Rapid Growing Superficial Cutaneous Leiomyosarcoma of the Face
A 73-year-old Korean woman presented with a painless nodule on the right temporal area of the face. Before she fell down on the street and acquired an abrasion wound on the right temporal area of her face, she and her family members demonstrated that she had unremarkable skin findings. Then, a nodule grew larger very rapidly within 3 months. She had been treated with a wound dressing in local clinics, but it had been worsening continuously.\nHer past history demonstrated that she had hypertension, diabetes, and iatrogenic Cushing's syndrome. Physical examination revealed a 2×3 cm, well-demarcated, soft erythematous nodule with central ulceration and bleeding (), and was otherwise unremarkable. Routine laboratory evaluations, including complete blood count, blood chemistry and urinalysis, showed normal findings. Also, chest X-ray and electrocardiography were within normal limits, too.\nSquamous cell carcinoma was suspected clinically and biopsy was done. Histopathologic examination showed a lesion predominantly located in the dermis and interlacing fascicles of spindle-shaped cells with varying degrees of intermingled collagen. Spindle cells had elongated blunt-ended nuclei with mitotic figures and pleomorphic hyperchromatic nuclei (). Immunohistochemically, the cells were positive for actin, vimentin and desmin, while CD-34, epithelial membrane antigen, cytokeratin (CK), Factor VIII, and S-100 were negative (). On positron emission tomography-computed tomography scanning, there were no specific signs of internal source and metastasis to other sites, except for a hypermetabolic image on the right temporal lesion (). Based on the above findings, she was diagnosed with superficial leiomyosarcoma of the cutaneous type.\nThe lesion was removed by wide surgical excision, and a full-thickness skin graft was performed. There has not been any clinical recurrence for 6 months after the operation.