Sclerosing sweat duct carcinoma in the peri-anal skin: a case report

Microcystic adnexal carcinoma: successful management of a large scalp lesion

Microcystic adnexal carcinoma (MAC) is a rare, malignant cutaneous neoplasm. It is important for us to become more aware of it, as it is often misdiagnosed, either clinically or histopathologically. We report a case of an extensive scalp lesion that was successfully treated using a combination of resection and adjuvant radiotherapy.

Cytologic features of microcystic adnexal carcinoma

Microcystic adnexal carcinoma (MAC) is an uncommon skin neoplasm with a predilection location around the lips. It is characterized by cords and nests of neoplastic cells forming ductular or glandular structures that are embedded in dense collagenous stroma. An eighty-seven year old Caucasian female patient presented with a painless, slowly enlarging mass measuring 3.3 × 2.7 × 1.0 cm on the lower lip for approximately 6 months. The patient underwent 2 fine needle aspiration biopsies (FNAs). Smears made from both FNAs demonstrated similar features including low cellular smears, three dimensional cell clusters forming a glandular structure, round to oval cells with high N:C ratio, occasional cytoplasmic lumens, without distinct hyperchromasia, focal inconspicuous nucleoli, smooth regular nuclear membranes, abundant naked nuclei, occasional squamoid cells and focal acellular stromal fragments in the background. The cytologic differential diagnosis included skin adnexal carcinoma and low grade mucoepidermoid carcinoma arising in the minor salivary gland. The mass was subsequently excised. The diagnosis of microcystic adnexal carcinoma was made. We report cytologic features of MAC and also suggest that MAC can possibly be diagnosed by FNA with the appropriate clinical vignette and immunohistochemical profile..

Microcystic adnexal carcinoma of the skin: the role of adjuvant radiotherapy

INTRODUCTION

Microcystic adnexal carcinoma (MAC) is a rare cutaneous tumour where the role of radiotherapy remains undefined. We contrast our institutional experience with current literature, define the local control rate and suggest a role for adjuvant radiotherapy in the treatment of this cancer.

METHODS

From 1992-2008, a retrospective review was undertaken for MAC treated with curative intent involving surgery and adjuvant radiotherapy at the Royal Brisbane Hospital and Mater Hospital Brisbane. Clinical, pathologic and treatment details as well as patterns of recurrence were analysed.

RESULTS

Fourteen cases of MAC received local excision and adjuvant radiotherapy. The median age was 71 years old, with nine of the cases in men. All cases occurred in the head and neck region with mean tumour size of 20.5 mm and mean depth of invasion of 9.9 mm. Peri-neural invasion occurred in 56% of cases and 69% had positive surgical margins. Various adjuvant radiotherapy schedules were used to treat the primary site resulting in a crude local control rate of 93%. Primary and nodal relapses were subsequently salvaged with further treatment.

CONCLUSION

While Mohs micrographic surgery may be considered the gold standard, wide local excision and adjuvant radiotherapy offers comparable control rates. Doses of 50 Gy or greater should be prescribed with generous margins (3-5 cm) owing to its tendency for peri-neural and deep invasion. There was no evidence that radiotherapy can cause aggressive transformation of the tumour. The role for definitive radiotherapy remains uncertain.

[Anal and anal margin tumors]

Tumors of the anal canal and anal margin are rare. They may raise specific problems for the pathologist. Benign tumors mainly consist of condylomas, cloacogenic polyps and fibro-epithelial polyps. Cancers are infrequent and consisted of well-differentiated squamous cell carcinoma, or poorly differentiated basaloid squamous cell carcinoma. The other malignant tumors are very rare.

First male apocrine genital carcinoma mimicking a penile cancer

Perineal apocrine carcinoma is a rare malignant tumor that has its origin in the apocrine sudoriparous glands of the genital and perianal regions. It often progresses quietly and metastasizes in the superficial inguinal and retrorectal lymph nodes. We report a case of a genital apocrine carcinoma located at the penile basis. To our knowledge our report represents the first case of a pathologically confirmed genital apocrine carcinoma mimicking a penile cancer.

Sweat duct carcinoma of lip with multiple cervical lymph nodes metastasis

Sclerosing sweat duct carcinoma (SSDC) is a rare cutaneous neoplasm. A 28-year-old man presented with 2-3 years history of a tetter on his upper lip, and a 3 cm x 4 cm lymph node was palpable in the left submandibular area. MRI showed a mass in the upper lip extending into the buccal mucosa and orbicular muscle, and multiple cervical lymph nodes metastasis on both sides was suspected. A biopsy was performed to have revealed syringomatous carcinoma. The patient underwent operation of extended removal of the upper lip along with right upper neck dissection and left radical neck dissection. 8 cm x 6 cm sized free forearm flap was used for the reconstruction of the lip. Postoperative course of the patient was uneventful and he has no signs of recurrence so far. Pertinent literatures on this rare tumor are reviewed.

