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Regmi A, Zelman B, Mudaliar KM, Speiser JJ. Solitary Vulvar Syringoma With Deep Extension; Potential for Misdiagnosis as the Microcystic Adnexal Carcinoma (MAC). Am J Dermatopathol 2023; 45:180-184. [PMID: 36729101 DOI: 10.1097/dad.0000000000002364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/06/2022] [Indexed: 02/03/2023]
Abstract
ABSTRACT A 43-year-old woman presented with a palpable, pruritic, minimally painful right vulvar lesion. Physical examination revealed approximately 2.0-cm tender nodule at 70' clock in the right labia majora. Histological sections of the excision specimen showed an unremarkable epidermis with large, well-circumscribed dermal proliferation with extension to the reticular dermis. Within this proliferation are small solid and ductal structures relatively evenly distributed in the sclerotic stroma. The epithelial elements consisted of monomorphous cuboidal cells and assumed round, oval, curvilinear, or have other peculiar geometric shapes, including "comma-like" or "tadpole"-like configurations. The tumor cells were positive for CEA, EMA, and estrogen receptor and negative for progesterone receptor. The clinical presentation and the deep extension of the tumor were similar to the microcystic adnexal carcinoma. Although a syringoma generally presents with multiple lesions and usually involves the superficial dermis, a syringoma with deep extension was favored based on the lack of follicular differentiation, atypia, mitoses, and perineural invasion. Microcystic adnexal carcinoma and syringoma have a morphologic overlap and are misdiagnosed in 30% of the cases. Thus, it is exceptionally important for pathologists to be aware of and be able to distinguish these entities. To the best of our knowledge, this is the first case of a solitary, painful vulvar syringoma with deep extension.
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Affiliation(s)
- Aayushma Regmi
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL; and
| | - Brandon Zelman
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL; and
| | | | - Jodi J Speiser
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL; and
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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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Nam G, Strenger R, Cutitar M, Wang Y. Low-grade adenosquamous carcinoma of the breast: A case with pathogenic germline mutation in the BRIP1 gene. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gerall CD, Sippel MR, Yracheta JL, Hogan FS. Microcystic Adnexal Carcinoma: A Rare, Commonly Misdiagnosed Malignancy. Mil Med 2020; 184:948-950. [PMID: 31125069 DOI: 10.1093/milmed/usz123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/19/2019] [Indexed: 11/14/2022] Open
Abstract
Microcystic adnexal carcinoma (MAC) is a rare, malignant cutaneous neoplasm that often presents as an inconspicuous, benign appearing lesion. Patients most commonly are asymptomatic and present for improved cosmesis, however perineural invasion may result in local numbness, paresthesia or pruritus. Although distant metastasis is rare, MAC has an increased propensity for local invasion, often resulting in significant morbidity as late presentation and misdiagnosis are common. A high index of suspicion is imperative, and deep tissue biopsy with defining histologic characteristics is required for diagnosis. Mohs micrographic surgery is currently the standard of care, providing the highest possibility for long-term cure. We present a case report of a 43-year-old male Air Force U-2 pilot with a benign presentation and initial clinical misdiagnoses of MAC, who underwent Mohs micrographic surgery followed by cervicofacial flap reconstruction of a 5.5 × 3.5 cm defect. We also identify increased radiation exposure of U-2 pilots as a potential risk factor for the early development of MAC, emphasizing the importance of exploring patient risk factors while having a high index of suspicion to aid in early diagnosis.
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Affiliation(s)
- Claire D Gerall
- AirMed Program, MCMR-SRZ-B, 3698 Chambers Pass Ste B, JBSA Ft. Sam Houston, TX 78234.,Department of Surgery, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229
| | - Michael R Sippel
- AirMed Program, MCMR-SRZ-B, 3698 Chambers Pass Ste B, JBSA Ft. Sam Houston, TX 78234.,Department of Surgery, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229
| | - Jaclyn L Yracheta
- AirMed Program, MCMR-SRZ-B, 3698 Chambers Pass Ste B, JBSA Ft. Sam Houston, TX 78234.,Department of Surgery, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229
| | - Fawn S Hogan
- AirMed Program, MCMR-SRZ-B, 3698 Chambers Pass Ste B, JBSA Ft. Sam Houston, TX 78234.,Department of Plastic Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive Bldg 3600, JBSA Fort Sam Houston, TX 78234
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5
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Le ST, Kamal HY, Khachemoune A. Mohs micrographic surgery for cutaneous malignancies: A focus review of its indications in pediatric age groups. Pediatr Dermatol 2018; 35:434-440. [PMID: 29575263 DOI: 10.1111/pde.13460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Mohs micrographic surgery (MMS) is a highly specialized technique that has been successful in the treatment of a variety of skin tumors. The technique can be performed as an outpatient procedure and encompasses surgical excision and intraoperative assessment of tumor margins in one setting by the same physician. The process ensures precise margin control with maximal preservation of healthy tissues. Mohs micrographic surgery has been practiced worldwide, including in the United States, Europe (United Kingdom, Germany, Spain, Netherlands, Switzerland), and Australia. Although it is commonly performed in adults with greater success, it has been discussed less frequently in children. In this article, we describe several cutaneous tumors in children and the role of Mohs micrographic surgery in their management. A PubMed search was conducted to review the most common cutaneous tumors in children treated using Mohs micrographic surgery. In this review, we discuss indications for Mohs micrographic surgery and pertinent studies examining success rates in children. Mohs micrographic surgery has been used to treat several tumors in children and offers the advantage of high cure rates and tissue conservation. This report emphasizes the benefits of Mohs micrographic surgery in children and highlights several cutaneous tumors for which it has been used to treat successfully.
