Porome eccrine et porocarcinome

Eccrine poroma localized in the second toe

Eccrine poroma is a rare adult benign adnexal tumor that originates in the excretory pore of the sweat gland. It is a small reddish lesion, protuberant, fleshy, and well-defined. It is located preferably in the palms of the hands and the soles of the feet [1]. Nevertheless, it may be found on any skin part of the body's surface [2]. We report a case of eccrine poroma of relatively rare localization on the second toe of the left foot. The biopsy confirmed the diagnosis by objectifying the histological lesions corresponding with the poroma. The article aims to report an eccrine poroma located in an unusual location, surgical treatment, and follow-up.

Eccrine porocarcinoma: case report and review of the literature

Eccrine porocarcinoma is a rare skin cancer that originates from the acrosyringium of eccrine sweat glands. From the clinical point of view the differential diagnosis with other skin cancers such as basal cell carcinoma and squamous cell carcinoma it is often impossible, only the histopathologic features can lead to the definitive diagnosis. Eccrine porocarcinoma can arise from a previous poroma or de novo, it may recur after surgical excision and cause lymph node and visceral metastasis. There are no international guidelines for treatment or follow-up of patients. The aim of this work was to present a rare case of eccrine porocarcinoma of the scalp successfully treated in our clinic and to extrapolate from the international literature the main clinical and histopathological features of eccrine porocarcinoma and the various experiences regarding the types of treatment.

[Multiple recurrent eccrine porocarcinoma with inguinal metastasis. A case report]

BACKGROUND

Eccrine porocarcinoma, first described in 1963, is a rare malignant lesion arising from the eccrine sweat glands. It is usually a primary tumour, or even more common, a malignant degeneration of an eccrine poroma. It usually affects older persons and is located most commonly on the lower extremities. About 20% of eccrine porocarcinoma will recur after treatment. The treatment is wide local excision of the primary lesion. This uncommon skin tumour has a locally aggressive behaviour and a high recurrence rate.

CLINICAL CASE

An 82 year-old man presenting with multiple recurrent eccrine porocarcinoma with inguinal metastasis. The treatment was a radical excision and inguinal lymphadenectomy. There were no postoperative complications, but there was local recurrence after six months.

CONCLUSION

Early diagnosis and wide excision is the best way to achieve a good prognosis, due to the aggressiveness of this tumour.

[Primary eccrine porocarcinoma: a clinicopathological study of 50 cases]

BACKGROUND

Eccrine porocarcinoma is a rare cutaneous tumor arising from the intra-epidermal portion of eccrine sweat glands, the acrosyringium. Histoprognostic studies in large series are rare. Herein, we report a retrospective study of 50 cases.

PATIENTS AND METHODS

Fifty cases of porocarcinoma were retrieved from a histopathological register. Each histopathological sample was evaluated for the following criteria: presence or absence of dermal invasion, pattern of the infiltrative component (pushing or infiltrative), tumor thickness, lymphovascular emboli, perineural invasion and mitotic index. Clinical data and outcome were also retrieved for each patient.

RESULTS

Mean patient age was 77 years (range: 43-99 years). The mean duration of progression prior to diagnosis was 4 years and 5 months. The 2 most common skin locations were the head (38%) and lower limbs (20%). The lesions showed no specific distinctive clinical features. Six cases were in situ, and 44 were invasive (23 with limited infiltration and 20 with scattered infiltration). Mean tumor thickness was 4.37 mm (range: 0.5 to 20 mm). Neighboring or remote epidermal involvement was noted in 7 cases. Lymphovascular emboli were observed in 3 cases. No cases of neurotropism were observed. The average mitotic index was 6.5 mitoses/high power (×400) field. A mean follow-up of 24.3 months was available for 48 patients. Local recurrence was noted in 5 patients, 4 of whom died from visceral metastases. These 5 cases showed no distinctive clinical features, a scattered pattern of the invasive component, cuticular cells, significant tumor thickness (mean 12.8 mm, range 9-20 mm), and an elevated mitotic index. Two histopathological criteria were significantly associated with a metastatic outcome: scattered pattern of the dermal invasive component (P=0.04) and significant tumor thickness, above 10mm (P<0.01).

CONCLUSION

Porocarcinoma is a tumor without any particular clinical criteria to distinguish it from squamous cell carcinoma. The architecture of the invasive component and tumor thickness constitute 2 important histoprognostic criteria.

Successful management of metastatic eccrine porocarcinoma

Eccrine porocarcinoma (EPC) is a rare tumor. It develops from the intraepidermal ductal portion of the eccrine sweat gland. Metastatic disease is rare. We report a new case of metastatic eccrine porocarcinoma with a successful management and a good response to docetaxel. A 54-year-old man was admitted with a mass in the breast. Biopsy specimen found carcinomatous tumor proliferation with large anastomosing ducts. Cellular atypia were noted, with eosinophilic cytoplasm and round to oval nuclei. The tumor showed positive immunoreactivity for ACE and negative to anti-PS-100. Resection was performed. One year later, he presented with local and metastatic recurrences. The patient had received 3 cycles of cisplatin and 5-fluorouracil; he progressed with increase in mass size and number of lung lesions. He has been undergoing three cycles of docetaxel with complete response in the lung and regression of the breast mass. The mass was excised. Porocarcinoma is a very rare entity and poorly understood. In the metastatic phase, it has modest or no sensitivity to anticancer treatment. Docetaxel should be considered in the metastatic eccrine porocarcinoma.