BACKGROUND Eccrine porocarcinoma(EPC)is a rare skin tumor that mainly affects the elderly population.Tumors often present with slow growth and a good prognosis.EPCs are usually distinguished from other skin tumors usi...BACKGROUND Eccrine porocarcinoma(EPC)is a rare skin tumor that mainly affects the elderly population.Tumors often present with slow growth and a good prognosis.EPCs are usually distinguished from other skin tumors using histopathology and immunohistochemistry.However,surgical management alone may be inadequate if the tumor has metastasized.However,currently,surgical resection is the most commonly used treatment modality.CASE SUMMARY A seventy-four-year-old woman presented with a slow-growing nodule in her left temporal area,with no obvious itching or pain,for more than four months.Histopathological examination showed small columnar and short spindle-shaped cells;thus,basal cell carcinoma was suspected.However,immunohistochemical analysis revealed the expression of cytokeratin 5/6,p63 protein,p16 protein,and Ki-67 antigen(40%),and EPC was taken into consideration.The skin biopsy was repeated,and hematoxylin and eosin staining revealed ductal differentiation in some cells.Finally,the patient was diagnosed with EPC,and Mohs micrographic surgery was performed.We adapted follow-up visits in a year and not found any recurrence of nodules.CONCLUSION This case report emphasizes the diagnosis and differentiation of EPC.展开更多
In Madagascar, a country with a tropical climate;skin cancers are often of epidermal or melanic origin. Adnexal tumors are not well known. We report the first case of an eccrine tumor in a 57-year-old woman with no pe...In Madagascar, a country with a tropical climate;skin cancers are often of epidermal or melanic origin. Adnexal tumors are not well known. We report the first case of an eccrine tumor in a 57-year-old woman with no personal or family history of cancer. She has no comorbidities. The patient presented with a 50 × 60 mm frontal swelling and an ulcerative lesion of the left half of the face that had been evolving for 5 months. The cerebral and cervical CT scan revealed bone lysis of the vault of the skull and left cervical lymphadenopathy. The CT chest-abdomen-pelvis showed no abnormal lesions. The mammogram was normal. The result of the pathological examination was in favor of a round-cell tumor. The AE1/AE3, CK7 and P63 markers were positive in the immunohistochemical study. The diagnosis of an advanced eccrine adenocarcinoma was retained after the exclusion of a visceral adenocarcinoma with cutaneous metastasis. The patient receives radiotherapy of 40 Gy in 20 fractions followed by 6 courses of Carboplatin-paclitaxel type chemotherapy. The lesion has decreased in size and dried up after these treatments. 3 months after stopping treatment for lack of financial means, the patient died at home. The diagnosis of an adnexal tumor requires more in-depth complementary examinations. Treatments should be multidisciplinary and adapted to each patient.展开更多
Eccrine Spiradenoma (ES) is an exceedingly rare sweat-gland tumor, it usually presents as a solitary lesion and painful nodule. ES is a kind of neoplasm with distinct histological characteristics and nonspecific clini...Eccrine Spiradenoma (ES) is an exceedingly rare sweat-gland tumor, it usually presents as a solitary lesion and painful nodule. ES is a kind of neoplasm with distinct histological characteristics and nonspecific clinical manifestations. Most ES cases have a benign course;however, malignant transformation would occur after a long period of latency. The diagnosis mostly depends on the clinic symptom, histological features and immunohistochemistry. Here, we report a case of ES and literature review. The aim of this study is to understand clinic and histological features for ES.展开更多
Recurrent eccrine syringomatous carcinoma is an extremely rare adnexal tumor predominantly found in the head and neck region. We present a case of a 75-year-old woman with a 7-year history of recurrent syringoid eccri...Recurrent eccrine syringomatous carcinoma is an extremely rare adnexal tumor predominantly found in the head and neck region. We present a case of a 75-year-old woman with a 7-year history of recurrent syringoid eccrine carcinoma in the scalp and auricle. She had undergone five previous oncologic resections and declined further oncologic ablation of the auricle, including temporal bone and external ear canal resection. We performed five sessions of palliative photodynamic therapy using topical aminolevulinic acid HCL 20% (ALA) and between 25 and 33 pulses of Intense Pulsed Light (Quantum) with an intensity of 30 Joules. The ALA incubation time was 3 hours, while the time between each session was 4 weeks. This treatment helped to control ulceration, pain, and swelling. We saw the patient 1 month after the last treatment, by that time she moved and we lost contact.展开更多
