Extraordinary Case ReportClear Cell Sarcoma With Cutaneous Presentation in a 4-Year-Old BoyWestover, Clinton MD*; Bacchi, Carlos MD†; Gru, Alejandro A. MD*Author Information *Department of Pathology, The University of Virginia, Charlottesville, VA; and †Department of Pathology, Consultoria em Patologia, Central São Paulo Estado, Brazil. Correspondence: Clinton Westover, MD, Department of Pathology, University of Virginia, PO Box 800214, 1215 Lee Street, Charlottesville, VA 22908-0214 (e-mail: firstname.lastname@example.org). The authors declare no conflicts of interest. The American Journal of Dermatopathology: September 2020 - Volume 42 - Issue 9 - p e131-e133 doi: 10.1097/DAD.0000000000001658 Buy Metrics Abstract We report a case of a 4-year-old Brazilian boy, who presented with an erythematous and painful nodule involving the skin of his left arm. Immunohistochemistry was performed for S100, SOX10, CD34, desmin, SMA, HMB-45, CD1a, and CD163, and fluorescence in situ hybridization for EWSR1 gene rearrangement using a break-apart probe was completed. Immunohistochemistry showed bland spindle cells with “floret-like” appearance simulating a giant cell fibroblastoma; tumor cells were positive for S100 and SOX10; neoplastic cells were negative for CD34, desmin, SMA, HMB-45, CD1a, and CD163; and fluorescence in situ hybridization showed an EWSR1 gene rearrangement. We report the youngest known case of cutaneous involvement of clear cell carcinoma at the age of 4. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.