A 41-year-old woman had a one-year history of ulcerated papule on the occipital area of the scalp. It was observed as a dome-shaped bean sized flesh colored ulcerated papule without specific signs or symptoms (Fig. 1). The patient felt the size had been increased insidiously during the above period.
Fig. 1. The skin lesion is a dome-shaped bean-sized flesh-colored ulcerated papule on the scalp.
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Fig. 2. Figure of the whole lesion. The arrow respectively indicates neurofibroma in the right upper portion, intratumoral fat in the middle portion, and eccrine hidrocystoma in the lower portion (H&E, x 20).
Fig. 3. The tumor is well-demarcated neoplasm composed of loosely arranged interlacing bundles of spindle cells with elongated nuclei, partly separated by wavy collagen and basophilic myxoid material. The focal areas of tumor were replaced with vacuolated cells in the mid dermis (H&E, x 40).
Her past medical and familial history was unremarkable. Laboratory tests including complete blood count, liver function test, thyroid function test, and urinary analysis were negative or normal. An excisional skin biopsy was performed. Histo- pathologically, we observed three different typical histopathologic findings at the same lesion (Fig. 2). First of all, it showed a well-circumscribed, non- encapsulated neoplasm composed of loosely arranged interlacing bundles of spindle cells with elongated nuclei. It was partly separated by wavy collagen and basophilic myxoid material with some mast cells, and focal areas of the lesion were replaced by adipose cells (Fig. 3). In another part of the lesion, several cystic structures lined by one or two layers of cuboid cells without evidence of decapitation secretion were observed (Fig. 4). The cystic structures showed positive staining for S-100 (Fig. 5A) and negative staining for vimentin and PAS (Fig. 5B, 5C). A pathologic diagnosis of neurofibroma showing fatty change, concurred with eccrine hidrocystoma was established, and complete excision was performed. Viagra Super Active
Fig. 4. In another part of the tumor, there are several cystic structures lined by one or two layers of cuboidal cells (H&E, x 40). There was no evidence of decapitation secretion (inset) (H&E, x 200).
Fig. 5. (A) Tumor cells of eccrine hidrocystoma were stained intensely for S-100 (S-100, x 200). (B) Tumor cells of eccrine hidrocystoma showed negative staining for vimentin (vimentin, x 200). (C) Tumor cells of eccrine hidrocystoma showed negative staining for PAS (PAS, x 200).