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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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2
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Plotzke JM, Adams DJ, Harms PW. Molecular pathology of skin adnexal tumours. Histopathology 2022; 80:166-183. [PMID: 34197659 DOI: 10.1111/his.14441] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 11/28/2022]
Abstract
AIMS Tumours of the cutaneous adnexa arise from, or differentiate towards, structures in normal skin such as hair follicles, sweat ducts/glands, sebaceous glands or a combination of these elements. This class of neoplasms includes benign tumours and highly aggressive carcinomas. Adnexal tumours often present as solitary sporadic lesions, but can herald the presence of an inherited tumour syndrome such as Muir-Torre syndrome, Cowden syndrome or CYLD cutaneous syndrome. In contrast to squamous cell carcinoma and basal cell carcinoma, molecular changes in adnexal neoplasia have been poorly characterised and there are few published reviews on the current state of knowledge. METHODS AND RESULTS We reviewed findings in peer-reviewed literature on molecular investigations of cutaneous adnexal tumours published to June 2021. CONCLUSIONS Recent discoveries have revealed diverse oncogenic drivers and tumour suppressor alterations in this class of tumours, implicating pathways including Ras/MAPK, PI3K, YAP/TAZ, beta-catenin and nuclear factor kappa B (NF-κB). These observations have identified novel markers, such as NUT for poroma and porocarcinoma and PLAG1 for mixed tumours. Here, we provide a comprehensive overview and update of the molecular findings associated with adnexal tumours of the skin.
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Affiliation(s)
- Jaclyn M Plotzke
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | | | - Paul W Harms
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
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3
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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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CYLD mutation characterizes a subset of HPV-positive head and neck squamous cell carcinomas with distinctive genomics and frequent cylindroma-like histologic features. Mod Pathol 2021; 34:358-370. [PMID: 32892208 PMCID: PMC7817524 DOI: 10.1038/s41379-020-00672-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022]
Abstract
Mutations in the tumor suppressor CYLD, known to be causative of cylindromas, were recently described in a subset of high-risk (hr) HPV-positive head and neck squamous cell carcinomas (HNSCC). Pathologic and genetic characterization of these CYLD-mutant carcinomas, however, remains limited. Here, we investigated whether CYLD mutations characterize a histopathologically and genomically distinct subset of hrHPV-positive HNSCC. Comprehensive genomic profiling via hybrid capture-based DNA sequencing was performed on 703 consecutive head and neck carcinomas with hrHPV sequences, identifying 148 unique cases (21%) harboring CYLD mutations. Clinical data, pathology reports, and histopathology were reviewed. CYLD mutations included homozygous deletions (n = 61/148; 41%), truncations (n = 52; 35%), missense (n = 26; 18%) and splice-site (n = 9; 6%) mutations, and in-frame deletion (n = 1; 1%). Among hrHPV-positive HNSCC, the CYLD-mutant cohort showed substantially lower tumor mutational burden than CYLD-wildtype cases (n = 555) (median 2.6 vs. 4.4 mut/Mb, p < 0.00001) and less frequent alterations in PIK3CA (11% vs. 34%, p < 0.0001), KMT2D (1% vs. 16%, p < 0.0001), and FBXW7 (3% vs. 11%, p = 0.0018). Male predominance (94% vs. 87%), median age (58 vs. 60 years), and detection of HPV16 (95% vs. 89%) were similar. On available histopathology, 70% of CYLD-mutant HNSCC (98/141 cases) contained hyalinized material, consistent with basement membrane inclusions, within crowded aggregates of tumor cells. Only 7% of CYLD-wildtype cases demonstrated this distinctive pattern (p < 0.0001). Histopathologic patterns of CYLD-mutant HNSCC lacking basement membrane inclusions included nonkeratinizing (n = 22, 16%), predominantly nonkeratinizing (nonkeratinizing SCC with focal maturation; n = 10, 7%), and keratinizing (n = 11, 8%) patterns. The latter two groups showed significantly higher frequency of PTEN alterations compared with other CYLD-mutant cases (38% [8/21] vs. 7% [8/120], p = 0.0004). Within our cohort of hrHPV-positive HNSCCs, CYLD mutations were frequent (21%) and demonstrated distinctive clinical, histopathologic, and genomic features that may inform future study of prognosis and treatment.
