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Cheung J, Rabinowitz MP, Tuluc M, Milman T. Periocular Microcystic Adnexal Carcinoma: A Case Report and a Major Review. Ophthalmic Plast Reconstr Surg 2023; 39:533-541. [PMID: 37279021 DOI: 10.1097/iop.0000000000002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To describe a patient with periocular microcystic adnexal carcinoma (MAC) and to review the clinical presentation, systemic work-up, histopathologic features, and outcome of all previously reported periocular MAC. METHODS A major literature review. PubMed/MEDLINE and Google Scholar databases were searched for all well-documented cases of periocular MAC. RESULTS The final analysis yielded 93 patients with MAC, 48 (52%) females, 39 (42%) males, and 6 with sex not specified (6%) with an average age of 56 years (range 3 days-95 years). Most tumors were localized to the eyebrow (26/93, 28%) and lower eyelid (20/93, 22%). Of patients with known information, MAC most commonly presented as a nodule (37/68, 54%) or plaque (20/68, 29%) with poorly-defined margins (20/51, 39%) and distortion of eyelid margin (13/51, 25%). Orbital involvement at any point of the disease course was seen in 20 of 93 (22%) patients. An accurate histopathologic diagnosis on initial biopsy was made in 25 of 70 (36%) cases. Initial management included surgical excision (47/93, 51%), Mohs micrographic surgery (17/93, 18%), and excision with frozen section control of margins (8/93, 9%). Aggressive or recurrent MAC was managed with multimodal therapies, including adjuvant radiation (10/34, 29%). The average follow-up after the last treatment was 3 years (median 2, range 0.2-20 years). In total, 33 of 86 (38%) tumors recurred, and 6 of 87 (7%) metastasized. Disease-related mortality occurred in 3 of 79 (4%) of patients. CONCLUSIONS Periocular MAC is frequently misdiagnosed on initial biopsy and has a tendency for recurrence and locally aggressive behavior, highlighting the importance of accurate timely diagnosis, and appropriate management.
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Affiliation(s)
- Jesse Cheung
- Lewis Katz School of Medicine of Temple University, Philadelphia, PA, U.S.A
| | - Michael P Rabinowitz
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Madalina Tuluc
- Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Tatyana Milman
- Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
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2
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Huang S, Xia Y, Zhu Y, Ren Z, Dong Y. Microcystic adnexal carcinoma of the eyelid and orbit: A case report and review of literature. Medicine (Baltimore) 2023; 102:e34709. [PMID: 37565854 PMCID: PMC10419370 DOI: 10.1097/md.0000000000034709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023] Open
Abstract
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.
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Affiliation(s)
- Shiwei Huang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yang Xia
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yueyang Zhu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Zhiyuan Ren
- Department of Mechanical Engineering, University of Illinois Urbana Champaign, Champaign, IL, USA
| | - Yaru Dong
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, Jilin, China
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3
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Nahm WJ, Chen S, Joseph S, Chu P, Yoo J. Neoadjuvant radiation to facilitate surgical treatment of a microcystic adnexal carcinoma with perineural invasion of the vulvar region. JAAD Case Rep 2023; 38:72-74. [PMID: 37600729 PMCID: PMC10433279 DOI: 10.1016/j.jdcr.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Affiliation(s)
- William J. Nahm
- New York University Grossman School of Medicine, New York, New York
| | - Stanley Chen
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | - Paul Chu
- Bridge Dermatopathology Services, Tarrytown, New York
| | - Jane Yoo
- Mount Sinai School of Medicine, New York, New York
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Wierzbicka M, Kraiński P, Bartochowska A. Challenges in the diagnosis and treatment of the malignant adnexal neoplasms of the head and neck. Curr Opin Otolaryngol Head Neck Surg 2023; 31:134-145. [PMID: 36912226 DOI: 10.1097/moo.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW The current review is to present the current knowledge regarding epidemiology, diagnostics, and management of malignant adnexal neoplasms (MANs). RECENT FINDINGS Immunotherapy and gene-related therapies are still being developed as the methods of salvage treatment in advanced and disseminated cases: CACNA1S, ATP2A1, RYR1, and MYLK3, as well as p53 or the JAK/STAT pathways, may be therapeutic targets; the efficiency of talimogene laherparepvec and nivolumab is assessed. SUMMARY MANs are rare tumors, but due to the aging of population their incidence is increasing. Their clinical presentation is unspecific, which makes the diagnosis challenging. Histopathological assessment is difficult even for experienced pathologists. Mohs micrographic surgery or wide local excision are recommended to treat primary lesions. Adjuvant radiotherapy may be beneficial in case of insufficient or positive surgical margins, in nodal metastases, in selected types of MANs like sebaceous, trichilemmal, and pilomatrix carcinomas, and as the induction treatment in large tumors located in medically fragile or cosmetically important regions. The role of chemotherapy is not well defined; however, it is recommended in distant metastases. Immunotherapy can improve the prognosis in advanced stage of the disease.
