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LETTER TO THE EDITOR proliferate in systemic small blood vessels, resulting in microvascular occlusion in organs. 4 IVLBCL is characterized by the absence of lymph node enlargement and the presence of non-specific findings such as fever, anemia, and elevated serum LDH, which may delay the diagnosis. 4 Recently, the usefulness of random skin biopsy has been reported in the diagnosis of IVLBCL. 5 In our case, IVLBCL was incidentally identified by the skin biopsy of AI. IVLBCL

Cutaneous syncytial myoepithelioma (CSM) is a recently recognized variant of myoepithelioma characterized by an intradermal syncytial proliferation of spindled, ovoid, and histiocytoid cells. Immunohistochemically, tumor cells usually show strong expression of S-100 protein and epithelial membrane antigen (EMA). Here we report a case of CSM in the thigh of a 51-year-old Japanese woman. Histopathological findings showed a sheetlike growth of ovoid cells and histiocytoid cells with an eosinophilic syncytial cytoplasm, and adipocytic metaplasia was widely observed in the tumor. Immunohistochemical staining revealed a diffuse, strong pattern for EMA, smooth muscle actin (SMA), and HHF35, and variable expression of S-100 protein and p63 in ovoid and histiocytoid cells without significant mitotic figures or pleomorphism. In addition, EWSR1-PBX3 gene fusion, which is characteristic of CSM, was observed in the tumor. Based on these findings, we diagnosed the patient as having CSM. Our case shows that CSM can exhibit extensive adipocytic metaplasia, which could make its histopathological diagnosis challenging.