A case of heteromorphic fibroxanthoma occurring in 2 places.

An 83-year-old woman noticed a brownish macule on her right temple 4 or 5 years ago. She noticed a sudden rapid enlargement and bulging of the macule and after a weeks time visited our hospital. It was a 10×9×3mm sized, fresh red colored, dome shaped tumor. It was easily bleeding on the surface and it had scale-crusts on themargin. The tumor was tender, elastic and slightly hard. There were some senile keratoses around the tumor.Almost one and a half years after resection, another tumor developed on the rightside of the bottom of her nose. It was a 7.5×7mm sized, pale red, dome shaped, elastic and slightly hard with crusts at center.Histopathological findings: The tumor on the right temple showed histiocyte like or fibroblast like cells proliferating from papillarly dermis through subcutaneous fat tissue. The nuclei were polymorphic and strongly atypical, sometimes had multinucleated and atypical mitotic figures. There were edema and capillary proliferations and extravasations of erythrocyts in stroma. Markedly solar elastosis was found in dermis close to the lesion.The immunohistochemical stain showed α1-ACT, Vimentin were positive but α1-AT, S-100 protein, Desmin, Myosin, PNA, EMA, CK-1 were negative with nuclei.The tumor on the nose had almost the same histology of the one on the temple but had a distinct epidermal collarette formation, formy cells and fewer edema.There were no findings of metastasis in the whole body. There is no evidence of local recurrence or metastasis 3 years and 8 months after the first surgical exision. Two atypical fibroxanthomas on the face seemed to be very rare.