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Affiliation(s)
- Stephanie T Le
- Drexel/Hahnemann University Hospital, Philadelphia, PA, USA
| | | | - Amor Khachemoune
- State University of New York Downstate and Veterans Affairs Medical Center, Brooklyn, NY, USA
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Aslam A. Microcystic Adnexal Carcinoma and a Summary of Other Rare Malignant Adnexal Tumours. Curr Treat Options Oncol 2018; 18:49. [PMID: 28681209 DOI: 10.1007/s11864-017-0491-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OPINION STATEMENT Microcystic adnexal carcinoma (MAC) is a rare, slow-growing, infiltrative malignant tumour most commonly found on the head and neck. It often presents as a solitary skin-coloured or yellow papule, plaque or nodule. Ultraviolet radiation, immunosuppression and ionising radiation are possible risk factors. Clinical and histological differential diagnoses include morpheaform basal cell carcinoma and desmoplastic trichoepithelioma. The diagnosis is usually made by skin biopsy, and the characteristic features are small keratin-filled cysts with nests and cords which resemble ductal structures. Immunohistochemistry can assist in differentiating MAC from other tumours. The local aggressive nature of the tumour and its potential to infiltrate beyond the assessed clinical margins warrant complete excision with marginal control, and we recommend Mohs micrographic surgery. Wide local excision is widely performed but is associated with recurrence given its infiltrative nature and extensive subclinical extension. The role of radiotherapy in the management of MAC is unclear.
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Affiliation(s)
- Arif Aslam
- St Helens and Knowsley Teaching Hospitals NHS Trust, Marshalls Cross Road, St Helens, WA9 3DA, UK.
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Jean-Jacques B, Michels JJ, Veyssiere A, Haidar D. [Microcystic adnexal carcinoma: A case report]. Ann Pathol 2018; 38:198-201. [PMID: 29622469 DOI: 10.1016/j.annpat.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 03/05/2018] [Indexed: 11/25/2022]
Abstract
We report a case of microcystic adnexal carcinoma in a 80-year-old woman. This is a rare malignant adnexal cutaneous tumor with glandular and follicular differentiation, rare, often asymptomatic, with late diagnosis and slow growth, locally aggressive and rarely metastatic. The distinction with other benign and malignant skin tumors is difficult.
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Affiliation(s)
- Bastien Jean-Jacques
- Service d'anatomie pathologique, CHU de Caen, avenue côte-de-nacre, 14033 Caen, France.
| | - Jean-Jacques Michels
- Service d'anatomie pathologique, CHU de Caen, avenue côte-de-nacre, 14033 Caen, France
| | - Alexis Veyssiere
- Service de chirurgie maxillo-faciale, CHU de Caen, avenue côte-de-nacre, 14033 Caen, France
| | - Dima Haidar
- Service de dermatologie, CHU de Caen, avenue côte-de-nacre, 14033 Caen, France
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Wood A, Conn BI. Sclerosing microcystic adenocarcinoma of the tongue: a report of 2 further cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:e94-e102. [DOI: 10.1016/j.oooo.2017.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 01/06/2023]
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9
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Fernandez-Flores A, Llamas-Velasco M, Saus C, Patel A, Rutten A. Microcystic adnexal carcinoma with sebaceous differentiation: Three cases. J Cutan Pathol 2018; 45:290-295. [DOI: 10.1111/cup.13109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/29/2017] [Accepted: 01/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Angel Fernandez-Flores
- Department of Cellular Pathology; Hospital El Bierzo; Ponferrada Spain
- Department of CellCOM-SB Group; Biomedical Investigation Institute of A Coruña; A Coruña Spain
- Department of Cellular Pathology; Hospital de la Reina; Ponferrada Spain
| | - Mar Llamas-Velasco
- Department of Dermatology; Hospital Universitario de La Princesa; Madrid Spain
| | - Carles Saus
- Department of Pathology; Hospital Universitario Son Espases; Palma Spain
| | - Anisha Patel
- Department of Dermatology; MD Anderson Cancer Center; Houston Texas
| | - Arno Rutten
- Private Practice, Friedrischafen; Friedrichshafen Dermatopathologie; Friedrischafen Germany
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