Background/Aim: Malignant chondroid syringoma is a rare tumor of unknown pathogenesis. Materials and Methods: Genetic analyses were performed on a malignant chondroid syringoma. Results: G-banding analysis of shortterm cultured tumor cells yielded the karyotype 46,Y,t(X;6)(p11;p21)[15]/46,XY[2]. RNA sequencing detected an in-frame fusion of PHF1 from 6p21 with TFE3 from Xp11, verified by RT-PCR and Sanger sequencing. Genomic PCR showed that the PHF1-TFE3 junction was identical to the fusion found by RNA sequencing and RT-PCR. Conclusion: Malignant chondroid syringoma is genetically related to tumors with PHF1 rearrangements such as low-grade endometrial sarcoma and ossifying fibromyxoid tumor, but also with tumors having TFE3 rearrangements such as renal cell carcinoma, alveolar soft part sarcoma, PEComa, and epithelioid hemangioendothelioma. Further investigations on malignant chondroid syringomas are needed in order to determine whether genetic heterogeneity exists among them and the clinical impact of the PHF1-TFE3 fusion. Malignant chondroid syringoma, also known as malignant mixed tumor of the skin, is a very rare tumor with less than 50 cases being described in the relevant literature. It is considered to be the malignant counterpart of benign chondroid syringoma (benign mixed tumor) (1, 2). Malignant chondroid syringomas are twice as common in women as in men and show predilection for the trunk and extremities (1-3). The clinical course is unpredictable (4). Half of the reported cases had local recurrences whereas nodal and distant metastases were observed in 39% and 36% of the cases, respectively. The most common sites for distant metastases are the lungs, bone, and brain (4). Malignant chondroid syringoma is composed of both epithelial and mesenchymal tissue. The epithelial component consists of neoplastic cells with hyperchromatic nuclei and abundant mitotic figures, with occasional areas of necrosis. The mesenchymal component may show myxoid, chondroid, osteoid, adipose or fibrous features enclosing clusters of epithelial cells (1-3). Malignant and benign chondroid syringomas are cutaneous myoepithelial neoplasms (5-9). Genetic studies of both cutaneous and soft tissue myoepithelial neoplasms have demonstrated considerable genetic heterogeneity (10-14). In some of these tumors, EWSR1-ZNF444, EWSR1-PBX1, EWSR1-PBX3 or EWSR1-POU5F1 fusion genes have been found (10, 12, 13, 15) whereas others had rearrangements of PLAG1 (11, 14). The differential diagnosis for myoepithelial tumor is extremely broad and may include ossifying fibromyxoid tumors (7, 16). In the latter, the PHD finger protein 1 gene (PHF1) is recurrently rearranged (17) with an EP400-PHF1 fusion being detected in some tumors (17, 18). Herein, we present a malignant chondroid syringoma which had a t(X;6)(p11;p21) as the sole karyotypic aberration. Using RNA sequencing and molecular methodologies, we demonstrated that the molecular consequence of the translocation was the fusion of the PHF1 gene from 6p21 with the transcription factor binding t...