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Lichtman-Mikol S, Kieft A, Beydoun R, Joiner M, Miller S. Malignant Eccrine Spiradenoma of the Posterior Scalp: An Odd Presentation. Cureus 2023; 15:e40033. [PMID: 37292109 PMCID: PMC10246931 DOI: 10.7759/cureus.40033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/10/2023] Open
Abstract
Malignant eccrine spiradenoma is a rare cutaneous adnexal neoplasm and is often a result of the malignant transformation of a benign eccrine spiradenoma. A woman without a history of skin cancer presented with a mass on her posterior scalp. An excisional biopsy was obtained, and histology was consistent with eccrine spiradenocarcinoma with the lesion extending to all margins of the excision specimen. Physical exam and imaging did not reveal lymph node involvement or distant spread of disease. It was recommended that the patient undergo wide local excision.
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Affiliation(s)
| | - Aria Kieft
- Department of Radiation Oncology, Wayne State University Detroit Medical Center, Detroit, USA
| | - Rafic Beydoun
- Department of Pathology, Wayne State University Detroit Medical Center, Detroit, USA
| | - Michael Joiner
- Department of Oncology, Wayne State University School of Medicine, Detroit, USA
| | - Steven Miller
- Department of Oncology, Wayne State University School of Medicine, Detroit, USA
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Gingrich AA, Fung MA, Konia T, Canter RJ. Locally Advanced Spiroadenocarcinoma in the Regional Axilla of a Breast Cancer Patient: Hallmarks of Definitive Diagnosis and Management. Rare Tumors 2015; 7:5912. [PMID: 26500731 PMCID: PMC4600993 DOI: 10.4081/rt.2015.5912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/28/2015] [Accepted: 06/14/2015] [Indexed: 11/28/2022] Open
Abstract
Eccrine spiroadenocarcinoma is an extremely rare malignant eccrine gland tumor which may masquerade as other more common malignancies such as poorly differentiated squamous carcinoma or metastatic breast cancer. We report a case of an ulcerated axillary skin lesion with bulky adenopathy in a 77 year-old female with a prior history of ipsilateral triple negative breast carcinoma. The clear transition of benign spiradenoma to malignant carcinoma was essential to establishing a definitive diagnosis and treatment plan.
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Affiliation(s)
- Alicia A Gingrich
- Division of Surgical Oncology, UC Davis School of Medicine , Sacramento, CA, USA
| | - Maxwell A Fung
- Departments of Dermatology and Pathology, UC Davis School of Medicine , Sacramento, CA, USA
| | - Thomas Konia
- Departments of Dermatology and Pathology, UC Davis School of Medicine , Sacramento, CA, USA
| | - Robert J Canter
- Division of Surgical Oncology, UC Davis School of Medicine , Sacramento, CA, USA
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Tseng J, Dhungel B, Mills JK, Diggs BS, Weerasinghe R, Fortino J, Vetto JT. Merkel cell carcinoma: what makes a difference? Am J Surg 2015; 209:342-6. [DOI: 10.1016/j.amjsurg.2014.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/02/2014] [Accepted: 06/03/2014] [Indexed: 11/25/2022]
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Abstract
Malignant eccrine spiradenoma (MES) is an extremely rare but aggressive tumour, resulting in high mortality. We report the first case in the UK of metastatic MES on the scalp of a 37-year-old man who initially presented with a raised nodular mass which had grown rapidly over a few months. Excision biopsy of the lesion was performed and histology confirmed MES with evidence of cytological atypia and necrosis. A further wide local excision of the lesion with a 1 cm surgical margin was performed and full clearance was achieved. At 10-month follow-up another similar lesion had developed close to the previously excised area. A CT scan demonstrated metastatic lesions in the lungs, liver and pelvis, and subsequently chemotherapy was initiated. Although MES is uncommon, it has a high propensity to metastasise, therefore prompt identification, treatment and close follow-up of these tumours is essential.
