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Ahmed MB, Elzawawi KE, AlHammadi A, Al-Malki A, Petkar M, Al Lahham S, Alsherawi A. A malignant spiradenoma of the forehead: a case report and literature review. Oxf Med Case Reports 2024; 2024:omae016. [PMID: 38532757 PMCID: PMC10962237 DOI: 10.1093/omcr/omae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/27/2024] [Indexed: 03/28/2024] Open
Abstract
Spiroadenomas, arising from sweat glands, are rare benign skin tumors primarily found as solitary nodules on the head, neck, and trunk. The malignant subtype, Spiradenocarcinoma (MSA), originating from benign spiradenomas, is extremely rare and occurs mainly in individuals over 50. MSA exhibits aggressiveness with higher metastasis rates and lower survival rates. Surgical excision is the standard management, supported by imaging modalities like MRI, CT-scan, and ultrasound. We present a 69-year-old female with a medical history of diabetes, hypertension, and dyslipidemia who presented in 2014 with multiple swellings on the forehead and left arm. Initial excisions revealed capillary hemangioma lesions. Subsequent visits involved the excision of further facial and body lesions, with some identified as intradermal nevi. In 2022, she presented to plastic surgery clinic with forehead swelling. The biopsy showed MSA lesion with involved margins. Thus, subsequent re-excision was carried out. One year later, she came with recurrent forehead swelling. Excision and direct closure of the lesion showed involvement of part of the subcutaneous tissue (fat globule) showing residual/recurrent MSA that is very close to nerve trunks. Malignant Spiradenomas (MSAs) usually arise from benign spiradenomas. Therefore, consideration is given to preemptive removal of these tumors due to their potential evolution. The primary treatment approach involves surgery, with a focus on wide local excision and a minimum margin of 1 cm to diminish the risk of metastasis. Vigilant follow-up is essential to promptly identify any recurrences or spreading.
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Affiliation(s)
- Mohamed Badie Ahmed
- Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Ayda AlHammadi
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
| | - Aysha Al-Malki
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
| | - Mahir Petkar
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Salim Al Lahham
- Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abeer Alsherawi
- Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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2
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Martineau J, Walz SN, Scampa M, Giordano S, Kalbermatten DF, Oranges CM. Spiradenocarcinoma: SEER Study of Epidemiology, Survival, and Treatment Options. J Clin Med 2023; 12:jcm12052045. [PMID: 36902832 PMCID: PMC10004548 DOI: 10.3390/jcm12052045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/09/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
(1) Background: Spiradenocarcinoma is an extremely rare malignant adnexal tumor and there are only few studies on survival outcomes. Our aim was to perform an analysis of the demographic and pathological characteristics, treatment patterns, and survival outcomes of patients affected by spiradenocarcinoma. (2) Methods: The Surveillance, Epidemiology, and End Results program database of the National Cancer Institute was searched for all cases of spiradenocarcinoma diagnosed between 2000 and 2019. This database is considered representative of the US population. Demographic, pathological, and treatment variables were retrieved. Overall and disease-specific survival were computed according to the different variables. (3) Results: 90 cases of spiradenocarcinoma (47 females, 43 males) were identified. Mean age at diagnosis was 62.8 years. Regional and distant disease at diagnosis were rare, occurring in 2.2% and 3.3% of cases, respectively. Surgery alone was the most frequent treatment (87.8%), followed by a combination of surgery and radiotherapy (3.3%) and radiation therapy only (1.1%). Five-year overall survival was 76.2% and five-year disease-specific survival was 95.7%. (4) Conclusions: Spiradenocarcinoma equally affects males and females. Regional and distant invasion rates are low. Disease-specific mortality is low and is probably overestimated in the literature. Surgical excision remains the main form of treatment.
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Affiliation(s)
- Jérôme Martineau
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Solange N. Walz
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Matteo Scampa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Salvatore Giordano
- Department of General and Plastic Surgery, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Daniel F. Kalbermatten
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
| | - Carlo M. Oranges
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-(0)223-727-997
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3
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Akgun GA, Ahmedov A, Parlar Aİ, Metineren MH, Deger AN. Lymphangiectatic Variant of Low-Grade Malignant Eccrine Spiradenoma. Ann Dermatol 2023; 35:71-74. [PMID: 36750462 PMCID: PMC9905852 DOI: 10.5021/ad.20.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 02/03/2023] Open
Abstract
Low-grade malignant eccrine spiradenoma (spiradenocarcinoma) is a rare sweat gland tumor, which usually arises from a pre-existing benign eccrine spiradenoma. This paper presents the case of a 55-year-old male who had a lesion in his right elbow for 10 years. The microscopic examination revealed a well-demarcated, multilobulated tumor in the dermis and subcutis, which presented with many blood-filled vessels and extensive hemorrhage. The tumor was composed of hyperchromatic, round to oval cells with nucleolar prominence, mild to moderate atypia, and increased mitotic index. Additionally, lymphangiectatic appearance was observed in areas with prominent stromal lymphedema. P53 and Ki-67 had high positivity. Surgical excision of the lesion was performed with adequate surgical margins, and the dissected lymph nodes in the axilla were tumor-negative. After 15 months of follow-up, there was no recurrence or distant metastasis.
