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Case Reports
. 2024 Sep 3;16(9):e68571.
doi: 10.7759/cureus.68571. eCollection 2024 Sep.

Giant Primary Cutaneous Myoepithelial Carcinoma of the Left Thigh With Inguinal and Pelvic Lymph Node Metastases

Ayaka Obata  1 , Hikaru Kawahara  1 , Hitomi Sugino  1 , Yoko Amagata  1 , Natsuko Saito-Sasaki  1 , Etsuko Okada  1 , Yu Sawada  1
Affiliations
Case Reports

Giant Primary Cutaneous Myoepithelial Carcinoma of the Left Thigh With Inguinal and Pelvic Lymph Node Metastases

Ayaka Obata et al. Cureus. .

Abstract

Myoepithelial carcinoma is an exceedingly rare malignancy, particularly when originating from the skin. It frequently arises from malignant transformations of pleomorphic adenomas in various locations such as the parotid gland, breast, soft tissues, and lungs. Primary cutaneous myoepithelial carcinoma is exceptionally rare, often leading to delayed diagnosis. We report a case of giant primary cutaneous myoepithelial carcinoma of the left thigh, initially misdiagnosed as squamous cell carcinoma (SCC). The patient, a 64-year-old male, presented with a rapidly enlarging, ulcerated, and necrotic skin lesion. The initial presentation mimicked SCC. Due to the large tumor size and anemia caused by the tumor, the patient underwent a reduced-dose chemotherapy regimen (cytarabine plus aclarubicin chemotherapy) to shrink the tumor, enabling successful local surgical resection. Post-surgery, the patient received radiotherapy and tegafur gimeracil oteracil potassium, resulting in disease control without progression for two years. This case highlights the diagnostic challenges of myoepithelial carcinoma, which can mimic SCC among numerous other tumors. Accurate diagnosis relies on immunohistochemical staining and careful pathological evaluation. The case underscores the importance of considering myoepithelial carcinoma in the differential diagnosis of ulcerative tumors.

Keywords: case report; chemotherapy; myoepithelial carcinoma; skin cancer; surgical resection.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Clinical presentation of the tumor
(A) A clinical image of the 20×20 cm pedunculated, red, raised lesion on the posterior aspect of the left thigh. The lesion showed an ulcerated and eroded surface with black and yellow necrosis. (B) A clinical image of the marked lymphadenopathy in the left inguinal region.
Figure 2
Figure 2. CT imaging findings
(A) A contrast-enhanced CT image showing the large mass in the posterior left thigh, with areas of enhancement and necrosis. The tumor and necrotic areas are indicated. (B) A CT image showing multiple enlarged lymph nodes from the left external iliac to the para-aortic regions.
Figure 3
Figure 3. Clinical images
(A) Tumor resection revealed partial infiltration into the underlying muscle. (B) After the resection, a split-thickness skin graft was performed.
Figure 4
Figure 4. Histological and immunohistochemical findings
(A) Histological slide showing the tumor with multiple, nodular, basophilic tumor nests infiltrating the dermis without a capsule; Magnification: x10. (B) High magnification view of the tumor cells exhibiting marked nuclear atypia with prominent nucleoli and numerous mitotic figures; Magnification: x100. (C) Immunohistochemical staining for calponin. (D) Immunohistochemical staining for α-SMA. (E) Immunohistochemical staining for HHF-35. (F) Immunohistochemical staining for PLAG1.
See this image and copyright information in PMC

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