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Affiliation(s)
- Whitney Chow
- St Andrew's Centre for Plastic Surgery and Burns, Mid Essex Hospital Services NHS Trust, Essex, UK
| | - Mat Griffiths
- St Andrew's Centre for Plastic Surgery and Burns, Mid Essex Hospital Services NHS Trust, Essex, UK
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Asuquo M, Ngim O, Nya A, Omotoso J, Asuquo ME. Malignant adnexal tumors: diagnostic and therapeutic challenges in Calabar, Nigeria. Int J Dermatol 2012; 51:619-21. [PMID: 22515592 DOI: 10.1111/j.1365-4632.2010.04575.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McLean SR, Shousha S, Francis N, Lim A, Eccles S, Nathan M, Brock CS, Palmieri C. Metastatic ductal eccrine adenocarcinoma masquerading as an invasive ductal carcinoma of the male breast. J Cutan Pathol 2007; 34:934-8. [DOI: 10.1111/j.1600-0560.2007.00749.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mojica P, Smith D, Ellenhorn JDI. Adjuvant Radiation Therapy Is Associated With Improved Survival in Merkel Cell Carcinoma of the Skin. J Clin Oncol 2007; 25:1043-7. [PMID: 17369567 DOI: 10.1200/jco.2006.07.9319] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Merkel cell carcinoma (MCC) is a rare cutaneous malignancy. Because of the absence of randomized studies, the real benefit of adjuvant radiation therapy in MCC is unclear. The aim of this study was to better define the role of adjuvant radiation therapy in the management of MCC. Methods The Surveillance, Epidemiology, and End Results (SEER) survey from the National Cancer Institute was queried from 1973 through 2002. Retrospective analysis was performed. The end point of the study was overall survival. Results There were 1,665 cases of MCC in the SEER registry. Presentation by stage were 55% stage I, 31% stage II, and 6% stage III. Eight percent of the cases could not be staged because of incomplete data. Surgical intervention was a component of therapy in 89% of the cases (n = 1,487). The median survival for the entire cohort was 49 months, and median follow-up was 40 months. Adjuvant radiation was a component of therapy in 40% of the surgical cases. The median survival for those patients receiving adjuvant radiation therapy was 63 months compared with 45 months for those treated without adjuvant radiation. The use of radiation was associated with an improved survival for patients with all sizes of tumors, but the improvement with radiation use was particularly prominent when analyzing those patients with primary lesions larger than 2 cm. Conclusion The use of adjuvant radiation therapy is associated with improved survival in patients with MCC. Prospective evaluation of adjuvant radiation therapy in this setting is warranted.
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Affiliation(s)
- Pablo Mojica
- Divisions of Surgery and Information Sciences City of Hope National Medical Center, Duarte, CA 91010, USA
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Hall J, Knee G, A'Hern RP, Clarke J, Glees JP, Ford HT, Eeles RA. Sweat-gland tumours: a clinical review of cases in one centre over 20 years. Clin Oncol (R Coll Radiol) 2006; 18:351-9. [PMID: 16703755 DOI: 10.1016/j.clon.2005.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS Sweat-gland tumours (SGTs) are uncommon, but malignant varieties are very rare. We have added our data on 30 new cases seen at the Royal Marsden NHS Foundation Trust to the published literature, particularly concentrating on clinical issues. We include a literature review. MATERIALS AND METHODS The Royal Marsden NHS Foundation Trust database was searched for cases of SGT from 1972. Data were collected on all cases, including patient demographics and tumour characteristics, treatment and outcome. RESULTS Thirty cases were confirmed histologically to be SGTs. Fourteen were malignant, 15 benign and the degree of malignancy in one was histologically indistinguishable. Mean age was 55 years (64 for malignant, 47 for benign tumours). The 15 patients with benign tumours were almost all treated with complete excision. Those with local relapse underwent successful re-excision. Their 5-year disease-free survival was 78% and cause-specific survival was 100%. Twelve of the 14 malignant tumours had localised disease at diagnosis, one had nodal disease and one had metastatic tumour nodules. All except one were treated with wide local excision. The patient with nodal involvement also had a lymph-node dissection. Two received adjuvant radiotherapy to the tumour bed. One received a melphalan limb perfusion. Eight of the 14 had no relapse. Six had locoregional relapse, and four of these also developed distant metastases. Visceral disease was always fatal. Radiotherapy and chemotherapy at relapse were unsuccessful. Five-year disease-free survival was 45%, and cause-specific survival was 57%. CONCLUSION These rare tumours should be treated initially with complete wide local excision. In malignant tumours, lymph-node involvement is a poor prognostic sign. Wide local excision remains the primary treatment. Adjuvant radiotherapy may be useful in high-risk cases.