BACKGROUND Porocarcinoma is a rare type of skin cancer that originates from sweat gland tumors.It is an aggressive malignant skin cancer that is difficult to diagnose clinically owing to its rarity and similarity to s...BACKGROUND Porocarcinoma is a rare type of skin cancer that originates from sweat gland tumors.It is an aggressive malignant skin cancer that is difficult to diagnose clinically owing to its rarity and similarity to squamous cell carcinoma(SCC).CASE SUMMARY This case involved a 92-year-old woman,a farmer by profession,presented with an exophytic and verrucous mass on her left palm that had formed 2 years prior and caused chronic pain and frequent bleeding.Initially,the patient was diagnosed with SCC using a punch biopsy;however,a repeat biopsy with addi-tional immunohistochemical tests was performed for porocarcinoma.Ultimately,the patient was diagnosed with porocarcinoma and reconstruction was planned using a full-thickness skin graft.After treatment,the range of motion of the palm was preserved,and the aesthetic outcome was favorable.At 6 mo of follow-up,the patient was satisfied with the outcome.CONCLUSION Porocarcinoma is commonly misdiagnosed as SCC;therefore,clinicians should consider porocarcinomas when evaluating mass-like lesions on the hands.展开更多
Background:Sweat secreted by eccrine sweat glands is transported to the skin surface through the lumen.The eccrine sweat gland develops from the initial solid bud to the final gland structure with a lumen,but how the ...Background:Sweat secreted by eccrine sweat glands is transported to the skin surface through the lumen.The eccrine sweat gland develops from the initial solid bud to the final gland structure with a lumen,but how the lumen is formed and the mechanism of lumen formation have not yet been fully elucidated.This study aimed to investigate the mechanism of lumen formation of eccrine gland organoids(EGOs).Methods:Human eccrine sweat glands were isolated from the skin for tissue culture,and the primary cultured cells were collected and cultured in Matrigel for 14 daysin vitro.EGOs at different development days were collected for hematoxylin and eosin(H&E)staining to observe morphological changes and for immunofluorescence staining of proliferation marker Ki67,cellular motility marker filamentous actin(F-actin),and autophagy marker LC3B.Western blotting was used to detect the expression of Ki67,F-actin,and LC3B.Moreover,apoptosis was detected using a terminal deoxynucleotidyl transferase dUTP nick end labeling(TUNEL)apoptosis assay kit,and the expression of poly(ADP-ribose)polymerase and Caspase-3 was detected by Western blot.In addition,3-methyladenine(3MA)was used as an autophagy inhibitor to detect whether the formation of sweat glands can be effectively inhibited.Results:The results showed that a single gland cell proliferated rapidly and formed EGOs on day 4.The earliest lumen formation was observed on day 6.From day 8 to day 14,the rate of lumen formation in EGOs increased significantly.The immunofluorescence and Western blot analyses showed that the expression of Ki67 gradually decreased with the increase in days,while the F-actin expression level did not change.Notably,the expression of autophagy marker LC3B was detected in the interior cells of EGOs as the apoptosis signal of EGOs was negative.Compared with the control group,the autophagy inhibitor 3MA can effectively limit the formation rate of the lumen and reduce the inner diameter of EGOs.Conclusion:Using our model of eccrine gland 3D-reconstruction in Matrigel,we determined that autophagy rather than apoptosis plays a role in the lumen formation of EGOs.展开更多
IntroductionEccrine spiradenoma (ES) is an uncommon adnexal tumor that is thought to originate from eccrine sweat glands.ES usually manifests as a blue-violet or florid solitary painful nodule with pain on palpation.E...IntroductionEccrine spiradenoma (ES) is an uncommon adnexal tumor that is thought to originate from eccrine sweat glands.ES usually manifests as a blue-violet or florid solitary painful nodule with pain on palpation.ES may affect any part of the body,but mostly affects the extremities without age and sex predilection.Multiple ES lesions are rarely documented.The typical pathological features,namely,small cells with hyperchromatic nuclei and large cells with dark nuclei,help with diagnosis and differentiation of ES from other painful skin tumors.Malignant transformation is rarely reported.Surgical excision is the most recommended treatment and provides a good prognosis.Here we report a rare multiple ES case with zosteriform presentation,and the patient had nothing crucial were out of normal limits including dermatological examination and routine investigations.展开更多
