Sarcomatoid carcinoma of the hand: a clinical case with an aggressive and uncommon presentation

Authors

  • K. Chittari,

    1. Departments of Dermatology, †Histopathology and ‡Plastic Surgery, Nottingham University Hospitals NHS Trust, UK; and *Department of Dermatology, East Kent Hospitals University NHS Trust, Canterbury, UK
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  • A. J. Birnie,

    1. Departments of Dermatology, †Histopathology and ‡Plastic Surgery, Nottingham University Hospitals NHS Trust, UK; and *Department of Dermatology, East Kent Hospitals University NHS Trust, Canterbury, UK
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  • K. R. Kulkarni,

    1. Departments of Dermatology, †Histopathology and ‡Plastic Surgery, Nottingham University Hospitals NHS Trust, UK; and *Department of Dermatology, East Kent Hospitals University NHS Trust, Canterbury, UK
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  • A. G. B. Perks,

    1. Departments of Dermatology, †Histopathology and ‡Plastic Surgery, Nottingham University Hospitals NHS Trust, UK; and *Department of Dermatology, East Kent Hospitals University NHS Trust, Canterbury, UK
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  • S. Varma

    1. Departments of Dermatology, †Histopathology and ‡Plastic Surgery, Nottingham University Hospitals NHS Trust, UK; and *Department of Dermatology, East Kent Hospitals University NHS Trust, Canterbury, UK
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  • Conflict of interest: none declared.

Dr Kim Chittari, Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
E-mail: kim.varma@nhs.net

Summary

Cutaneous sarcomatoid carcinoma is a high-grade malignancy. We describe a clinical case of an aggressive sarcomatoid carcinoma in an 87-year-old woman, who presented to the outpatients department with a haemorrhagic nodule on the dorsum of her right hand. By the time of excision 3 weeks later, the nodule had enlarged to 100 × 90 × 65 mm in size. On histological examination, a poorly differentiated carcinoma was seen, with both carcinomatous and sarcomatous elements, in keeping with a sarcomatoid carcinoma. The tumour was positive for cytokeratin, epithelial, smooth-muscle actin, and vimentin stains. Two months later, the patient presented with a recurrent growth on the excised scar along with numerous large right axillary lymph nodes. A right axillary dissection along with excision of the growth confirmed tumour recurrence with metastasis to lymph nodes. Soon after, the patient developed cerebral metastasis, which proved fatal. This case thus highlights the aggressive potential of sarcomatoid carcinoma.

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