Track: Case Reports

Topic: Neoplasia,Carcinogensis,Tumor Biology

Abstract:

Pleomorphic dermal sarcoma (PDS) is a rare and aggressive skin cancer primarily affecting sun-damaged skin on the scalp, head, and neck. It is known for frequent local recurrence and a tendency to metastasize to the lungs. This report examines two PDS cases with lung metastases, proposing the impact of histologic features on outcomes.

The first case involves a 90-year-old male with a history of treated cutaneous squamous cell carcinoma and Merkel cell carcinoma. He presented with a postauricular PDS mass that metastasized to the lung within six months. Histology showed spindle to epithelioid cells and occasional multinucleated cells with atypical mitotic figures. The immunoprofile was positive for CD10 and patchy SMA, but negative for p40, p63, S100, SOX10, CK AE1/AE3, and CK5. Following radiation therapy for lung metastasis, there was no recurrence over a year of follow-up.

The second case involves an 83-year-old male with a remote history of shoulder melanoma. He developed a PDS on his scalp, with histology revealing spindle to epithelioid cells and plasmacytoid/rhabdoid cells. The immunoprofile was positive for CD10 and negative for p40, CK5/6, and SOX10. One month after Mohs surgery, he developed satellite lesions and biopsy-confirmed metastatic lymph nodes, with additional lung and liver metastases confirmed by imaging. His condition rapidly deteriorated, leading to death within a month.

These cases underscore the importance of recognizing specific histologic features, such as plasmacytoid/rhabdoid cells, in PDS diagnosis to tailor prognosis and management. They emphasize the need for aggressive treatment strategies in high-grade cases.

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Anitha Rao, MD