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Affiliation(s)
- Gizem Akkas Akgun
- Department of Pathology, Kutahya University of Health Sciences, Kutahya, Turkey.
| | - Anvar Ahmedov
- Department of Plastic Surgery, Kutahya University of Health Sciences, Kutahya, Turkey
| | - Ali İhsan Parlar
- Department of Cardiovascular Surgery, Kutahya University of Health Sciences, Kutahya, Turkey
| | | | - Ayse Nur Deger
- Department of Pathology, Kutahya University of Health Sciences, Kutahya, Turkey
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4
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Lach K, Gharpuray-Pandit D, Franko A, Brenn T. Distant metastasis from morphologically low-grade spiradenocarcinoma: A report of two cases. J Cutan Pathol 2023. [PMID: 36617528 DOI: 10.1111/cup.14388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/16/2022] [Accepted: 01/03/2023] [Indexed: 01/10/2023]
Abstract
Malignant tumors arising from benign eccrine spiradenomas are rare. They are divided by morphology into low-grade and high-grade spiradenocarcinomas, with prognosis and metastatic potential closely linked to their histopathologic features. Tumors with low-grade morphology are known for their indolent behavior, with only two reported instances of metastatic spread. We report herein two further low-grade metastatic spiradenocarcinomas resulting in distant metastasis. Both tumors showed a background of a benign spiradenoma and subtle histopathologic signs of malignant transformation, characterized by loss of the dual-cell population, up to moderate cytological atypia and increased mitotic activity. Both patients developed metastases to the lungs years after the initial presentation, and one showed additional lymph nodal disease. We show that even the morphologically low-grade tumors may rarely show more aggressive behavior. Although often challenging, recognition of the morphologically low-grade malignant spiradenocarcinoma and long-term follow-up of the patients are important to detect metastatic disease.
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Affiliation(s)
- Katherine Lach
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Angela Franko
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Thomas Brenn
- Department of Pathology and Laboratory Medicine, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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5
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Adnexal and Sebaceous Carcinomas. Dermatol Clin 2022; 41:117-132. [DOI: 10.1016/j.det.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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6
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Kibe Y, Tanahashi K, Ohtakara K, Okumura Y, Ohka F, Takeuchi K, Nagata Y, Motomura K, Akahori S, Mizuno A, Sasaki H, Shimizu H, Yamaguchi J, Nishikawa T, Yokota K, Saito R. Direct intracranial invasion of eccrine spiradenocarcinoma of the scalp: a case report and literature review. BMC Neurol 2022; 22:223. [PMID: 35717180 PMCID: PMC9206259 DOI: 10.1186/s12883-022-02749-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Eccrine spiradenocarcinoma (SC), also known as malignant eccrine spiradenoma, is a rare malignant cutaneous adnexal neoplasm arising from long-standing benign eccrine spiradenoma. Malignant skin tumors rarely show direct intracranial invasion. However, once the intracranial structure is infiltrated, curative excision with sufficient margins can become extremely difficult, particularly when the venous sinuses are involved. No effective adjuvant therapies have yet been established. Here, we report an extremely rare case of scalp eccrine SC with direct intracranial invasion, which does not appear to have been reported previously. Case presentation An 81-year-old woman presented with a large swelling on the parietal scalp 12 years after resection of spiradenoma from the same site. The tumor showed intracranial invasion with involvement of the superior sagittal sinus and repeated recurrences after four surgeries with preservation of the sinus. The histopathological diagnosis was eccrine SC. Adjuvant high-precision external beam radiotherapy (EBRT) proved effective after the third surgery, achieving remission of the residual tumor. The patient died 7 years after the first surgery for SC. Conclusions Scalp SC with direct intracranial invasion is extremely rare. Radical resection with tumor-free margins is the mainstay of treatment, but the involvement of venous sinuses makes this unfeasible. High-precision EBRT in combination with maximal resection preserving the venous sinuses could be a treatment option for local tumor control.
