Clear cell atypical fibroxantoma: a rare variant of atypical fibroxanthoma and review of the literature

Abstract

Atypical fibroxanthoma (AFX) is a superficial variant of pleomorphic malignant fibrous histiocytoma. Clear cell atypical fibroxanthoma (CCAFXA) is a rare variant of atypical fibroxanthoma. A 74-year-old male patient presented with a rapidly growing nodule on the shoulder, which had appeared over a 5-months period. Lesion was excised by the plastic surgeon. Microscopic examination showed an ulcerated nodule composed of pleomorphic spindled and polygonal cells with clear or vacuolated cytoplasm. The neoplastic cells were stained positively with CD68 and CD10 and were stained negative with S-100, Melan A, muscle-specific actin, or pan-cytokeratin. Final diagnosis was clear cell atypical fibroxanthoma. CCAFXA should be differentiated from other clear-cell neoplasms of the skin. Best of our knowledge only 11 cases CCAFXA of have been reported in published studies till date. Herein, we reported 12th case in literature of CCAFXA and review of the literature.

Keywords: Clear cell atypical fibroxanthoma; Differential diagnosis; Immunohistochemistry; Skin.

[Table/Fig-1]:

There is hyperkeratotic epidermis under sheets of neoplastic cells in the papillary dermis (HE, x200)

[Table/Fig-2]:

Neoplastic cells present large hyperchromatic nucleus, prominent nucleoli, multinucleation and abundant clear or eosinophlic granular cytoplasm (HE, x200)

[Table/Fig-3]:

Neoplastic cells was focal positivity with CD68 (x400)

[Table/Fig-4]:

Neoplastic cells was diffuse positivity with CD10 (x100)