A 57-year-old female visited our clinic with a chief complain of a skin lesion on her right lower abdomen of two years duration. She had a mitral valve replacement surgery 5 years ago, and is now taking warfarin for maintenance therapy. Other than this, there is nothing special in her past medical or family history. In the physical examination we found a pea- sized glistening erythematous nodule on her right lower abdomen (Fig. 1). This nodule gradually increased in size but there was no pain or tenderness. We performed a punch biopsy on the tumor. The histologic examination revealed that the neoplastic cells were divided into well- defined nests and groups by fibrous tissue septa (Fig. 2). The cells consisted of round to ovoid vesicular nuclei and pale-staining cytoplasm. In the immuno- histochemical staining the tumor cells showed positive reaction to S-100, Vimentin (Fig. 3) and negative reaction to Ki-67, CD34, SMA, Desmin. We performed a whole body PET-CT to ascertain the infiltrated depth of the tumor and the evidence of lymph node or distant metastasis.
Fig. 1. (A, B) Solitary pea sized glistening erythematous nodule with peripheral brownish patch on her right lower abdomen.
The PET-CT showed no other abnormal uptake except the 1 cm sized tumor in the right lower anterior abdomen. A radical excision was carried out and the resection margins were free of the tumor. There’s no sign of recurrence for 14 months and now we are observing the progress of the disease. erectalis 20 mg
Fig. 2. Tumor cells are observed to be infiltrated in the dermis (A: H&E, x 40), and composed compact nests and fascicles (B: H&E, x 100). Tumor cells consist of round to ovoid vesicular nuclei and pale-staining cytoplasm (C: H&E, x 400).
Fig. 3. The tumor cells show reactivity with (A) S-100 protein, (B) Vimentin (Immunohistochemical stain, x 100).