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Affiliation(s)
- Yuji Kibe
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kuniaki Tanahashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Kazuhiro Ohtakara
- Department of Radiation Oncology, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi, Japan
| | - Yuka Okumura
- Department of Pathology and Laboratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Fumiharu Ohka
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kazuhito Takeuchi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yuichi Nagata
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kazuya Motomura
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Sho Akahori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Akihiro Mizuno
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroo Sasaki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroyuki Shimizu
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Junya Yamaguchi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Tomohide Nishikawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kenji Yokota
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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7
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Wargo JJ, Carr DR, Plaza JA, Verschraegen CF. Metastatic Spiradenocarcinoma Managed With PD-1 Inhibition. J Natl Compr Canc Netw 2022; 20:1-3. [PMID: 35196645 DOI: 10.6004/jnccn.2021.7119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
Spiradenomas are rare skin adnexal tumors, usually benign, appearing in early adulthood. The etiology of this tumor is still debated. The tumor suppressor gene CYLD, responsible for the Brooke-Spiegler syndrome, causes spiradenomas, trichoepitheliomas, and cylindromas. With time, spiradenomas can degenerate into aggressive spiradenocarcinomas. With only 117 malignant cases reported, treatment recommendations are based on case reports and expert opinion. There is no standard of care beyond surgical resection for localized disease and no guidelines for management of metastatic disease. With the advent of immunotherapy and PD-1 inhibition, we present the first reported case of a metastatic spiradenocarcinoma managed with pembrolizumab.
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Affiliation(s)
| | | | - Jose A Plaza
- Department of Pathology, The Ohio State University Wexner Medical Center; and
| | - Claire F Verschraegen
- Division of Medical Oncology, The Ohio State University James Cancer Hospital, Columbus, Ohio
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8
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Wu C, Chow M, Temby M, McCalmont TH, Daud A. Response to PD-1 Immunotherapy in Metastatic Spiradenocarcinoma. JCO Precis Oncol 2022; 5:340-343. [PMID: 34994598 DOI: 10.1200/po.20.00285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Clinton Wu
- Departments of Melanoma Oncology, University of California, San Francisco, San Francisco, CA
| | - Melissa Chow
- Departments of Melanoma Oncology, University of California, San Francisco, San Francisco, CA
| | - Michelle Temby
- Departments of Melanoma Oncology, University of California, San Francisco, San Francisco, CA
| | - Timothy H McCalmont
- Departments of Dermatology and Pathology, University of California, San Francisco, San Francisco, CA
| | - Adil Daud
- Departments of Melanoma Oncology, University of California, San Francisco, San Francisco, CA
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9
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Current Diagnosis and Treatment Options for Cutaneous Adnexal Neoplasms with Apocrine and Eccrine Differentiation. Int J Mol Sci 2021; 22:ijms22105077. [PMID: 34064849 PMCID: PMC8151110 DOI: 10.3390/ijms22105077] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/15/2021] [Accepted: 05/02/2021] [Indexed: 12/16/2022] Open
Abstract
Adnexal tumors of the skin are a rare group of benign and malignant neoplasms that exhibit morphological differentiation toward one or more of the adnexal epithelium types present in normal skin. Tumors deriving from apocrine or eccrine glands are highly heterogeneous and represent various histological entities. Macroscopic and dermatoscopic features of these tumors are unspecific; therefore, a specialized pathological examination is required to correctly diagnose patients. Limited treatment guidelines of adnexal tumor cases are available; thus, therapy is still challenging. Patients should be referred to high-volume skin cancer centers to receive an appropriate multidisciplinary treatment, affecting their outcome. The purpose of this review is to summarize currently available data on pathogenesis, diagnosis, and treatment approach for apocrine and eccrine tumors.
