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Soror NN, Lutaya I, Shah P, Hemrock L, Bennett R, Gibson G. A Rare Case of Primary Adenocarcinoma of the Eyelid: Case Presentation and Review of Literature. Cureus 2021; 13:e16580. [PMID: 34430175 PMCID: PMC8378301 DOI: 10.7759/cureus.16580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/25/2022] Open
Abstract
Primary mucinous adenocarcinoma (PMA) of the eyelid is a very rare malignancy with an incidence of 0.07 per million. Most cases are elderly males with an indolent course of local growth over months. We report a rare case of a 61-year-old gentleman with an aggressive course of PMA. The patient presented with a painless lower right eyelid swelling that developed over a four-month period. Incisional biopsy of the mass disclosed mucinous adenocarcinoma, positive for cytokeratin (CK)7 but negative for thyroid transcription factor 1, S100, and CK20 expression. Magnetic resonance imaging of the orbits revealed an enhancing infiltrative mass extending from the right lower eyelid to the medial canthus and posteriorly into the orbit, the right ethmoid sinuses, and extraconal fat within the orbit. Workup for metastatic disease including scans of chest, abdomen, and pelvis as well as positron emission tomography/computed tomography were negative for other masses. The patient underwent extensive surgery that included exenteration of the right orbit and cervical lymph node dissection followed by adjuvant radiation therapy and chemotherapy due to the extent of periorbital tumor invasion of contiguous tissues. Diagnosis of PMA is a clinical challenge, and immunohistochemistry is essential for diagnosis. To confirm it as a primary tumor, exclusion of metastasis from elsewhere is appropriate. Reported treatment modalities include Mohs micrographic surgery or excision with frozen section and safety margin. Exenteration of the orbit may be indicated depending on the extent of orbital invasion by the tumor. There is limited evidence to guide treatment and follow-up, with information consisting mostly of published case reports and case series.
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Affiliation(s)
- Noha N Soror
- Internal Medicine, Western Reserve Health Education/Northeast Ohio Medical University, Warren, USA
| | - Innocent Lutaya
- Internal Medicine, American University of Antigua, Warren, USA
| | - Parth Shah
- Internal Medicine, Western Reserve Health Education/Northeast Ohio Medical University, Warren, USA
| | - Lori Hemrock
- Medical Oncology, The Hope Center for Cancer Care, Warren, USA
| | | | - Gary Gibson
- Internal Medicine, Steward Health Care, Warren, USA
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Analysis of Head and Neck Primary Cutaneous Mucinous Carcinoma: An Indolent Tumor of the Eccrine Sweat Glands. J Craniofac Surg 2020; 32:e244-e247. [DOI: 10.1097/scs.0000000000006968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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3
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Urias D, Sylejmani GB, Rakovica L, Dumire R, Gassman A. Mucinous Eccrine Carcinoma of the Sweat Glands: Characteristics, Treatment, and Survival Outcomes of a Rare Malignancy. Am Surg 2018. [DOI: 10.1177/000313481808400815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel Urias
- Conemaugh Memorial Medical Center Johnstown, Pennsylvania
| | | | - Loran Rakovica
- Conemaugh Memorial Medical Center Johnstown, Pennsylvania
| | - Russell Dumire
- Conemaugh Memorial Medical Center Johnstown, Pennsylvania
| | - Andrew Gassman
- Conemaugh Memorial Medical Center Johnstown, Pennsylvania
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Lozada KN, Qazi MS, Khorsandi AS, Chai RL. Primary mucinous eccrine carcinoma of the buccal space: A case report and review of the literature. Am J Otolaryngol 2018; 39:242-246. [PMID: 29331306 DOI: 10.1016/j.amjoto.2017.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/29/2017] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Mucinous eccrine carcinoma is a rare entity that most commonly affects the head and neck. Due to its low frequency of occurrence, review of its etiology, histopathology, and treatment strategies is beneficial to all clinicians who may encounter similar appearing masses. OBSERVATION An 84-year-old male presented with a blue mass on the left cheek. This mass started as a small bump and grew significantly over one year. His primary care physician monitored its growth and ultimately referred to an otolaryngologist. Imaging findings revealed a multi-lobular solid and cystic left buccal lesion. FNA was suggestive of low grade mucoepidermoid carcinoma. INTERVENTION Patient underwent surgical excision with primary closure of the defect. Frozen section was consistent with low grade salivary malignancy. Final pathology revealed primary mucinous eccrine carcinoma of the skin. CONCLUSIONS AND RELEVANCE Mucinous eccrine carcinoma is a rare entity commonly seen in the head and neck region. Mucinous deposits to the skin from primaries elsewhere in the body are much more common than primary lesions of the skin. Histology is a key component of the diagnosis but full oncologic workup is required. Treatment typically includes wide local excision with possible adjuvant chemotherapy or radiation for high risk features.
