Case report of cutaneous histiocytic sarcoma: diagnostic and therapeutic\ndilemmas
An 82-year-old female patient presented since 15 days prior to consultations two\nasymptomatic nodular and crateriform lesions, about 1.0 cm wide, covered with central\nkeratosis and crust and erythematous-violaceous infiltrated edges in the right arm and\nbreast ( and ). An excisional biopsy of the lesions was made. The histological\ndiagnosis was of indeterminate malignant neoplasm with deep margins involved and the\nimmunohistochemical examination was positive for CD68, CD4, CD11c, fascin , CD45, CD163\nand lysozyme, factor XIIIa was inconclusive and markers of melanin, B and T cells and\ncytokeratin were negative (, and ). The\nultrasonography of soft tissues, breast and axillary lymph nodes and brain and abdomen\nCT scans showed no signs of neoplastic disease. Tomography of the chest revealed\nmultiple bilateral pulmonary nodules, which were stable in sequential scans and\ntherefore were not biopsied. Other hematological tumors having been excluded, a\ndiagnosis of primary cutaneous histiocytic sarcoma was made. The management included\nobservation of excision sites without expanding margins and periodic oncological and\ndermatological follow-up. No sign of recurrence was evidenced in the twelve-month\nfollow-up period.