Poroid hidradenoma is a benign eccrine neoplasm of the poroma family. We report a 65-year-old male patient who presented to his general practitioner with a poroid hidradenoma in zone 2 of the flexor surface of his lef...Poroid hidradenoma is a benign eccrine neoplasm of the poroma family. We report a 65-year-old male patient who presented to his general practitioner with a poroid hidradenoma in zone 2 of the flexor surface of his left middle finger. Diagnosis was confirmed histologically, after which the patient was referred to us for wider excision. Although poroid hidradenoma is a benign tumour, wide local excision is mandatory. Here we discuss the reasoning behind this and present a rationale for excision margins.展开更多
Background Eccrineangiomatoushamartoma(EAH)is a rare benign disease that comprises vascular and eccrine malformations.Pain is one of the most common symptoms and surgical resection is generally required.Objective To r...Background Eccrineangiomatoushamartoma(EAH)is a rare benign disease that comprises vascular and eccrine malformations.Pain is one of the most common symptoms and surgical resection is generally required.Objective To report a novel surgical technique that can alleviate severe pain caused by a large lesion in an EAH patient.Methods On magnetic resonance imaging(MRI),a subcutaneous abnormal signal was detected in the right hip and groin area of an 18-year-old male.The lesion was carefully elevated from the normal tissue above the plane of the deep fascia and was sutured in situ.Additionally,a small sample of the central lesion tissue was collected for histological examination.Results The visual analog scale score of pain decreased from 9 points to 2 points at 1week and to 0 points at 2 weeks after the surgery.The only complication observed was local numbness,which recovered spontaneously.No recurrence of pain was observed after 1 year of surgery.Histological findings demonstrated that the numbers of eccrine sweat glands and abnormal vessels decreased post-surgery.Conclusion The surgical procedure used in our case may represent a novel,easy,safe,and effective option for the treatment of a large,severely painful EAH.展开更多
Syringocystadenoma papilliferum(SCAP)is a rare benign skin tumor that develops from the apocrine or eccrine glands.Here,we report the case of a 2-year-old girl who presented with an asymptomatic,slowly growing lesion ...Syringocystadenoma papilliferum(SCAP)is a rare benign skin tumor that develops from the apocrine or eccrine glands.Here,we report the case of a 2-year-old girl who presented with an asymptomatic,slowly growing lesion on her scalp.On physical examination,a 2 cm×1 cm red papillary plaque with a crusted surface was noted on her scalp.Histopathological examination revealed papillomatous expansion of the epidermis and cystic invaginations extending from the epidermis down to the deep dermis.The cystic structures were lined by papillae with two layers of columnar epithelium,which showed decapitation secretion.Based on the above clinicopathological findings,a diagnosis of congenital scalp SCAP was made.展开更多
Introduction:The most common cutaneous adnexal tumors in children were follicular,especially pilomatricoma,and a few were predominant glandular/ductal differentiation,malignant forms are occasionally encountered.Case ...Introduction:The most common cutaneous adnexal tumors in children were follicular,especially pilomatricoma,and a few were predominant glandular/ductal differentiation,malignant forms are occasionally encountered.Case presentation:A 10-year-old male child was presented with a nodular in posterior occipital for half a year with no symptoms.Histopathology showed there was acanthosis in epidermis,partially with local ulceration and crusting;and in the dermis,there was irregular scattered or agglomerated infiltration of diffused epithelial cells,partly presenting as basaloid,but no obvious peripheral palisading arrangement;and in the center there was extensive necrosis;cellular pleomorphism,scattered mitotic figures,focal clear cell areas,and adenoid differentiation can also be seen,there was scattered infiltration of mixed inflammatory cells in the stroma.Immunohistochemistry showed cytokeratin(CK)5/6^(+),CK 8/18^(+),epithelial membrane antigen^(+),gata3 transcription factor 3^(+),cell adhesion15(focal^(+)),Ki67(^(+),30%),carcinoembryonic antigen(focal^(+)),CK 7(focal^(+)),gross cystic disease fluid protein-15-,P63^(+),S-100-.Final diagnosis was the malignant cutaneous adnexal tumor with eccrine differentiation,most likely the nodular clear cell hidradenocarcinoma.The patient has no special discomfort follow-up observation after extended resection and lymph node examination.Discussion:The histopathology showed infiltrative growth pattern,deep