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Affiliation(s)
- Kirkland N Lozada
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States.
| | - Muhammed S Qazi
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Azita S Khorsandi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Raymond L Chai
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Beteddini OSA, Sheikh S, Shareefi F, Shahab R. Primary mucinous adenocarcinoma of the scalp: A case report and literature review. Int J Surg Case Rep 2015; 10:241-4. [PMID: 25708135 PMCID: PMC4429839 DOI: 10.1016/j.ijscr.2015.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/31/2015] [Accepted: 02/02/2015] [Indexed: 11/04/2022] Open
Abstract
Primary mucinous adenocarcinoma of the skin is a rare tumour. Distinguishing between this primary neoplasm and the more frequently encountered metastatic mucinous deposits on the skin from primaries elsewhere is a diagnostic dilemma. Because of the high rate of recurrence, adequate excision with wide margins is advocated. Moh’s micrographic surgery can be a particularly advantageous treatment modality in this setting. Proper patient counselling and follow-up are important in treating this low-grade, indolent and frequently recurring tumour.
Introduction Primary mucinous adenocarcinoma or mucinous eccrine carcinoma of the skin is a rare malignant neoplasm showing predilection to the head and neck. Distinguishing between these primary neoplasms and the more frequent metastatic mucinous deposits on the skin from primaries in the breast and gastrointestinal tract constitutes a diagnostic dilemma. Presentation of case We report a case of a 61-year-old lady who presented with a slow-growing, painless scalp nodule. Upon excision, it was diagnosed as “primary mucinous adenocarcinoma”. An extensive work-up in search for another primary tumour failed to show a primary malignancy elsewhere and the diagnosis of a primary eccrine mucinous adenocarcinoma of the skin was rendered. Discussion A review of the literature on this entity is presented, discussing diagnostic challenges and therapeutic options that of interest to surgeons, pathologists and dermatologists. Conclusion These tumours are indolent and low-grade, with a tendency for local, sometimes multiple, recurrences. Proper patient counselling and follow-up are important in treatment. Sound collaboration between clinicians and pathologists, for good therapeutic results, is of utmost importance.
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Affiliation(s)
- Osama S Al Beteddini
- Surgery Department, Johns Hopkins Aramco Healthcare/Dhahran Health Center, Saudi Aramco, P.O. Box 76, Dhahran 31311, Eastern Province, Saudi Arabia.
| | - Salwa Sheikh
- Pathology Department, Johns Hopkins Aramco Healthcare/Dhahran Health Center, Saudi Aramco, P.O. Box 76, Dhahran 31311, Eastern Province, Saudi Arabia
| | - Faisal Shareefi
- Surgery Department, Johns Hopkins Aramco Healthcare/Dhahran Health Center, Saudi Aramco, P.O. Box 76, Dhahran 31311, Eastern Province, Saudi Arabia
| | - Rana Shahab
- Dermatology Department, Johns Hopkins Aramco Healthcare/Dhahran Health Center, Saudi Aramco, P.O. Box 76, Dhahran 31311, Eastern Province, Saudi Arabia
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Skin adnexal carcinoma of the head and neck: a retrospective study in a tertiary referral center. Eur Arch Otorhinolaryngol 2014; 272:1001-1010. [DOI: 10.1007/s00405-014-3324-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/06/2014] [Indexed: 11/28/2022]
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Zhang L, Ge S, Fan X. A brief review of different types of sweat-gland carcinomas in the eyelid and orbit. Onco Targets Ther 2013; 6:331-40. [PMID: 23620669 PMCID: PMC3633551 DOI: 10.2147/ott.s41287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Sweat-gland carcinoma is a rare cutaneous appendage malignant tumor. Primary sweat-gland cancer can arise in the eyelid and orbit and is extremely rare. It has been classified into different types, and is usually locally recurrent after surgery. The tumors also appear in the orbit, which is characterized by metastasis. Therefore, great attention should be paid to the development of sweat-gland carcinomas. Specifically, our report briefly reviews the types of sweat-gland carcinomas that occur in the eyelid and orbit according to pathological classifications.