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10
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Wagner K, Jassal K, Lee JC, Ban EJ, Cameron R, Serpell J. Challenges in diagnosis and management of a spiradenocarcinoma: a comprehensive literature review. ANZ J Surg 2021; 91:1996-2001. [PMID: 33522696 DOI: 10.1111/ans.16626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spiradenocarcinoma is a rare skin adnexal neoplasm that may behave aggressively. It is often associated with a benign slow-growing spiradenoma that has undergone malignant transformation. Given the paucity of cases in the literature, there is a lack of consensus on treatment. METHODS The terms 'malignant spiradenoma' or 'spiradenocarcinoma' were systematically used to search the PubMed, MEDLINE and Google Scholar databases. A total of 182 cases of spiradenocarcinoma were identified as eligible for this comprehensive literature review. RESULTS Spiradenocarcinoma was commoner in older age and Caucasian race. In most cases, surgical excision for local disease is the mainstay of treatment. Lymph node dissection is usually reserved for those with suspected or confirmed lymph node metastases. High rates of local recurrence (20.8%), metastasis (37.4%) and mortality (19.1%) were identified, prompting some authors to suggest regular follow up including chest X-rays and liver function tests. CONCLUSIONS Patients with spiradenocarcinoma may benefit from a magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography/computed tomography to establish the extent of disease. We recommend wide local excision as the treatment of choice to achieve surgical margins of ≥1 cm, with node resection to be determined on a case-to-case basis. Regular follow up is important given the high rate of local recurrence, metastasis and mortality. This should include an examination of the regional lymph nodes. Further research is required to refine an evidence-based approach to spiradenocarcinoma.
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Affiliation(s)
- Katy Wagner
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Karishma Jassal
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - James C Lee
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Ee-Jun Ban
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Rhoda Cameron
- Department of Pathology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jonathan Serpell
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
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11
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You D, Ma Z, Liu J, Song X, Dong W. Malignant Eccrine Spiradenoma of the External Auditory Canal: A Case Report and Literature Review. Front Oncol 2021; 10:574112. [PMID: 33469512 PMCID: PMC7813981 DOI: 10.3389/fonc.2020.574112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Spiradenocarcinoma, or malignant eccrine spiradenoma (MES), is a rare sweat gland tumor originating from eccrine sweat glands. To the best of our knowledge, only two cases of MES of the external auditory canal have been reported to date. Here, we report a third case of MES located in the external auditory canal.
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Affiliation(s)
- Dong You
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Yantai, China
| | - Zhao Ma
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Yantai, China
| | - Jing Liu
- Department of Pathology, Yantai Yuhuangding Hospital, Yantai, China
| | - Xiao Song
- Department of Pathology, Rongcheng City People's Hospital, Rongcheng, China
| | - Wei Dong
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Yantai, China
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12
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Held L, Ruetten A, Saggini A, Kempter W, Tiedke C, Weber-Kuhn S, De Saint Aubain N, Mentzel T. Metaplastic spiradenocarcinoma: Report of two cases with sarcomatous differentiation. J Cutan Pathol 2020; 48:384-389. [PMID: 33051901 DOI: 10.1111/cup.13897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 01/09/2023]
Abstract
Spiradenocarcinoma (SC) is a very rare malignant skin adnexal tumor with sweat gland differentiation that develops from a pre-existing spiradenoma, cylindroma, or hybrid tumor called spiradenocylindroma, or arises de novo. We present two exceptionally rare SC cases showing sarcomatous differentiation; we also discuss the clinicopathologic features of SC, as well as its differential diagnoses and available therapeutic modalities. Given the aggressive behavior of SC, rapid diagnosis and complete removal of the tumor with tumor-free margins is mandatory. Owing to the marked morphological heterogeneity of individual SC cases, dermatopathologists must be familiar with the different possible histopathologic manifestations of this neoplasm.
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Affiliation(s)
- Laura Held
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | - Arno Ruetten
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | - Andrea Saggini
- Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - Carmen Tiedke
- Centre of Orthopedic and Trauma Surgery, Department of Oncologic Surgery, Sarcoma Centre Berlin, Brandenburg, Berlin, Germany
| | - Susanne Weber-Kuhn
- Pathology Department, MVZ am Helios Klinikum Emil von Behring, Berlin, Germany
| | | | - Thomas Mentzel
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
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13
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Goyal A, Marghitu T, Goyal N, Rubin N, Patel K, Goyal K, O'Leary D, Bohjanen K, Maher I. Surgical management and lymph-node biopsy of rare malignant cutaneous adnexal carcinomas: a population-based analysis of 7591 patients. Arch Dermatol Res 2020; 313:623-632. [PMID: 32965516 DOI: 10.1007/s00403-020-02143-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/21/2020] [Accepted: 09/12/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze the prognosis of cutaneous adnexal malignancies, survival relative to surgical management, and utility of lymph-node biopsy. DESIGN Population-based study of the SEER-18 database from 1975 to 2016. PARTICIPANTS 7591 patients with sweat gland carcinoma, hidradenocarcinoma, spiradenocarcinoma, sclerosing sweat duct tumor/microcystic adnexal tumor (SSDT/MAC), porocarcinoma, eccrine adenocarcinoma, and sebaceous carcinoma RESULTS: Five-year OS ranged from 68.0 to 82.6%, while 5-year DSS ranged from 94.6 to 99.0%. The majority of patients were treated with narrow (42.4%) or wide local excision (16.9%). DSS at 5 years showed that patients with stage IV had significantly poorer survival (50.3%) than I, II, or III (99.3%, 97.8%, and 89.0% respectively). 5-year OS was significantly higher for narrow excision (excision with < 1 cm margin, 78.5%) than observation (65.0%), excisional biopsy (66.8%), or wide local excision (WLE, 73.2%). Lymph-node biopsy was performed in a minority of cases (8.1%) and patients showed no significant difference in survival based on nodal status. The sensitivity and specificity of lymph-node biopsy for all malignancies were 46% and 80%, respectively. The PPV and NPV for that group were 0.46 and 0.80, respectively. Invasion of deep extradermal structures was a poor predictor of nodal positivity. CONCLUSIONS These malignancies have excellent DSS. Narrow excisions demonstrate better 5-year DSS and OS compared with WLE. Lymph-node biopsy is a poor predictor of survival in advanced stage disease and utility is limited.