extension,necrosis,nuclear pleomorphism,mitoses,desmoplastic stromal reaction and the clear cell area and adenoid differentiation.Immunohistochemistry was positive for CK8/18,EMA,CK5/6,P63,gata3 transcription factor 3 and negative for S-100 and GCDFP-15,some gland-derived markers such as CK7,CEA were focal positive,and we have not found the preexisting benign poroma and porocarcinoma in situ,so we preferred the diagnosis of hidradenocarcinoma.The differential diagnosis such as porocarcinoma,clear cell squamous cell carcinoma,and basal cell carcinoma were taken into account.Conclusion:The diagnosis was challenging by clinical manifestations.Histopathology and immunohistochemistry should be combined with clinical presentation,history to reach the final diagnose.展开更多
文摘BACKGROUND Eccrine porocarcinoma(EPC)is a rare skin tumor that mainly affects the elderly population.Tumors often present with slow growth and a good prognosis.EPCs are usually distinguished from other skin tumors using histopathology and immunohistochemistry.However,surgical management alone may be inadequate if the tumor has metastasized.However,currently,surgical resection is the most commonly used treatment modality.CASE SUMMARY A seventy-four-year-old woman presented with a slow-growing nodule in her left temporal area,with no obvious itching or pain,for more than four months.Histopathological examination showed small columnar and short spindle-shaped cells;thus,basal cell carcinoma was suspected.However,immunohistochemical analysis revealed the expression of cytokeratin 5/6,p63 protein,p16 protein,and Ki-67 antigen(40%),and EPC was taken into consideration.The skin biopsy was repeated,and hematoxylin and eosin staining revealed ductal differentiation in some cells.Finally,the patient was diagnosed with EPC,and Mohs micrographic surgery was performed.We adapted follow-up visits in a year and not found any recurrence of nodules.CONCLUSION This case report emphasizes the diagnosis and differentiation of EPC.
文摘In Madagascar, a country with a tropical climate;skin cancers are often of epidermal or melanic origin. Adnexal tumors are not well known. We report the first case of an eccrine tumor in a 57-year-old woman with no personal or family history of cancer. She has no comorbidities. The patient presented with a 50 × 60 mm frontal swelling and an ulcerative lesion of the left half of the face that had been evolving for 5 months. The cerebral and cervical CT scan revealed bone lysis of the vault of the skull and left cervical lymphadenopathy. The CT chest-abdomen-pelvis showed no abnormal lesions. The mammogram was normal. The result of the pathological examination was in favor of a round-cell tumor. The AE1/AE3, CK7 and P63 markers were positive in the immunohistochemical study. The diagnosis of an advanced eccrine adenocarcinoma was retained after the exclusion of a visceral adenocarcinoma with cutaneous metastasis. The patient receives radiotherapy of 40 Gy in 20 fractions followed by 6 courses of Carboplatin-paclitaxel type chemotherapy. The lesion has decreased in size and dried up after these treatments. 3 months after stopping treatment for lack of financial means, the patient died at home. The diagnosis of an adnexal tumor requires more in-depth complementary examinations. Treatments should be multidisciplinary and adapted to each patient.
文摘Eccrine Spiradenoma (ES) is an exceedingly rare sweat-gland tumor, it usually presents as a solitary lesion and painful nodule. ES is a kind of neoplasm with distinct histological characteristics and nonspecific clinical manifestations. Most ES cases have a benign course;however, malignant transformation would occur after a long period of latency. The diagnosis mostly depends on the clinic symptom, histological features and immunohistochemistry. Here, we report a case of ES and literature review. The aim of this study is to understand clinic and histological features for ES.
文摘Recurrent eccrine syringomatous carcinoma is an extremely rare adnexal tumor predominantly found in the head and neck region. We present a case of a 75-year-old woman with a 7-year history of recurrent syringoid eccrine carcinoma in the scalp and auricle. She had undergone five previous oncologic resections and declined further oncologic ablation of the auricle, including temporal bone and external ear canal resection. We performed five sessions of palliative photodynamic therapy using topical aminolevulinic acid HCL 20% (ALA) and between 25 and 33 pulses of Intense Pulsed Light (Quantum) with an intensity of 30 Joules. The ALA incubation time was 3 hours, while the time between each session was 4 weeks. This treatment helped to control ulceration, pain, and swelling. We saw the patient 1 month after the last treatment, by that time she moved and we lost contact.
