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Case Reports

Abstract

Cutaneous squamous cell carcinoma (cSCC) with osteoclast-like giant cells (OLGCs) is a rare histologic variant of squamous cell carcinoma with only a few cases reported in the literature.  These typically present on the head and neck of older patients and are more commonly reported in males.  Most believe the giant cells represent a reactive histiocytic response to invasive carcinoma, although others have hypothesized that they represent transformed tumor cells.  We report the case of a 69-year-old male who presented with a rapidly enlarging lesion on his right cheek. It began spontaneously as a small spot approximately 10 days prior to presentation and quickly progressed to a large, golf ball-sized mass. CT imaging showed a vascularized mass without deep soft tissue invasion. Surgical excision showed an ulcerated 4.5 cm tumor mass, composed of sheets of epithelioid to spindle cells filling and replacing the dermis with numerous OLGCs.  Given the morphology, atypical fibroxanthoma (AFX) and carcinosarcoma were the primary differential diagnoses. However, immunohistochemistry showed strong, focal positivity for cytokeratin AE1/AE3, and diffuse nuclear staining for p63 and p40, confirming squamous differentiation.  SOX10, ERG, and CD31 were negative, excluding melanocytic, vascular, and hematolymphoid neoplasms. The tumor extended to the peripheral margins, and a subsequent excision revealed no residual tumor.  This case illustrates a rare variant of cSCC, initially mistaken clinically as a pyogenic granuloma and histologically mimicking AFX. Recognizing this rare variant is essential to avoid diagnostic pitfalls and ensure timely management.