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5
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Williams EA, Montesion M, Sharaf R, Corines J, Patel PJ, Gillespie BJ, Pavlick DC, Sokol ES, Alexander BM, Williams KJ, Elvin JA, Ross JS, Ramkissoon SH, Hemmerich AC, Tse JY, Mochel MC. CYLD-mutant cylindroma-like basaloid carcinoma of the anus: a genetically and morphologically distinct class of HPV-related anal carcinoma. Mod Pathol 2020; 33:2614-2625. [PMID: 32461623 PMCID: PMC7685972 DOI: 10.1038/s41379-020-0584-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/12/2022]
Abstract
Rare reports of anal carcinoma (AC) describe histologic resemblance to cutaneous cylindroma, but mutations in the tumor suppressor CYLD, the gene responsible for familial and sporadic cylindromas, have not been systematically investigated in AC. Here, we investigate CYLD-mutant AC, focusing on molecular correlates of distinct histopathology. Comprehensive genomic profiling (hybrid-capture-based DNA sequencing) was performed on 574 ACs, of which 75 unique cases (13%) harbored a CYLD mutation. Clinical data, pathology reports, and histopathology were reviewed for each CYLD-mutant case. The spectrum of CYLD mutations included truncating (n = 50; 67%), homozygous deletion (n = 10; 13%), missense (n = 16; 21%), and splice-site (n = 3; 4%) events. Compared with CYLD-wildtype AC (n = 499), CYLD-mutant ACs were significantly enriched for females (88% vs. 67%, p = 0.0001), slightly younger (median age 59 vs. 61 years, p = 0.047), and included near-universal detection of high-risk HPV sequences (97% vs. 88%, p = 0.014), predominantly HPV16 (96%). The CYLD-mutant cohort also showed significantly lower tumor mutational burden (TMB; median 2.6 vs. 5.2 mut/Mb, p < 0.00001) and less frequent alterations in PIK3CA (13% vs. 31%, p = 0.0015). On histopathologic examination, 73% of CYLD-mutant AC (55/75 cases) showed a striking cylindroma-like histomorphology, composed of aggregates of basaloid cells surrounded by thickened basement membranes and containing characteristic hyaline globules, while only 8% of CYLD-wildtype tumors (n = 34/409) contained cylindroma-like hyaline globules (p < 0.0001). CYLD-mutant carcinomas with cylindroma-like histomorphology (n = 55) showed significantly lower TMB compared with CYLD-mutant cases showing basaloid histology without the distinctive hyaline globules (n = 14) (median 1.7 vs. 4.4 mut/Mb, p = 0.0058). Only five CYLD-mutant cases (7%) showed nonbasaloid conventional squamous cell carcinoma histology (median TMB = 5.2 mut/Mb), and a single CYLD-mutant case showed transitional cell carcinoma-like histology. Within our cohort of ACs, CYLD mutations characterize a surprisingly large subset (13%), with distinct clinical and genomic features and, predominantly, a striking cylindroma-like histopathology, representing a genotype-phenotype correlation which may assist in classification of AC.
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Affiliation(s)
- Erik A Williams
- Foundation Medicine, Inc., 150 Second Street, Cambridge, MA, 02141, USA.
| | - Meagan Montesion
- Foundation Medicine, Inc., 150 Second Street, Cambridge, MA, 02141, USA
| | - Radwa Sharaf
- Foundation Medicine, Inc., 150 Second Street, Cambridge, MA, 02141, USA
| | - James Corines
- Department of Pathology, State University of New York Upstate Medical University, 766 Irving Avenue, Syracuse, NY, 13210, USA
| | - Parth J Patel
- Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, 19140, USA
| | | | - Dean C Pavlick
- Foundation Medicine, Inc., 150 Second Street, Cambridge, MA, 02141, USA
| | - Ethan S Sokol
- Foundation Medicine, Inc., 150 Second Street, Cambridge, MA, 02141, USA
| | - Brian M Alexander
- Foundation Medicine, Inc., 150 Second Street, Cambridge, MA, 02141, USA
| | - Kevin Jon Williams
- Department of Physiology and Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, 19140, USA
| | - Julia A Elvin
- Foundation Medicine, Inc., 150 Second Street, Cambridge, MA, 02141, USA
| | - Jeffrey S Ross
- Foundation Medicine, Inc., 150 Second Street, Cambridge, MA, 02141, USA
- Department of Pathology, State University of New York Upstate Medical University, 766 Irving Avenue, Syracuse, NY, 13210, USA
| | - Shakti H Ramkissoon
- Foundation Medicine, Inc., 150 Second Street, Cambridge, MA, 02141, USA
- Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | | | - Julie Y Tse
- Foundation Medicine, Inc., 150 Second Street, Cambridge, MA, 02141, USA
- Department of Pathology & Laboratory Medicine, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Mark C Mochel
- Departments of Pathology and Dermatology, Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA
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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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7