文摘BACKGROUND Porocarcinoma is a rare type of skin cancer that originates from sweat gland tumors.It is an aggressive malignant skin cancer that is difficult to diagnose clinically owing to its rarity and similarity to squamous cell carcinoma(SCC).CASE SUMMARY This case involved a 92-year-old woman,a farmer by profession,presented with an exophytic and verrucous mass on her left palm that had formed 2 years prior and caused chronic pain and frequent bleeding.Initially,the patient was diagnosed with SCC using a punch biopsy;however,a repeat biopsy with addi-tional immunohistochemical tests was performed for porocarcinoma.Ultimately,the patient was diagnosed with porocarcinoma and reconstruction was planned using a full-thickness skin graft.After treatment,the range of motion of the palm was preserved,and the aesthetic outcome was favorable.At 6 mo of follow-up,the patient was satisfied with the outcome.CONCLUSION Porocarcinoma is commonly misdiagnosed as SCC;therefore,clinicians should consider porocarcinomas when evaluating mass-like lesions on the hands.
基金This manuscript was supported in part by the grants from the National Natural Science Foundation of China(Nos.82172231,81772102)the Taihe Foundation(No.2021JJXM060)。
文摘Background:Sweat secreted by eccrine sweat glands is transported to the skin surface through the lumen.The eccrine sweat gland develops from the initial solid bud to the final gland structure with a lumen,but how the lumen is formed and the mechanism of lumen formation have not yet been fully elucidated.This study aimed to investigate the mechanism of lumen formation of eccrine gland organoids(EGOs).Methods:Human eccrine sweat glands were isolated from the skin for tissue culture,and the primary cultured cells were collected and cultured in Matrigel for 14 daysin vitro.EGOs at different development days were collected for hematoxylin and eosin(H&E)staining to observe morphological changes and for immunofluorescence staining of proliferation marker Ki67,cellular motility marker filamentous actin(F-actin),and autophagy marker LC3B.Western blotting was used to detect the expression of Ki67,F-actin,and LC3B.Moreover,apoptosis was detected using a terminal deoxynucleotidyl transferase dUTP nick end labeling(TUNEL)apoptosis assay kit,and the expression of poly(ADP-ribose)polymerase and Caspase-3 was detected by Western blot.In addition,3-methyladenine(3MA)was used as an autophagy inhibitor to detect whether the formation of sweat glands can be effectively inhibited.Results:The results showed that a single gland cell proliferated rapidly and formed EGOs on day 4.The earliest lumen formation was observed on day 6.From day 8 to day 14,the rate of lumen formation in EGOs increased significantly.The immunofluorescence and Western blot analyses showed that the expression of Ki67 gradually decreased with the increase in days,while the F-actin expression level did not change.Notably,the expression of autophagy marker LC3B was detected in the interior cells of EGOs as the apoptosis signal of EGOs was negative.Compared with the control group,the autophagy inhibitor 3MA can effectively limit the formation rate of the lumen and reduce the inner diameter of EGOs.Conclusion:Using our model of eccrine gland 3D-reconstruction in Matrigel,we determined that autophagy rather than apoptosis plays a role in the lumen formation of EGOs.
文摘IntroductionEccrine spiradenoma (ES) is an uncommon adnexal tumor that is thought to originate from eccrine sweat glands.ES usually manifests as a blue-violet or florid solitary painful nodule with pain on palpation.ES may affect any part of the body,but mostly affects the extremities without age and sex predilection.Multiple ES lesions are rarely documented.The typical pathological features,namely,small cells with hyperchromatic nuclei and large cells with dark nuclei,help with diagnosis and differentiation of ES from other painful skin tumors.Malignant transformation is rarely reported.Surgical excision is the most recommended treatment and provides a good prognosis.Here we report a rare multiple ES case with zosteriform presentation,and the patient had nothing crucial were out of normal limits including dermatological examination and routine investigations.
文摘Poroid hidradenoma is a benign eccrine neoplasm of the poroma family. We report a 65-year-old male patient who presented to his general practitioner with a poroid hidradenoma in zone 2 of the flexor surface of his left middle finger. Diagnosis was confirmed histologically, after which the patient was referred to us for wider excision. Although poroid hidradenoma is a benign tumour, wide local excision is mandatory. Here we discuss the reasoning behind this and present a rationale for excision margins.