Microcystic Adnexal Carcinoma: Report of Seven Cases Including One with Lung Metastasis

BACKGROUND

Microcystic adnexal carcinoma (MAC) is a rare cutaneous neoplasm, with a high rate of local recurrences.

OBJECTIVE

A series of MAC was analyzed and compared to previously published cases.

METHODS

Seven cases of MAC were identified in the register of the institution. Medical and pathological records were reviewed.

RESULTS

The primary MAC were located on the face in all patients, and 85% were initially misdiagnosed. The mean follow-up duration was 108 months. The recurrence rate was high: 4 patients developed recurrences. In 3 patients, the course of the disease was severe: one of them developed pathologically proven lung metastasis.

CONCLUSION

The present study and review of the literature confirm the clinically aggressive evolution of MAC and its rare ability to give rise to metastasis. Long-term clinical follow-ups with imaging investigations are mandatory.

Proximal-Type Epithelioid Sarcoma: Report of Two Cases in the Perineum

The authors report two cases of perineal proximal-type epithelioid sarcoma in middle-aged men, age 51 and 43 years old. Both tumors were located in the right side. In the first patient a 7.5-cm, well-encapsulated tumor was completely excised. The second patient was a referral case with incomplete excision, but the computed tomography scan and magnetic resonance imaging showed a 14-cm nonencapsulated tumor involving the soft tissues of the inner thigh and perineum, as well as metastasis in right inguinal and retroperitoneal lymph nodes. Both neoplasms had a predominant solid pattern alternating with occasional discohesive areas. Both were composed of large oval to polygonal cells with vesicular nuclei, conspicuous nucleoli, and amphophilic to eosinophilic cytoplasm. Rhabdoid phenotype was identified in the second case only. The first neoplasm displayed 15% necrosis, 7 mitoses per 10 high-power field, focal vascular invasion, and no extracapsular invasion. The other exhibited 60% necrosis, 12 mitoses per 10 high-power fields, extensive vascular invasion, no distinct capsule, and invasion of the surrounding fatty tissue. Both were positive for vimentin, cytokeratin, epithelial membrane antigen, and CD34. Muscle-specific actin was negative in the first case and focally positive in the second. CD56 was positive in the second case and negative in the first case. Desmin, CD45, CD30, factor VIII, CD31, S100, HMB45, calretinin, and synaptophysin were negative in both. Since proximal-type epithelioid sarcoma can be confused with a number of other soft tissue tumors with epithelioid and/or rhabdoid features, the authors emphasize the immunohistochemical differential diagnosis.

Microcystic adnexal carcinoma: report of four cases treated with Mohs' micrographic surgical technique

BACKGROUND

Microcystic adnexal carcinoma (MAC) is a rare and aggressive malignant tumor of the sweat glands. Clinically, it often presents as a firm subcutaneous nodule on the head and neck regions. On histology, MAC exhibits both pilar and sweat duct differentiation with a stroma of dense collagen. It often extends beyond the clinical margins with local spreading in the dermal, subcutaneous, and perineural tissue planes. It has a high local recurrence rate after standard excision. Recent preliminary reports have indicated more favorable cure rates with Mohs' micrographic surgery (MMS).

OBJECTIVE

To present our data on four cases of MAC treated by MMS. We also compared our findings with more recently reported series in the English language literature.

METHODS

We reviewed the medical records of four patients (two males and two females) with MAC treated by MMS over the last 3 years. We also obtained follow-up data.

RESULTS

In all four patients with MAC treated by MMS, there were no recurrences, with a mean follow-up of 1 year.

CONCLUSION

We report an additional four MAC cases treated by MMS. The accumulated data continue to confirm that, if the diagnosis of MAC is made early, and if the anatomic location is accessible to excision by MMS, a favorable outcome can be expected.

Metastatic microcystic adnexal carcinoma in an immunocompromised patient

BACKGROUND

Microcystic adnexal carcinoma is an uncommon, locally aggressive cutaneous neoplasm. To date, there are only two reports of histologically proven lymph node involvement with this tumor. We describe a case of a patient with microcystic adnexal carcinoma who developed multiple local metastasis in transit with histologically proven lymph node involvement and was diagnosed with chronic lymphocytic leukemia.

OBJECTIVE

To describe the details of our case and to review what is currently known about this tumor.

METHODS

Mohs micrographic surgery was utilized for tumor removal.

RESULTS

This patient developed multiple tumors of the scalp over the period of a 1 year which were histologically proven to be microcystic adnexal carcinoma. All tumors were noncontiguous and presented on the scalp. During the histologic analysis of the last tumor removed by Mohs micrographic surgery a lymph node was resected which revealed infiltrative microcystic adnexal carcinoma.

CONCLUSIONS

We present the case of an immunocompromised patient treated for microcystic adnexal carcinoma with Mohs micrographic surgery who proceeded to develop local metastasis in transit.