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Rashid M, van der Horst M, Mentzel T, Butera F, Ferreira I, Pance A, Rütten A, Luzar B, Marusic Z, de Saint Aubain N, Ko JS, Billings SD, Chen S, Abi Daoud M, Hewinson J, Louzada S, Harms PW, Cerretelli G, Robles-Espinoza CD, Patel RM, van der Weyden L, Bakal C, Hornick JL, Arends MJ, Brenn T, Adams DJ. ALPK1 hotspot mutation as a driver of human spiradenoma and spiradenocarcinoma. Nat Commun 2019; 10:2213. [PMID: 31101826 PMCID: PMC6525246 DOI: 10.1038/s41467-019-09979-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/08/2019] [Indexed: 01/12/2023] Open
Abstract
Spiradenoma and cylindroma are distinctive skin adnexal tumors with sweat gland differentiation and potential for malignant transformation and aggressive behaviour. We present the genomic analysis of 75 samples from 57 representative patients including 15 cylindromas, 17 spiradenomas, 2 cylindroma-spiradenoma hybrid tumors, and 24 low- and high-grade spiradenocarcinoma cases, together with morphologically benign precursor regions of these cancers. We reveal somatic or germline alterations of the CYLD gene in 15/15 cylindromas and 5/17 spiradenomas, yet only 2/24 spiradenocarcinomas. Notably, we find a recurrent missense mutation in the kinase domain of the ALPK1 gene in spiradenomas and spiradenocarcinomas, which is mutually exclusive from mutation of CYLD and can activate the NF-κB pathway in reporter assays. In addition, we show that high-grade spiradenocarcinomas carry loss-of-function TP53 mutations, while cylindromas may have disruptive mutations in DNMT3A. Thus, we reveal the genomic landscape of adnexal tumors and therapeutic targets.
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Affiliation(s)
- Mamunur Rashid
- Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, UK
| | - Michiel van der Horst
- Department of Pathology, Maasstad Hospital, Maasstadweg 21, Rotterdam, 3079 DZ, The Netherlands
| | - Thomas Mentzel
- Dermatopathologie Friedrichshafen, Siemensstrasse 6/1, 88048, Friedrichshafen, Germany
| | - Francesca Butera
- Dynamical Cell Systems Laboratory. Chester Beatty Laboratories, Division of Cancer Biology. Institute of Cancer Research, London, SW3 6JB, UK
| | - Ingrid Ferreira
- Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, UK
| | - Alena Pance
- Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, UK
| | - Arno Rütten
- Dermatopathologie Friedrichshafen, Siemensstrasse 6/1, 88048, Friedrichshafen, Germany
| | - Bostjan Luzar
- Institute of Pathology, Medical Faculty University of Ljubljana, Korytkova 2, Ljubljana, 1000, Slovenia
| | - Zlatko Marusic
- University Hospital Center Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia
| | | | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Steven D Billings
- Department of Pathology, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Sofia Chen
- Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, UK
| | - Marie Abi Daoud
- Departments of Pathology & Laboratory Medicine and Medicine and The Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, T2L 2K8, Canada
| | - James Hewinson
- Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, UK
| | - Sandra Louzada
- Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, UK
| | - Paul W Harms
- Departments of Pathology and Dermatology, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109-5602, USA
| | - Guia Cerretelli
- Division of Pathology, Cancer Research UK Edinburgh Centre, The University of Edinburgh, Institute of Genetics & Molecular Medicine, Crewe Road, Edinburgh, EH4 2XR, UK
| | - Carla Daniela Robles-Espinoza
- Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, UK
- Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Campus Juriquilla, Blvd Juriquilla 3001, Santiago de Querétaro, 76230, Mexico
| | - Rajiv M Patel
- Departments of Pathology and Dermatology, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109-5602, USA
| | - Louise van der Weyden
- Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, UK
| | - Chris Bakal
- Dynamical Cell Systems Laboratory. Chester Beatty Laboratories, Division of Cancer Biology. Institute of Cancer Research, London, SW3 6JB, UK
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Mark J Arends
- Division of Pathology, Cancer Research UK Edinburgh Centre, The University of Edinburgh, Institute of Genetics & Molecular Medicine, Crewe Road, Edinburgh, EH4 2XR, UK
| | - Thomas Brenn
- Departments of Pathology & Laboratory Medicine and Medicine and The Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, T2L 2K8, Canada
- Division of Pathology, Cancer Research UK Edinburgh Centre, The University of Edinburgh, Institute of Genetics & Molecular Medicine, Crewe Road, Edinburgh, EH4 2XR, UK
| | - David J Adams
- Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, UK.