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Affiliation(s)
- Amrita Goyal
- Department of Dermatology, University of Minnesota, 516 Delaware St SE, Minneapolis, MN, 55401, USA.
| | | | - Nikhil Goyal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nathan Rubin
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Krishnan Patel
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Kavita Goyal
- Department of Dermatology, University of Minnesota, 516 Delaware St SE, Minneapolis, MN, 55401, USA
| | - Daniel O'Leary
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Kimberly Bohjanen
- Department of Dermatology, University of Minnesota, 516 Delaware St SE, Minneapolis, MN, 55401, USA
| | - Ian Maher
- Department of Dermatology, University of Minnesota, 516 Delaware St SE, Minneapolis, MN, 55401, USA
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14
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Abstract
Malignant sweat gland neoplasms are a confusing area within dermatopathology, with many entities reported under several designations in the literature. This review describes the key clinical and histopathologic features of select malignant adnexal neoplasms, including porocarcinoma, papillary carcinoma, adenoid cystic carcinoma, cribriform carcinoma, apocrine hidradenocarcinoma, malignant mixed tumor of the skin, syringoid carcinoma, cylindrocarcinoma, spiradenocarcinoma, mucinous carcinoma, polymorphous sweat gland carcinoma, microcystic adnexal carcinoma, secretory carcinoma of the skin, and primary cutaneous signet ring cell carcinoma. For entities with overlapping features, differential diagnoses are discussed.
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Affiliation(s)
- Christine S Ahn
- Department of Pathology, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Omar P Sangüeza
- Department of Pathology, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA.
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15
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Catteau X, D'haene N, Noël JC. Low grade malignant eccrine spiradenoma of the vulva: case report, review of the literature and discussion about the role of p53 and HPV. Diagn Pathol 2020; 15:24. [PMID: 32169099 PMCID: PMC7071686 DOI: 10.1186/s13000-020-00945-9] [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: 01/07/2020] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malignant eccrine spiradenoma is one of the rarest sweat-gland tumors. Here, we describe a rare case of low grade malignant eccrine spiradenoma located at the vulva. CASE PRESENTATION The vulvar lesion was described as a mass measured 3.5 cm and located in the dermis and subcutis with no attachment to the epidermis. The neoplasm was arranged in ragged sheets or solid nodules sometimes with focal necrosis. The tumor cells had hyperchromatism, pleomorphism, and prominent nucleoli with high mitotic index and KI-67 estimated at 70-80%. CONCLUSIONS It's only the fifth case of malignant eccrine spiradenoma localized at the vulva. This is the first time that an HPV genotyping was made in this type of lesion with no HPV found while the p16 expression was diffuse. Moreover, it's the first time that a p53 mutation is detected by sequencing in this location.
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Affiliation(s)
- Xavier Catteau
- CUREPATH (Chirec institute- Brussels, CHU Tivoli - La Louvière), Rue de Borfilet, 12A, 6040 Jumet, Charleroi, Belgium. .,Pathology Department, Erasme University Hospital, Université Libre de Bruxelles, CP 610, Route de Lennik, 808, 1070, Brussels, Belgium.
| | - Nicky D'haene
- Pathology Department, Erasme University Hospital, Université Libre de Bruxelles, CP 610, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Jean-Christophe Noël
- Pathology Department, Erasme University Hospital, Université Libre de Bruxelles, CP 610, Route de Lennik, 808, 1070, Brussels, Belgium
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