case_images: PMC10288419_01
case_images: (a) Clinical feature: exophytic, ulcerated, hemorrhagic nodular tumor of 7 cm, over the right thigh (arrow). (b) Macroscopically, dermo-hypodermic tumor, multinodular, whitish with hemorrhagic areas (circle).
case_images: 10.1177_2632010X231178629-fig1.jpg
case_images: PMC10288419_01_10.1177_2632010X231178629-fig1.jpg
case_images: fig1-2632010X231178629
case_images: A 92-year-old female with no significant medical history, coming with a 7 cm exophytic, ulcerated, hemorrhagic nodular tumor rapidly growing for 8 months over the right thigh (Figure 1a and b).
case_images: Tumor section, sheets of clear cells with numerous branching capillaries between tumor cells (hematoxylin and eosin stain x100).
case_images: 10.1177_2632010X231178629-fig2.jpg
case_images: PMC10288419_01_10.1177_2632010X231178629-fig2.jpg
case_images: fig2-2632010X231178629
case_images: Histological examination after 10% buffered formalin fixation, impregnation, and block paraffin embedding, showed a dermal, and subcutaneous neoplasm with irregular nests and nodules, numerous branching capillaries were noted between tumor cells (Figure 2).
case_images: Higher magnification shows there are cellular atypia and atypical mitotic figures (hematoxylin and eosin stain x400).
case_images: 10.1177_2632010X231178629-fig3.jpg
case_images: PMC10288419_01_10.1177_2632010X231178629-fig3.jpg
case_images: fig3-2632010X231178629
case_images: Cells had abundant clear cytoplasm and enlarged polymorphic and vesicular nuclei with prominent nucleoli (Figure 3).
case_images: Immunohistochemical staining (a) cytoplasmic positive staining of Melan A (x400) (b) membranous and cytoplasmic positive staining of smooth muscle actin (SMA) (x400), (c) membranous positive staining of CD 10 (x400). (d) Positive staining of CD34 highlighting numerous thin-walled capillaries between tumor cells (x100).
case_images: 10.1177_2632010X231178629-fig4.jpg
case_images: PMC10288419_01_10.1177_2632010X231178629-fig4.jpg
case_images: fig4-2632010X231178629
case_images: On immunohistochemistry, tumor cells co-expressed smooth muscle, and melanic markers, they are positive for Melan-A (Figure 4a), and smooth muscle actin (SMA; Figure 4b), they also expressed vimentin, CD10 (Figure 4c), and CD68. It should be noted that the immunostaining by CD34 highlighted the numerous branching capillaries between tumor cells (Figure 4d).