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Affiliation(s)
- J Hall
- Royal Marsden NHS Foundation Trust, London, UK
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Abstract
Malignant transformation of eccrine spiradenoma is extremely rare. We describe the case of a 70-year-old man with malignant eccrine spiradenoma of the forearm and metastases to the axillary lymph nodes. Surgical excision with adequate margins and lymph node dissection was performed. Tamoxifen therapy was instituted after obtaining positive immunostaining results for estrogen receptor. After 41 months of follow-up, there has been no recurrence or distant metastases. Wide local excision and close follow-up are crucial in the management of malignant eccrine spiradenoma. The role of other therapeutic modalities, including hormonal therapy, remains to be determined.
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Affiliation(s)
- Imran Mirza
- Department of Pathology, Danbury Hospital, Danbury, CT 06810, USA
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Abstract
Merkel cell carcinoma (MCC) is a rare, highly malignant cutaneous tumor, primarily of the head and neck, that requires timely diagnosis, adequate staging, and aggressive therapy. MCC tends to be overlooked in the early stage, has a high propensity for invading local and regional nodal basins, and exhibits a high postoperative recurrence rate, with distant thoracic, abdominal, and central nervous system metastases. Conventional radiography and cross-sectional imaging show lesions similar to those originating from other small cell carcinomas. Nuclear medicine procedures such as sentinel node scintigraphy, somatostatin receptor scintigraphy, and positron emission tomography may be used to supplement judicious cross-sectional imaging evaluation, thereby adding diagnostic value in staging and providing therapeutic guidance. Ultimately, however, the diagnosis relies exclusively on pathologic findings at immunohistochemical staining and electron microscopy. The rarity of MCC and the resulting insufficient awareness of this neoplasm often delay correct identification and treatment, which essentially consists of wide-margin surgical excision of the primary tumor and local and regional radiation therapy. To date, clinical information is still insufficient to fully appreciate the role of imaging in MCC management. A better imaging algorithm is expected with increased awareness and improved clinical understanding of this uncommon skin neoplasm.
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Affiliation(s)
- Ba D Nguyen
- Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, AZ 85259, USA
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Abstract
Malignant eccrine spiradenoma is an exceedingly rare tumor. A case of a 72-year-old women with this highly aggressive malignancy arising from a long-standing lower leg lesion is reported. Management during the course of disease included surgery, radiation therapy (RT), hyperthermic limb perfusion chemotherapy, and chemotherapy. The patient died of her disease, with widespread metastatic disease 20 months after the diagnosis. A review of the literature is presented, and treatment considerations are summarized.
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Affiliation(s)
- J S Tay
- Department of Radiation Oncology, Saint Mary's Medical Center, San Francisco, CA 94117, USA
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Cruse CW, Reintgen D, Glass F, Messina J, Trotti A, DeConti R, Wells K. Neuroendocrine Carcinoma of the Skin. Cancer Control 1997; 4:346-348. [PMID: 10763041 DOI: 10.1177/107327489700400407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- CW Cruse
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
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