2c). Finally, we performed gene knockdown experiments. RANK knockdown induced a decrease in cell viability in the HAMON cells, not in the HUVECs (Fig. 2d-g). Mechanistically, knockdown of RANK suppressed the phosphorylation of Erk (Fig. 2f). In various cancers, positive associations between RANK-RANKL signalling and tumour development have been reported. 6 Recent clinical trials in lung cancer have shown that denosumab could reduce the risk of skeletal-related events and improve overall survival more than zoledronic acid. 7,8 Also, the RANK-RANKL signalling pathway is known to be involved in cancer cell migration and angiogenesis. 6 Jones et al. 9 demonstrated that the migration of RANK-expressing cancer cells was accelerated by RANKL, which is reported to be involved in the MAP kinase pathways. 6 Further, RANK-RANKL signalling pathways stimulate angiogenesis through an Src and phospholipase C-mechanism. 10 The results of the present and previous studies suggest that RANK-RANKL pathways highly contribute to angiogenesis and cell proliferation in CAS cells (Fig. 2h). In conclusion, we have reported a case of CAS with metastases in the sternum and liver which have remained stable through denosumab therapy. Also, we demonstrated that the RANK/ RANK pathway is activated in CAS. Our data suggest that the inhibition of RANK-RANKL signalling could be a potential treatment option for CAS.

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Adenomatoid tumors are benign tumors of mesothelial origin that are usually encountered in the genital tract. Although they have been observed in other organs, the skin appears to be a very rare location, with only one case reported in the literature to our knowledge. We report a second case of an adenomatoid tumor, arising in the umbilicus of a 44-year-old woman. The patient presented with an 8-month-old erythematous and firm plaque under the umbilicus. A skin biopsy showed numerous microcystic spaces dissecting a fibrous stroma and lined by flattened to cuboidal cells with focal intraluminal papillary formation. This little-known diagnosis constitutes a diagnostic pitfall for dermatopathologists and dermatologists, and could be misdiagnosed as other benign or malignant entities. Through this case report, a practical approach and diagnostic keys have been devised to avoid misdiagnosis and overtreatment.