Microcystic Adnexal Carcinoma and a Summary of Other Rare Malignant Adnexal Tumours

Microcystic adnexal carcinoma of the eyelid and orbit: A case report and review of literature

Microcystic adnexal carcinoma (MAC), a rare and low-grade malignant skin tumor, is characterized by a high rate of misdiagnosis and a preponderance for local recurrence, but seldom seen nodal or distant metastasis. Although MAC typically occurs almost in the head and neck region, primary eyelid or orbital MAC is very rare. To explore the unique characteristics of the eyelid and orbital MAC, we reviewed the relevant literature. Based on its distinctive anatomical location and the aggressive behavior, eyelid or orbital MAC not only exhibit a high rate of misdiagnosis and local recurrence, but also lead to serious complications such as disfigurement after orbital exenteration, paranasal sinuses or intracranial invasion, even death. Misdiagnosis of MAC commonly result from its rarity and nonspecific clinical and histopathological presentation. To reduce or avoid misdiagnosis, it is important to increase awareness for MAC and obtain a full-thickness biopsy specimen in histopathological analysis. Due to its extensive invasive growth pattern, MAC has a high rate of local recurrence, so complete excision with clear margins and long-term follow-up of patients with MAC are necessary. About those serious complications of the eyelid and orbital MAC, early and accurate diagnosis, complete excision is very important. Moreover, an interprofessional team consisting of ophthalmologist, otolaryngologist, neurologist, dermatologist, pathologist, radiologist is needed to evaluate and treat this disease. In summary, increasing awareness, early and accurate diagnosis, complete excision, long-term follow-up, and a multidisciplinary team is crucial for management of the eyelid and orbital MAC.

Microcystic adnexal carcinoma misdiagnosed as a “recurrent epidermal cyst”: A case report

BACKGROUND

Microcystic adnexal carcinoma (MAC) is a rare malignant cutaneous adnexal neoplasm, often presenting as a flesh-colored and slow-growing indurated plaque or cystic nodule in the mid-facial region. Its characteristic indolent presentation usually leads to initial misdiagnosis, resulting in tumor mismanagement and added morbidity due to increased propensity for local invasion.

CASE SUMMARY

A 63-year-old Chinese male patient with a long-term history of excessive ultraviolet irradiation had received two surgeries for an “epidermal cyst” on his glabella and was presented to our hospital’s Dermatology Department for further diagnosis and therapy of the lesion on his glabella. One month ago, his two 7 mm × 7 mm subcutaneous nodules were diagnosed as "recurrent epidermal cysts", and he underwent local excision surgery. Additionally, he has post medical history of surgery for right clear cell renal carcinoma. According to his biopsy, the patient was diagnosed as MAC in our hospital, and a tumor remnant was found on his wound. He then underwent wide local excision to achieve negative margins and reconstruction of full-thickness flap transplantation for tissue coverage. He remained tumor-free after six months of follow-up.

CONCLUSION

This case highlights the importance of MAC’s possible pathogenic factor of excessive ultraviolet exposure, its differential diagnosis to avoid misdiagnosis and mismanagement to adverse prognosis, the patient’s particular medical history of clear cell renal carcinoma, the alert for any tumor recurrence in older patients, and his uncommon multiple nodules mess consisting of two 7 mm × 7 mm subcutaneous nodules, that will enrich the existing knowledge of MAC’s clinical features.

Facial microcystic adnexal carcinoma — treatment with a “jigsaw puzzle” advancement flap and immediate esthetic reconstruction: A case report

BACKGROUND

Microcystic adnexal carcinoma (MAC) is a rare malignant tumor of the skin that is commonly found on the face. It grows slowly and has a low mortality rate. However, for various reasons, including strong histological invasiveness, clinical inexperience and inadequate procedure design, immediate or permanent facial deformity may occur after surgical operations.

CASE SUMMARY

This article describes a middle-aged female artist who was diagnosed with MAC on the left upper lip. She declined the recommended treatment plan, which included two-stage reconstruction, skin grafting, or surgery that could have resulted in obvious facial dysfunction or esthetic deformity. We accurately designed a personalized procedure involving a “jigsaw puzzle advancement flap” for the patient based on the lesion location and the estimated area of skin loss. The procedure was successful; both pathological R0 resection and immediate and long-term esthetic reconstruction effects were achieved.

CONCLUSION

This study suggests that when treating facial MAC or other skin malignancies, a surgical team should have sufficient plastic surgery-related knowledge and skills. An optimal surgical plan for an individual is needed to achieve good facial esthetics and functional recovery and shorten the treatment course.

Microcystic adnexal carcinoma of the head and neck: Characteristics, treatment, and survival statistics

Studies on microcystic adnexal carcinoma (MAC) survival rates have been limited. This effort examines the association of patient demographics, treatment modalities, and tumor stage with overall survival (OS) in patients with MAC of the head and neck. All cases of MAC with primary sites of the skin of the head and neck, confirmed histologically, and diagnosed from 2004 to 2016 in the National Cancer Database, were analyzed. We utilized Kaplan-Meier and Cox proportional-hazard models to analyze the characteristics and survival outcomes of the 415 cases that met the criteria. The mean age of diagnosis was 63.8 years (SD ±15.8). Mean OS was 10.8 years with 5- and 10-year OS being 81.0% and 68.0%, respectively. Women were more frequently affected (59.0%; P < .001). Stand-alone primary site surgery was the most common treatment (81.4%): 15.9% of patients were treated with postexcision radiation therapy (RT). 18.3% were treated with RT with or without surgery and/or chemotherapy. RT was independently associated with a decreased hazard of death (HR = 0.23; P = .044). MAC of the head and neck disproportionately affects whites, is more common in women, and has the potential to metastasize. Surgical excision is the commonest treatment; our study shows benefit from judicious RT.