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Affiliation(s)
- Leilei Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai, People's Republic of China
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8
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Mucinous eccrine carcinoma: a rare case of recurrence with lacrimal gland extension. Ophthalmic Plast Reconstr Surg 2012; 28:e109-10. [PMID: 22327636 DOI: 10.1097/iop.0b013e31823c80ba] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mucinous eccrine carcinoma (MEC) is a rare skin cancer of sweat gland origin with a high rate of recurrence. The most common sites are head and neck, with 40% of cancers found on the eyelid. The clinical appearance and differential diagnosis of MEC are highly varied, but histologically it is similar to metastatic carcinomas, specifically breast and colon. A diagnosis of primary MEC always warrants a full systemic workup to ensure that no other malignancy is present. This cancer is known for frequent recurrences, but rarely metastasizes to distant organs. MEC is resistant to both chemotherapy and radiation; surgical excision remains the treatment of choice in most cases. The authors report a unique case of extension of MEC to the lacrimal gland with a brief review of histologic characteristics of this tumor.
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Nizawa T, Oshitari T, Kimoto R, Kajita F, Yotsukura J, Asanagi K, Baba T, Takahashi Y, Oide T, Kiyokawa T, Kishimoto T, Yamamoto S. Early-stage mucinous sweat gland adenocarcinoma of eyelid. Clin Ophthalmol 2011; 5:687-9. [PMID: 21629575 PMCID: PMC3104798 DOI: 10.2147/opth.s19855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Indexed: 11/23/2022] Open
Abstract
We present the findings of an early-stage primary mucinous sweat gland adenocarcinoma in the lower eyelid of a Japanese patient. The patient was a 73-year-old man who had had a nodule on the left lower eyelid for two years. He was referred to our hospital with a diagnosis of a swollen chalazion. The clinical and histopathological records were reviewed and the mass was excised. Histopathological examination revealed a mucinous sweat gland adenocarcinoma. Postoperative magnetic resonance imaging and positron emission tomography excluded systemic metastases. After the histopathological findings, a complete surgical excision of the margins of the adenocarcinoma was performed, with histopathological confirmation of negative margins. After the final histopathological examination, the patient was diagnosed with a primary mucinous sweat gland adenocarcinoma of the left eyelid. Six months after the surgery, no recurrence has been observed. Because the appearance of mucinous sweat gland adenocarcinoma of the eyelid is quite variable, the final diagnosis can only be made by histopathological examination. A complete surgical excision is recommended.
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Affiliation(s)
- Tomohiro Nizawa
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
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10
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Sheth RN, Placantonakis DG, Gutin PH. Intracranial and spinal metastases from eccrine mucinous carcinoma: case report. Neurosurgery 2011; 67:E861-2. [PMID: 20657314 DOI: 10.1227/01.neu.0000377860.59894.a3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Mucinous eccrine carcinoma (MEC) is a rare but distinct type of sweat gland tumor. MECs tend to recur locally, and their spread to distant organs is very uncommon. This article describes the first case of MEC metastasizing to the brain and the spine. CLINICAL PRESENTATION A 45-year-old female presented with a 2-year history of a scalp mass in the occipital area with lymph node spread. She underwent excision of the mass and neck lymph node dissection. Pathology confirmed the diagnosis of MEC. Postoperatively, she received radiation to the involved areas. Four years later the patient presented with left hemiparesis and underwent craniotomy for gross total resection of the metastasis. This recurred after 2.5 years and she underwent another craniotomy for gross total resection followed by whole brain radiation. In addition, the patient had metastases to T11 vertebral body and the left C6 to 7 neural foramen. Moreover, the patient developed leptomeningeal disease in the spine. The metastases to the spine were treated with radiation therapy. The patient died 1.5 years later. CONCLUSION Even though it is rare for MEC to spread to distant organs, physicians should be aware of the risk of metastatic invasion of the brain and spine and be vigilant about surveillance of these sites. MEC metastases to the brain should be treated aggressively with surgical resection followed by stereotactic radiosurgery to the tumor bed. Spine metastases should be treated with a combination of surgery and image-guided radiation therapy, depending on the degree of cord compression from epidural metastatic disease.
