case_images: PMC3934611_01
case_images: a An ulcerated reddish nodule on the left toe. b The neoplasm occupied the entire dermis (hematoxylin-eosin stain). c-f Histopathological findings of the neoplasm in the left toe. Pleomorphic spindle cells with eosinophilic cytoplasm, blunt-ended nuclei, and perinuclear vacuoles (c hematoxylin-eosin stain). Cells were diffusely positive for alpha-SMA (d) and desmin (e). Cells were focally positive for S-100 (f). g-l Histopathological findings of the lymph node. g Cytologically uniform eosinophilic spindle cell neoplasm showed remarkable neural-like cytomorphology (hematoxylin-eosin staining). Cells were diffusely positive for S-100 (h) and alpha-SMA (i). Cells were focally positive for MiTF (j) and HMB45 (k). Only a small number of cells were positive for melan-A (l) [original magnifications: x12.5 (b); x200 (d-i); x400 (c, j-l)].
case_images: cde-0006-0016-g01.jpg
case_images: PMC3934611_01_cde-0006-0016-g01.jpg
case_images: F1
case_images: A 63-year-old woman presented with an ulcerated reddish nodule on the left toe (fig. 1a). Histopathologically, the neoplasm occupied the entire dermis (fig. 1b) and was composed of pleomorphic spindle cells with eosinophilic cytoplasm, blunt-ended nuclei, and perinuclear vacuoles (fig. 1c). Alfa smooth muscle actin (alpha-SMA; fig. 1d) and desmin (fig. 1e) were diffusely positive. S-100 was focally positive (fig. 1f). Analysis of the excised lymph node showed replacement of lymph node tissue with a cytologically uniform eosinophilic spindle cell neoplasm (fig. 1g). S-100 (fig. 1h) and alpha-SMA (fig. 1i). Staining for microphthalmia transcription factor (MiTF; fig. 1j) and HMB45 (fig. 1k) was focally positive. Melan-A-positive cells were scarcely observed (fig. 1l).