基金This work was supported by the Clinical Research Plan of SHDC(16CR1007A),the Clinical Research Program(JYLJ001)and the Fundamental research program(JYZZ083B)of the Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine。
文摘Background Eccrineangiomatoushamartoma(EAH)is a rare benign disease that comprises vascular and eccrine malformations.Pain is one of the most common symptoms and surgical resection is generally required.Objective To report a novel surgical technique that can alleviate severe pain caused by a large lesion in an EAH patient.Methods On magnetic resonance imaging(MRI),a subcutaneous abnormal signal was detected in the right hip and groin area of an 18-year-old male.The lesion was carefully elevated from the normal tissue above the plane of the deep fascia and was sutured in situ.Additionally,a small sample of the central lesion tissue was collected for histological examination.Results The visual analog scale score of pain decreased from 9 points to 2 points at 1week and to 0 points at 2 weeks after the surgery.The only complication observed was local numbness,which recovered spontaneously.No recurrence of pain was observed after 1 year of surgery.Histological findings demonstrated that the numbers of eccrine sweat glands and abnormal vessels decreased post-surgery.Conclusion The surgical procedure used in our case may represent a novel,easy,safe,and effective option for the treatment of a large,severely painful EAH.
文摘Syringocystadenoma papilliferum(SCAP)is a rare benign skin tumor that develops from the apocrine or eccrine glands.Here,we report the case of a 2-year-old girl who presented with an asymptomatic,slowly growing lesion on her scalp.On physical examination,a 2 cm×1 cm red papillary plaque with a crusted surface was noted on her scalp.Histopathological examination revealed papillomatous expansion of the epidermis and cystic invaginations extending from the epidermis down to the deep dermis.The cystic structures were lined by papillae with two layers of columnar epithelium,which showed decapitation secretion.Based on the above clinicopathological findings,a diagnosis of congenital scalp SCAP was made.
基金supported by the Hunan technical innovation guidance program(No.2017SK51301)。
文摘Introduction:The most common cutaneous adnexal tumors in children were follicular,especially pilomatricoma,and a few were predominant glandular/ductal differentiation,malignant forms are occasionally encountered.Case presentation:A 10-year-old male child was presented with a nodular in posterior occipital for half a year with no symptoms.Histopathology showed there was acanthosis in epidermis,partially with local ulceration and crusting;and in the dermis,there was irregular scattered or agglomerated infiltration of diffused epithelial cells,partly presenting as basaloid,but no obvious peripheral palisading arrangement;and in the center there was extensive necrosis;cellular pleomorphism,scattered mitotic figures,focal clear cell areas,and adenoid differentiation can also be seen,there was scattered infiltration of mixed inflammatory cells in the stroma.Immunohistochemistry showed cytokeratin(CK)5/6^(+),CK 8/18^(+),epithelial membrane antigen^(+),gata3 transcription factor 3^(+),cell adhesion15(focal^(+)),Ki67(^(+),30%),carcinoembryonic antigen(focal^(+)),CK 7(focal^(+)),gross cystic disease fluid protein-15-,P63^(+),S-100-.Final diagnosis was the malignant cutaneous adnexal tumor with eccrine differentiation,most likely the nodular clear cell hidradenocarcinoma.The patient has no special discomfort follow-up observation after extended resection and lymph node examination.Discussion:The histopathology showed infiltrative growth pattern,deep extension,necrosis,nuclear pleomorphism,mitoses,desmoplastic stromal reaction and the clear cell area and adenoid differentiation.Immunohistochemistry was positive for CK8/18,EMA,CK5/6,P63,gata3 transcription factor 3 and negative for S-100 and GCDFP-15,some gland-derived markers such as CK7,CEA were focal positive,and we have not found the preexisting benign poroma and porocarcinoma in situ,so we preferred the diagnosis of hidradenocarcinoma.The differential diagnosis such as porocarcinoma,clear cell squamous cell carcinoma,and basal cell carcinoma were taken into account.Conclusion:The diagnosis was challenging by clinical manifestations.Histopathology and immunohistochemistry should be combined with clinical presentation,history to reach the final diagnose.
