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We report the case of a two patients who presented with a solitary, asymptomatic, angiomatoid nodule on the right thigh. Histopathological finding showed a poorly circumscribed lesion, located in the dermis. The morphological aspect strongly suggested the diagnosis of atypical fibrous histiocytoma (AFH), but surprisingly, the neoplastic cells were diffusely CD30+, with a membrane staining devoid of paranuclear dot. The lesions were tested for p80/ALK1 expression. Surprisingly, we found a diffuse cytoplasmic positivity. Interestingly, using break-apart fluorescent in situ hybridization (FISH), we evidenced an ALK rearrangement in nearly 50% of the neoplastic cells. The expression of CD30 and ALK1 with ALK gene rearrangement raised the possibility of three diagnoses: a primary cutaneous anaplastic large cell lymphoma (ALCL), a cutaneous inflammatory myofibroblastic tumor (IMT), an AFH of the skin associated with ALK gene rearrangement and CD30 positivity. The three hypotheses were discussed and finally, although p80/ALK1 expression and cytogenetic abnormalities in fibrous histiocytoma (FH) are not yet reported to the best of our knowledge, we favored the diagnosis of AFH., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Lymphoepithelial carcinoma is a relatively common malignancy in the nasopharynx, but it rarely occurs in other sites. We report 3 additional cases of cutaneous location. Histopathologically, the tumors consisted of multiple well-circumscribed dermal-hypodermal nodules composed of aggregates of undifferentiated malignant cells. These cells had moderate amounts of eosinophilic cytoplasm and vesicular nuclei with prominent nucleoli. There was no squamous or glandular differentiation. For each case, a heavy lymphoplasmacytic infiltrate was found. No dysplasia was noted in the epidermis. In one case, the tumoral component showed numerous Sternberg-like cells scattered within a lymphocytic background. This case might be mistaken with a Hodgkin's lymphoma. Immunohistochemistry showed that the neoplastic cells were positive for cytokeratin and epithelial membrane antigen. In the present report, studying the stroma reaction cell components, we have stressed the presence of numerous factor XIIIa-positive dendritic cells in 2 cases. Because of the role of these cells in the immune response of normal stroma, their presence herein might be in relation with the favorable prognosis of this type of primary skin carcinoma. No Epstein-Barr viral genomic sequences were detected by in situ hybridization. This negativity for Epstein-Barr virus may be a help in the differential diagnosis from metastatic undifferentiated nasopharyngeal carcinoma.