Microcystic adnexal carcinoma: report of rare cases

Microcystic adnexal carcinoma (MAC) is a rare, locally aggressive malignant neoplasm that derives from cutaneous eccrine/apocrine glands. MAC is classified as an eccrine/apocrine gland tumor and usually occurs in the skin. Here, we characterized and compared two cases of MAC. One is extremely rare in terms of its occurrence in the tongue. The other occurred in the lip, which is common. Histories of disease, diagnosis, and differentials were reviewed by the attending physicians. Hematoxylin and Eosin (HE) slides were evaluated by an experienced pathologist. Immunological markers for malignant eccrine/apocrine gland tumors were used to characterize the tumor’s nature. The examined markers included EMA, CK5/6, CK8/18, CK7, CK20, p63, S-100, Calponin, CD10, MYB, Bcl-2, Her-2, CD34, SMA, p53, CD43, CD117, and Ki-67. Both patients were males, presented with painless lumps in the lower lip and in the tongue, respectively. Both lumps were similar in terms of appearance, being whitish, and infiltrative with irregular borders. Both tumors also had similar histological features with nests of bland keratinocytes, cords, and ductal differentiation filled with Periodic acid–Schiff (PAS)-positive eosinophilic material. In both cases, circular or ovary tumor cells invaded into muscles and nerves. All tumor cells were CK5/6, CK8/18, EMA, and CK7 positive. Particularly, keratinocytes were p63 positive, and paraductal cells were p63, S-100, and SMA positive. Therefore, the rare case of MAC in the tongue appears to derive from the salivary gland.

Desmoplastic Trichoepithelioma: Histopathologic and Immunohistochemical Criteria for Differentiation of a Rare Benign Hair Follicle Tumor From Other Cutaneous Adnexal Tumors

Desmoplastic trichoepitheliomas (DTEs) are benign cutaneous neoplasms that originate from the hair follicle and exhibit a preference for the facial region. This type of neoplasm is characterized by accelerated growth, with vigorous histologic and immunohistochemical features that may be confused with other skin cancers. Thus, the objective of this study is to establish a definitive diagnosis that can be widely used. This review was systematically carried out and includes case series and studies to establish valuable data that can be used for research. The articles were sought in PubMed, MEDLINE, and Google Scholar using the keywords "desmoplastic trichoepithelioma," "morphea basal cell carcinoma," "microcystic adnexal carcinoma," "syringoma," and "cutaneous breast carcinoma." From a total of 65 journal articles, we chose 42 studies describing the clinical features, etiology, histopathology, and immunohistochemical characteristics of tumors. After quality assessment, 10 studies were selected, representing the differentiating features among the four mentioned cutaneous tumors. The differential diagnosis of DTE also includes other cutaneous and follicular tumors. At present, there is no standardized grading system for trichogenic tumors, although several symptomatic terms have been offered. More recently, immunohistochemistry and histopathological studies support the differentiation between the above-mentioned cutaneous tumors. However, additional research needs to be conducted to obtain complete information regarding the specific distinct traits of the indicated cutaneous tumors.

Axillary and elbow lymph node metastasis arising after complete excision of microcystic adnexal carcinoma of a hand: A rare presentation

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MAC arising at a hand may require wider excision in order to achieve best result.

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The metastatic route could be explained the spreading via lymphatic system.

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CT scan renders more details and more precise diagnosis in a suspicious situation.

Introduction

Microcystic adnexal carcinoma (MAC), a malignant transformation of adnexal structures, constitutes a rare locally aggressive malignancy of skin. Generally, the disease is associated with local invasion and distant metastases are extremely rare. We presented a case of MAC with distant metastasis after adequate wide excision.

Presentation of case

A 65-year-old man presented with a scar-like lesion at his left hand’s middle finger. As pathologic result from incisional biopsy confirmed MAC, the patient was then treated with ray amputation. Eight years later, there was a presence of scar changes. There was a palpable node at medial epicondyle and presence of enlarged lymph nodes at axilla by imaging with Computed tomography (CT) scan. Following left hand amputation and node dissection at elbow and axillary region, pathologic examination confirmed recurrence and metastasis of MAC. He went through adjuvant radiation with a complete response. At present, two years after surgery, he remains in complete remission.

Discussion

The presence of a recurrent MAC with distant lymph node metastasis after primary surgery is rare. The metastatic route as presented with the positive nodes at elbow and axilla could be explained the spreading via lymphatic system.

Conclusion

MAC arising at a hand may require wider excision in order to achieve best result. Although this malignancy is a slowly progressive disease, distant metastasis should always be concerned, especially when there are suspicious presentations. CT scan will render more details and make more precise diagnosis in the suspicious situation.

An Overview of Uncommon Cutaneous Malignancies, Including Skin Appendageal (Adnexal) Tumours and Sarcomas

A standardised classification of malignant skin appendageal (adnexal) tumours and sarcomas is required for improved patient management and prognosis. This has been hindered by considerable morphological variation both within and between tumour types, the use of many synonyms for the same tumour types and variation in classification between pathologists. This update uses the improved classification in the 2018 WHO classification of skin tumours as the basis to discuss malignant skin appendageal tumours, sarcomas and cutaneous metastases that regularly present to skin cancer clinicians, multidisciplinary skin cancer teams and tumour boards, with current evidence for management, where appropriate.