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Affiliation(s)
- Rishi N Sheth
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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Segal A, Segal N, Gal A, Tumuluri K. Mucinous sweat gland adenocarcinoma of the eyelid - current knowledge of a rare tumor. Orbit 2010; 29:334-340. [PMID: 21158574 DOI: 10.3109/01676830.2010.516469] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To review the medical literature on mucinous sweat gland adenocarcinoma of the eyelid (MSA) and present two new cases. METHODS Details of published case reports and small series (between 1971-2010) were evaluated and summarized including two patients diagnosed and treated at our institution. Data regarding age, gender, ethnicity, precise location, clinical presentation, treatment and follow up of each patient were collected. RESULTS 25 reports describing 55 patients were found in the medical literature. The mean age was 61.3 years (30-87), 22(59%) were male and 28(80%) were Caucasian. In 23(44.2%) patients the lesion was in the lower lid, in 20(38.5%) in the upper lid, in 3(5.7%) involving both lids and in 6(11.6%) in a canthus. In 12(21.8%) patients a lesion with a benign diagnosis was previously excised from the same location. In 2 of them histological re-examination resulted in a diagnosis of MSA. Intraorbital involvement was found in 2(3.6%) patients. Regional lymph node metastasis was found in 2(4.4%) patients. Surgical excision was the treatment of choice using Mohs' micrographic-controlled excision technique in recent years. Radiotherapy was applied to 2 patients with clinical resolution in 1. Recurrence of the tumor was reported in 14(30%) patients. CONCLUSIONS MSA is a rare tumor of the eyelid with no clinically distinguishing features. It should be suspected particularly with recurrent eyelid lesions and must be differentiated from metastatic disease. The tumor may extend into the orbit and metastasize regionally. Surgical removal with continued regular follow-up examination is the treatment of choice.
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Affiliation(s)
- Avichai Segal
- Oculoplastic Surgery Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia.
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12
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Kim JB, Choi JH, Kim JH, Park HJ, Lee JS, Joh OJ, Song KY. A case of primary cutaneous mucinous carcinoma with neuroendocrine differentiation. Ann Dermatol 2010; 22:472-7. [PMID: 21165225 DOI: 10.5021/ad.2010.22.4.472] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/02/2010] [Accepted: 03/03/2010] [Indexed: 11/08/2022] Open
Abstract
Primary cutaneous mucinous carcinoma is a rare malignant tumor that originates from the deepest portion of the eccrine sweat duct. Common sites of involvement are the face and scalp. Biopsy shows dermal epithelial cell islands embedded in mucin pools separated by fibrous septae. It is difficult to differentiate this tumor histologically from metastatic adenocarcinoma. Recurrence after excision is common but metastases are rare. We report a primary cutaneous mucinous carcinoma with neuroendocrine differentiation on the right cheek of a 63-year-old man.
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Affiliation(s)
- June-Bum Kim
- Department of Dermatology, Seoul Veterans Hospital, Seoul, Korea
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13
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Boussofara L, Ghariani N, Yacoubi MT, Denguezli M, Belajouza C, Nouira R. [A large temporal tumor]. Ann Pathol 2008; 28:514-6. [PMID: 19084724 DOI: 10.1016/j.annpat.2007.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2007] [Indexed: 11/18/2022]
Affiliation(s)
- Lobna Boussofara
- Service de Dermatologie, Faculté de Médecine Ibn Jazzar, CHU Farhat-Hached, 4002 Sousse, Tunisie
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Cecchi R, Rapicano V. Primary cutaneous mucinous carcinoma: Report of two cases treated with Mohs' micrographic surgery. Australas J Dermatol 2006; 47:192-4. [PMID: 16867002 DOI: 10.1111/j.1440-0960.2006.00271.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a 72-year-old woman who presented with a slowly enlarging, asymptomatic, cystic nodule on the right eyebrow, and a 66-year-old woman who had a reddish, nodular lesion on the left lower eyelid. Incisional biopsy from the two neoplasms showed dermal epithelial cell islands embedded in mucin pools. Tumour cells stained positive for cytokeratin 7, oestrogen and progesterone receptors, and negative for vimentin and S-100 protein. These findings were consistent with a diagnosis of mucinous carcinoma. Extensive work-ups excluded cutaneous metastases from primary visceral mucinous carcinomas. To ensure complete tumour removal, both patients underwent Mohs' micrographic surgery (standard fresh-frozen technique). They remain disease-free 42 and 26 months after surgical excision, respectively. Mohs' micrographic surgery appears to be a rational and effective treatment for this uncommon malignancy.
