA+, Desmin+) can be ruled out, then dermal pleomorphic sarcoma is favored over AFX because of the deep infiltrate into the subcutis.

Agree

AFX type cutaneous sarcoma (I'm not a supporter of the term pleomorphic dermal sarcoma for such lesions - think I've given my diatribe on it previously!) with low metastatic risk (<10% probably).

Agree with John Zhang.. 

Agree with J Zang and Mona! If melanoma/SCC/LMS markers neg-->Dermal Pleomorphic Sarcoma is favored over AFX because of deep subcutaneous tissue infiltration. CD10 positivity is uninfluent in this case...

We have often called these AFX/MFH overlaps with the caveat about metastatic potential due to extension into fat. Having said that, I've also been surprised when the case is stained and it turns out to be melanoma or spindled SCC! Will wait for immunos.

Hi Everybody,

Doctor Chaudhry has said that the final diagnosis is Cutaneous Leiomyosarcoma.

Perhaps controversially I'd still call it AFX-type sarcoma (with myomatous differentiation) particularly as it lacks clear-cut cigar-shaped nuclei. ! I'm sure it's academic. I don't bother doing desmin or SMA on AFX-type cutaneous sarcomas as management is same as far as I'm aware. I'd be interested in the CD10 as they are almost always strongly diffuse in AFX & AFX-type cutaneous sarcomas.