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| IJCEP Copyright © 2007-All rights reserved. |
| International Journal of Clinical and Experimental Pathology |
Int J Clin Exp Pathol 1(6), 524-530; 2008
Original Article
Diagnostic Utility of P63 and CD10 in Distinguishing Cutaneous Spindle
Cell/Sarcomatoid Squamous Cell Carcinomas and Atypical Fibroxanthomas
Jordan M. Hall, Jeff S. Saenger and Oluwole Fadare
Department of Pathology and Laboratory Services, Brooke Army Medical Center, Fort Sam Houston, TX 78235, U.S.A; Department of
Pathology, Wilford Hall Medical Center, Lackland AFB, TX 78236, U.S.A.; Department of Pathology, University of Texas Health Science
Center at San Antonio, San Antonio, TX 78229
Received 22 Feb 2008; Accepted and available online 7 March 2008
Abstract: The pathologic distinction of atypical fibroxanthomas (AFXs) from cutaneous spindle cell/sarcomatoid squamous cell
carcinomas (SCSCCs) may occasionally pose a significant diagnostic challenge, given the substantial clinicopathologic overlap between
these lesions. Recent studies indicate that p63 and CD10 are expressed in significant proportions of SCSCC and AFX, respectively. The
purpose of this study is to investigate the utility of CD10 and p63 in distinguishing cutaneous SCSCCs and AFXs. The
immunohistochemical expression of p63, CD10, cytokeratin AE-1/3, cytokeratin 5/6 and a cytokeratin cocktail (Kermix) was evaluated in an
archived group of 23 AFXs and 10 SCSCCs. CD10 was positive in 18/23 AFXs (78%), with most demonstrating strong and/or diffuse
staining. Three of 23 AFXs (13%), all negative for cytokeratins, showed focal and weak nuclear staining for p63. Two of 23 AFXs (9%)
demonstrated very focal or weak staining for only one cytokeratin; in both cases, p63 and CD10 were negative. One AFX was negative with
all immunostains. CD10 was positive in 6/10 SCSCCs (60%), with half demonstrating strong and/or diffuse staining. P63 was positive in
9/10 SCSCCs (90%), with most demonstrating strong and diffuse staining. One SCSCC was negative for p63, but positive with two
cytokeratin immunostains. In conclusion, the expression of any of the cytokeratins evaluated herein significantly distinguished AFX from
SCSCC. CD10 used in isolation, however, was not useful in making this distinction (positive in 18/23 AFXs versus 6/10 SCSCCs, p=0.4).
The addition of CD10 to a panel that includes p63 did not provide any additional information to that obtained from the latter alone. Overall,
the most effective combination to distinguish AFX from SCSCC was p63 and cytokeratin AE-1/3. Positivity for both p63 and cytokeratin
AE-1/3 was seen in 9/10 SCSCCs (90%) and was not observed in any of the 23 AFXs (p<0.0001). The usefulness of CD10 in this
differential diagnosis is limited. (IJCEP802001).
Key Words: Atypical fibroxanthoma, p63, CD10, skin, sarcomatoid/spindle cell squamous cell carcinoma
Full Text PDF
Address all correspondences to: CPT Jordan Hall, MD, Department of Pathology, Wilford Hall Medical Center, 2200 Bergquist Drive, Ste
1, Lackland AFB, TX, 78236, U.S.A, Telephone: (210) 292-7741, Fax: (210) 292-2269, E-mail: Jordan.Hall@lackland.af.mil
Original Article
Diagnostic Utility of P63 and CD10 in Distinguishing Cutaneous Spindle
Cell/Sarcomatoid Squamous Cell Carcinomas and Atypical Fibroxanthomas
Jordan M. Hall, Jeff S. Saenger and Oluwole Fadare
Department of Pathology and Laboratory Services, Brooke Army Medical Center, Fort Sam Houston, TX 78235, U.S.A; Department of
Pathology, Wilford Hall Medical Center, Lackland AFB, TX 78236, U.S.A.; Department of Pathology, University of Texas Health Science
Center at San Antonio, San Antonio, TX 78229
Received 22 Feb 2008; Accepted and available online 7 March 2008
Abstract: The pathologic distinction of atypical fibroxanthomas (AFXs) from cutaneous spindle cell/sarcomatoid squamous cell
carcinomas (SCSCCs) may occasionally pose a significant diagnostic challenge, given the substantial clinicopathologic overlap between
these lesions. Recent studies indicate that p63 and CD10 are expressed in significant proportions of SCSCC and AFX, respectively. The
purpose of this study is to investigate the utility of CD10 and p63 in distinguishing cutaneous SCSCCs and AFXs. The
immunohistochemical expression of p63, CD10, cytokeratin AE-1/3, cytokeratin 5/6 and a cytokeratin cocktail (Kermix) was evaluated in an
archived group of 23 AFXs and 10 SCSCCs. CD10 was positive in 18/23 AFXs (78%), with most demonstrating strong and/or diffuse
staining. Three of 23 AFXs (13%), all negative for cytokeratins, showed focal and weak nuclear staining for p63. Two of 23 AFXs (9%)
demonstrated very focal or weak staining for only one cytokeratin; in both cases, p63 and CD10 were negative. One AFX was negative with
all immunostains. CD10 was positive in 6/10 SCSCCs (60%), with half demonstrating strong and/or diffuse staining. P63 was positive in
9/10 SCSCCs (90%), with most demonstrating strong and diffuse staining. One SCSCC was negative for p63, but positive with two
cytokeratin immunostains. In conclusion, the expression of any of the cytokeratins evaluated herein significantly distinguished AFX from
SCSCC. CD10 used in isolation, however, was not useful in making this distinction (positive in 18/23 AFXs versus 6/10 SCSCCs, p=0.4).
The addition of CD10 to a panel that includes p63 did not provide any additional information to that obtained from the latter alone. Overall,
the most effective combination to distinguish AFX from SCSCC was p63 and cytokeratin AE-1/3. Positivity for both p63 and cytokeratin
AE-1/3 was seen in 9/10 SCSCCs (90%) and was not observed in any of the 23 AFXs (p<0.0001). The usefulness of CD10 in this
differential diagnosis is limited. (IJCEP802001).
Key Words: Atypical fibroxanthoma, p63, CD10, skin, sarcomatoid/spindle cell squamous cell carcinoma
Full Text PDF
Address all correspondences to: CPT Jordan Hall, MD, Department of Pathology, Wilford Hall Medical Center, 2200 Bergquist Drive, Ste
1, Lackland AFB, TX, 78236, U.S.A, Telephone: (210) 292-7741, Fax: (210) 292-2269, E-mail: Jordan.Hall@lackland.af.mil