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Affiliation(s)
- Roberto Cecchi
- Department of Dermatology, Spedali Riuniti, Pistoia, Italy.
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Abstract
BACKGROUND Squamoid eccrine ductal carcinoma is a rare cutaneous malignancy. There are no accepted standards for surgical margins in eccrine carcinomas. OBJECTIVE We report a case of squamoid eccrine ductal carcinoma resembling squamous cell carcinoma and discuss Mohs micrographic surgery as a surgical modality for eccrine carcinomas. METHOD The patient was a 30-year-old Korean woman with a 4-year history of a nodule on her neck. Following primary diagnosis of squamous cell carcinoma by punch biopsy, the tumor was completely removed by Mohs micrographic surgery with a 2 mm cancer-free margin. RESULT A one-stage Mohs micrographic surgical procedure was performed, and the size of the tumor mass was 2.3 x 2.5 cm in width and 1.5 cm in depth. On histopathologic examination, the tumor was characterized by both eccrine and squamous differentiation. The squamous cells expressed epithelial membrane antigen and cytokeratin 5 and 6, and the cells forming ductal structures expressed anti-carcinoembryonic antigen. Although eccrine carcinomas show a generally aggressive clinical course, the patient was disease free at 14 months after surgery. DISCUSSION Squamoid eccrine ductal carcinoma should be considered in the differential diagnosis of squamous cell carcinoma and other cutaneous adnexal neoplasms showing squamoid and ductal features of differentiation. In addition, Mohs micrographic surgery can be an option sufficient for complete surgical removal of eccrine carcinomas such as squamoid eccrine ductal carcinoma.
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Affiliation(s)
- Yong Ju Kim
- Department of Dermatology, Korea University Guro Hospital, Seoul, Korea
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Mohs Micrographic Surgery for Squamoid Eccrine Ductal Carcinoma. Dermatol Surg 2005. [DOI: 10.1097/00042728-200511000-00019] [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]
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Bindra M, Keegan DJ, Guenther T, Lee V. Primary cutaneous mucinous carcinoma of the eyelid in a young male. Orbit 2005; 24:211-4. [PMID: 16169809 DOI: 10.1080/01676830590946970] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Primary cutaneous mucinous carcinoma of the eyelid is an adenocarcinoma of the eccrine glands. It is rare and locally aggressive but the prognosis following local excision, confirmed with tumour-free margins, is good. This tumour is usually described in the elderly. We present the occurrence, clinical and histological features, and management of this tumour in a young male.A 36-year-old male presented with a small cystic right lower lid lesion, which had increased in size and pigmentation over two years. He underwent excision biopsy for diagnostic purposes followed by Moh's micrographic surgical removal. The defect was repaired with an upper eyelid skin graft. A full oncological screen including whole-body computed tomography scan excluded the presence of primary mucinous carcinoma elsewhere and any metastatic spread. There has been no recurrence of tumour 18 months following excision. Ophthalmologists should be aware of the occurrence of this tumour in a younger age group than previously described. Moh's micrographic surgery is the most suitable method of treatment following exclusion of both distant primaries and metastases.