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Affiliation(s)
- Małgorzata Wierzbicka
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences
- Institute of Human Genetics, Polish Academy of Sciences
| | - Patryk Kraiński
- Department of Clinical Pathology and Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - Anna Bartochowska
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences
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Yang SX, Mou Y, Wang S, Hu X, Li FQ. Microcystic adnexal carcinoma misdiagnosed as a “recurrent epidermal cyst”: A case report. World J Clin Cases 2022; 10:8034-8039. [PMID: 36158483 PMCID: PMC9372837 DOI: 10.12998/wjcc.v10.i22.8034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/10/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Si-Xuan Yang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Yan Mou
- Department of Dermatology, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Shu Wang
- Department of Radiotherapy, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Xin Hu
- Department of Microbiology, Graduate School of Medicine, Kyoto University, Kyoto 606-8510, Japan
| | - Fu-Qiu Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
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Pratiwi NI, Djawad K, Wijaya JK, Ghaznawie M, Wahab S, Nurdin A. A diagnostic challenge in an atypical variant of microcystic adnexal carcinoma mimicking ulcerative basal cell carcinoma: a case report and brief literature review. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2022. [DOI: 10.15570/actaapa.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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7
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Microcystic adnexal carcinoma: report of rare cases. Biosci Rep 2020; 40:221808. [PMID: 31912868 PMCID: PMC6974419 DOI: 10.1042/bsr20191557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/20/2019] [Accepted: 01/06/2020] [Indexed: 01/21/2023] Open
Abstract
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.
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Haug K, Breuninger H, Metzler G, Eigentler T, Eichner M, Häfner HM, Schnabl SM. Prognostic Impact of Perineural Invasion in Cutaneous Squamous Cell Carcinoma: Results of a Prospective Study of 1,399 Tumors. J Invest Dermatol 2020; 140:1968-1975. [PMID: 32169476 DOI: 10.1016/j.jid.2020.01.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 01/13/2023]
Abstract
Perineural infiltration (PNI) and desmoplasia are believed to be high-risk factors in the prognosis of squamous cell carcinoma (SCC). In the literature, dependences between PNI, de-differentiation, and desmoplasia remain unclear. The aim of this study was to analyze the respective prognostic impact of these factors in regard to local recurrence and metastasis. Between 2005 and 2015, 1,399 unselected primary SCCs of 1,434 patients were diagnosed. If a patient had multiple tumors, the tumor with the highest risk profile was selected. Histological sections of all tumors with a tumor thickness of ≥6 mm and desmoplastic SCC with a tumor thickness of 2.1-5.9 mm were re-examined for PNI. Median follow-up was 36.5 months. PNI was present exclusively within tumors of the desmoplastic type (14.5%). PNI was present significantly more often in patients developing lymph node metastasis (3% all non-desmoplastic SCC, 17% desmoplastic SCC, and 29% desmoplastic SCC with PNI) and local recurrence (3%, 26%, and 64%) and associated with overall tumor-specific death (4%, 25%, and 54%). Using a multivariate model of disease recurrence, tumor thickness ≥6 mm, tumor horizontal size ≥20 mm, immunosuppression, desmoplasia, and PNI remained significant factors. In conclusion, PNI was found to be an additional marker indicative of an unfavorable prognosis and an independent high-risk factor within the desmoplastic type of SCC.
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Affiliation(s)
- Konrad Haug
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Helmut Breuninger
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Gisela Metzler
- Centre for Dermatohistopathology and Oral and Maxillofacial Pathology Tübingen-Wuerzburg and Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Thomas Eigentler
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Martin Eichner
- Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | | | - Saskia M Schnabl
- Department of Dermatology, University of Tübingen, Tübingen, Germany.
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Kim DW, Lee G, Lam MB, Harris EJ, Lam AC, Thomas T, Chau NG, Tishler RB. Microcystic Adnexal Carcinoma of the Face Treated With Definitive Chemoradiation: A Case Report and Review of the Literature. Adv Radiat Oncol 2019; 5:301-310. [PMID: 32280832 PMCID: PMC7136639 DOI: 10.1016/j.adro.2019.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/29/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Daniel W Kim
- Department of Radiation Oncology Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Grace Lee
- Department of Radiation Oncology Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Miranda B Lam
- Department of Radiation Oncology Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Ethan J Harris
- University of Illinois College of Medicine, Chicago, Illinois
| | - Allen C Lam
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Tom Thomas
- Head and Neck Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.,Head and Neck Reconstructive Surgery and Transoral Robotic Surgery, Atlantic Center for Head and Neck Surgery, Carol G. Simon Cancer Center, Morristown, New Jersey
| | - Nicole G Chau
- Harvard Medical School, Boston, Massachusetts.,Head and Neck Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Roy B Tishler
- Department of Radiation Oncology Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Head and Neck Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
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