Journal of Cutaneous Pathology最新文献

Skin cancer is a major global health concern, where early and accurate detection is crucial for improving patient outcomes. Traditional diagnostic methods, such as manual visual inspection and conventional machine learning models, often suffer from subjectivity, high computational costs, and limited annotated data. Althoug deep learning has improved automated skin cancer detection, existing models face challenges like overfitting, insufficient generalization, and complex architectures that limit real-time clinical application. To address these limitations, we propose MAF-DermNet, a deep learning framework that integrates Multi-Scale Attention Fusion (MAF) with depthwise separable convolutions for efficient and accurate skin cancer detection. Our approach enhances data diversity using DCGAN-based synthetic augmentation to improve model robustness. By leveraging multi-resolution inputs and a residual attention block, MAF-DermNet effectively captures subtle lesion features while preserving critical low-level information. Extensive experiments demonstrate exceptional performance, with accuracy exceeding 99.9% and macro F1 scores above 99.5%. In addition to its superior classification capabilities, MAF-DermNet offers enhanced interpretability and computational efficiency, making it well-suited for clinical deployment. Future work will focus on integrating clinical metadata and optimizing the model for diverse healthcare settings to further improve early diagnosis and treatment outcomes.

Primary cutaneous apocrine carcinoma (PCAC) is an exceptionally rare cutaneous malignancy originating from apocrine glands, occurring most commonly in the axilla and anogenital regions. It typically follows a slow-growing clinical course, although aggressive behavior has been documented in select cases. While local recurrence and regional metastasis are not uncommon in PCAC, instances of distant metastases are rare, with only a handful of cases reported, including involvement of the liver, bone, and lung. We present a unique case of PCAC with pagetoid features arising in the groin and metastasizing to the esophagus, a highly unusual presentation not well described in the existing literature. PCAC manifesting as extramammary Paget's disease (EMPD), characterized by single malignant epithelial cells scattered throughout the epidermis, represents a rare and diagnostically challenging variant. Its ability to mimic metastatic carcinomas from various organs necessitates thorough clinical and pathological correlation for accurate diagnosis. This case report aims to illuminate the potentially aggressive behavior of PCAC and emphasizes the need for long-term surveillance and awareness of its less typical presentations.

Eccrine spiradenomas are benign sweat gland neoplasms that rarely undergo malignant transformation. Carcinosarcoma arising from an eccrine spiradenoma is exceptionally rare. A 41-year-old male presented with a rapidly growing neck/shoulder mass, progressive numbness, spasticity, and weakness. Further workup additionally revealed an epidural mass with spinal cord compression. Both masses were excised and predominantly showed morphologic features of high-grade osteosarcoma, with overtly malignant spindled cells producing lace-like osteoid. However, a single section from the upper back mass contained a roughly 2 mm focus of conventional eccrine spiradenoma, with an adjacent small focus having features of a poorly differentiated non-small cell carcinoma. The final diagnosis was that of a high-grade carcinosarcoma with heterologous osteosarcomatous differentiation, arising from a pre-existing eccrine spiradenoma, with metastasis to the T4-5 epidural region. The patient experienced rapid regrowth of the spinal mass and underwent radiotherapy but had unresectable metastatic disease at 2 months follow-up. We describe what is to our knowledge only the 21st example of carcinosarcoma arising from eccrine spiradenoma, mimicking metastatic osteosarcoma. Awareness of this very rare entity, careful sampling, close microscopic examination, and, in selected cases, ancillary immunohistochemistry are the keys to making this challenging diagnosis.

FUS::TFCP2-rearranged rhabdomyosarcoma is a recently identified malignant neoplasm characterized by immunohistochemical evidence of the co-expression of rhabdomyoblastic markers and ALK. Herein, we report a case of cutaneous spindle cell/sclerosing rhabdomyosarcoma with FUS::TFCP2 fusion that was initially interpreted as an ALK-rearranged mesenchymal neoplasm in a 43-year-old male due to negative desmin expression, a rhabdomyoblastic marker. RNA sequencing was performed to detect ALK fusion counterparts; however, no ALK counterpart fusion was observed, and FUS::TFCP2 fusion was detected. Myogenin was negative, but MyoD1 was positive. Detection of FUS signals using FISH led to the diagnosis of FUS::TFCP2-rearranged rhabdomyosarcoma. In cases of ALK positivity and spindle cell or epithelioid cell morphology, FUS::TFCP2-rearranged rhabdomyosarcoma should be considered in the differential diagnosis using staining for rhabdomyoblastic markers other than desmin.