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AUSTRALIAN DERMATOPATHOLOGY SOCIETY MASSIVE CUTANEOUS TUMOUR OF THE SCALP

A 59 year old part-Aboriginal woman had noticed a tumour on the left frontal region of her scalp for 13 years, with rapid increase in size over the last year (Figure 1). The patient was otherwise well except for mild diabetes mellitus controlled by diet. The tumour, which was 6 cm in diameter, ulcerated and of yellowish colour (Figure 2), was treated by excision and the defect was closed with a transposition flap. Microscopically the neoplasm had a distinctly lobular pattern, composed mainly of uniform cells with large oval vesicular nuclei, prominent single nucleoli, scanty cytoplasm and plentiful mitoses (Figure 3a). Invasion extended into the deep dermis, infiltrating the stroma and appendages. Several tumour lobules contained central groups of large atypical epithelial cells with vacuolated cytoplasm (Figure 3b) containing abundant lipid as demonstrated by an oil red O stain (Figure 4). Areas of calcification and necrosis were also present. Small ductal structures seen in several areas of the tumour were lined by flattened epithelium which stained positively for carcinoembryonic antigen in an immunoperoxidase preparation.