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Affiliation(s)
- M Bindra
- Central Eye Service, Central Middlesex Hospital, London, U.K
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Jih MH, Friedman PM, Kimyai-Asadi A, Goldberg LH. A rare case of fatal primary cutaneous mucinous carcinoma of the scalp with multiple in-transit and pulmonary metastases. J Am Acad Dermatol 2005; 52:S76-80. [PMID: 15858515 DOI: 10.1016/j.jaad.2004.06.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Primary cutaneous mucinous carcinoma is a rare neoplasm derived from the sweat glands. It is usually located in the head and neck region, with the eyelids being the most common site of presentation. Recurrence following primary excision is common but metastasis is rare. CASE REPORT We report a patient presenting with rapidly progressive cutaneous mucinous carcinoma on the right parietal scalp. Systemic work-up failed to reveal an occult primary source. The tumor was treated with Mohs micrographic surgery with clear margins. However, within two months, the patient developed new lesions on the scalp both adjacent to and separate from the original previously excised area, as well as metastasis to the right parotid gland. The patient received adjuvant radiation therapy both to the scalp lesions and to the parotid gland with apparent control of locoregional disease. However, two weeks after completing radiation therapy, the patient was found to have developed pulmonary metastases and died soon thereafter. CONCLUSION Primary mucinous carcinoma arising in the skin is rare and usually follows an indolent course. We report the rare occurrence of a mucinous carcinoma of the scalp that developed multiple cutaneous tumors caused by in-transit metastases, as well as parotid gland metastases and eventual fatal pulmonary metastases.
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Affiliation(s)
- Ming H Jih
- DermSurgery Associates, Houston, Texas 77030, USA.
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Abstract
BACKGROUND Eccrine carcinomas (ECs) are rare tumors with potentially aggressive clinical behavior and a high recurrence rate following conventional surgical excision. With the exception of microcystic adnexal carcinoma (MAC), there have been few reports on the use of Mohs micrographic surgery (MMS) as a primary treatment for EC. OBJECTIVE To review the use of MMS for EC and compare treatment outcomes with those of conventional surgical excision. METHODS We report our use of MMS in 7 cases of EC and review the literature regarding the use of MMS for EC excluding microcystic adnexal carcinoma (MAC), which has been described elsewhere. RESULTS A total of 19 case reports describing MMS for non-MAS malignant eccrine neoplasms were reviewed. There were no reported recurrences over an average follow-up period of 29 months, whereas the local recurrence rate following conventional surgical excision of these neoplasms from 10-70%. CONCLUSIONS While the clinical experience is limited, the use of MMS appears to decrease recurrence rates when compared to conventional surgical excision. Further experience and longer follow-up intervals will be necessary to demonstrate superior efficacy and recommended surgical margins.
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Affiliation(s)
- John K Wildemore
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Schwartz RA, Wiederkehr M, Lambert WC. Secondary mucinous carcinoma of the skin: metastatic breast cancer. Dermatol Surg 2004; 30:234-5. [PMID: 14756660 DOI: 10.1046/j.1076-0512.2003.30074.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer in women. Its involvement of skin is the most frequent of visceral cancers in women. In cutaneous metastatic disease, including breast cancer, the clinical and histologic pattern may be specific or nonspecific. Specific clinical patterns of cutaneous metastatic disease are linked with breast cancer but occur less often with other cancers metastatic to skin. Likewise, specific histologic patterns of cutaneous metastatic disease are linked with breast cancer but occur less often with other cancers metastatic to skin. OBJECTIVE To present a case of a mucinous breast cancer metastatic to skin where the histologic pattern is similar to the primary tumor. METHODS This is a case report and a literature review. RESULTS Metastatic breast cancer may rarely resemble primary skin cancer, in this case primary mucinous carcinoma of the skin. We describe a 60-year-old woman with breast cancer with the incidental finding of a nonspecific, soft, solitary nodule on her back. It was found to contain mucinous material and on close examination was found to be a metastatic mucinous carcinoma of the skin from a primary adenocarcinoma of the breast. CONCLUSION One usually considers that hard, firm nodules are more suggestive of cutaneous metastatic disease than soft, nondescript ones, but one should be careful to consider secondary mucinous carcinoma of the skin and a histologically similar solitary cutaneous metastasis.
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Affiliation(s)
- Robert A Schwartz
- Dermatology and Pathology, New Jersey Medical School, Newark, New Jersey, USA
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Secondary Mucinous Carcinoma of the Skin. Dermatol Surg 2004. [DOI: 10.1097/00042728-200402000-00029] [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]
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