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Huang A, Vyas NS, Mercer SE, Phelps RG. Histological findings and pathologic diagnosis of spiradenocarcinoma: A case series and review of the literature. J Cutan Pathol 2019; 46:243-250. [DOI: 10.1111/cup.13408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/07/2018] [Accepted: 12/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Amy Huang
- Department of DermatologyState University of New York Downstate Medical Center Brooklyn New York
| | - Nikki S. Vyas
- Department of PathologyIcahn School of Medicine at Mount Sinai New York New York
| | | | - Robert G. Phelps
- Department of PathologyIcahn School of Medicine at Mount Sinai New York New York
- Department of DermatologyIcahn School of Medicine at Mount Sinai New York New York
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Abstract
INTRODUCTION Spiradenocarcinomas (SCs) are rare and potentially aggressive skin adnexal tumors. Optimal treatment has not yet been established. Experiences with this carcinoma are mostly presented in case reports and few case series. OBJECTIVE To generate to a synopsis of published data on SC with regard to diagnostic procedures, treatment, and outcome. RESULTS Median patient age was 60 years and sex distribution was balanced. Tumor manifestations were evenly distributed within the sweat gland carrying skin. The most commonly reported symptom was accelerated growth of a longstanding indolent lesion, typically present for more than 2 years. Metastatic spread to the lung, bone, lymph nodes, liver, kidney, and breast has been documented. For staging computed tomography (CT) and positron emission tomography-CT are recommended, especially for detection of hematogenic metastases and lymph node involvement. Clear resection margins and tumor free regional lymph nodes reduce recurrence and carcinoma related death. Although low-grade SCs were reported over 3 times more often, high-grade carcinomas show a greater likelihood for recurrence and lethal outcome. CONCLUSION Suspicion of an SC should lead to performance of a magnetic resonance imaging for defining tumor extent, and a fludeoxyglucose positron emission tomography-CT for detection of metastases. Radical tumor excision and resection of tumor involved regional lymph nodes are essential for a curative approach. Histopathological evaluation should involve determination of tumor differentiation grade, because high-grade carcinomas seem to have a much more aggressive behavior. Excision of distant metastases has no therapeutic value. Follow-up needs to be carried out in short intervals with frequent imaging.
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Basal Cell Carcinoma With Matrical Differentiation: Clinicopathologic, Immunohistochemical, and Molecular Biological Study of 22 Cases. Am J Surg Pathol 2017; 41:738-749. [PMID: 28368926 DOI: 10.1097/pas.0000000000000841] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Basal cell carcinoma (BCC) with matrical differentiation is a fairly rare neoplasm, with about 30 cases documented mainly as isolated case reports. We studied a series of this neoplasm, including cases with an atypical matrical component, a hitherto unreported feature. Lesions coded as BCC with matrical differentiation were reviewed; 22 cases were included. Immunohistochemical studies were performed using antibodies against BerEp4, β-catenin, and epithelial membrane antigen (EMA). Molecular genetic studies using Ion AmpliSeq Cancer Hotspot Panel v2 by massively parallel sequencing on Ion Torrent PGM were performed in 2 cases with an atypical matrical component (1 was previously subjected to microdissection to sample the matrical and BCC areas separately). There were 13 male and 9 female patients, ranging in age from 41 to 89 years. Microscopically, all lesions manifested at least 2 components, a BCC area (follicular germinative differentiation) and areas with matrical differentiation. A BCC component dominated in 14 cases, whereas a matrical component dominated in 4 cases. Matrical differentiation was recognized as matrical/supramatrical cells (n=21), shadow cells (n=21), bright red trichohyaline granules (n=18), and blue-gray corneocytes (n=18). In 2 cases, matrical areas manifested cytologic atypia, and a third case exhibited an infiltrative growth pattern, with the tumor metastasizing to a lymph node. BerEP4 labeled the follicular germinative cells, whereas it was markedly reduced or negative in matrical areas. The reverse pattern was seen with β-catenin. EMA was negative in BCC areas but stained a proportion of matrical/supramatrical cells. Genetic studies revealed mutations of the following genes: CTNNB1, KIT, CDKN2A, TP53, SMAD4, ERBB4, and PTCH1, with some differences between the matrical and BCC components. It is concluded that matrical differentiation in BCC in most cases occurs as multiple foci. Rare neoplasms manifest atypia in the matrical areas. Immunohistochemical analysis for BerEP4, EMA, and β-catenin can be helpful in limited biopsy specimens. From a molecular biological prospective, BCC and matrical components appear to share some of the gene mutations but have differences in others, but this observation must be validated in a large series.
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11
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Jacquemus J, Dalle S, Faure M, Chouvet B, Beatrix O, Balme B. [Malignant transformation of an eccrine spiradenoma]. Ann Dermatol Venereol 2016; 144:203-207. [PMID: 28277254 DOI: 10.1016/j.annder.2016.09.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/20/2016] [Accepted: 09/02/2016] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Malignant eccrine spiradenoma is a rare and aggressive tumor, developed on the epithelium of eccrine sweat glands. Typically, it occurs after malignant transformation of benign eccrine spiradenoma, but sometimes it happens de novo. OBSERVATION We report a case of malignant eccrine spiradenoma in a 62-year-old woman. The patient presented a rapid increase in size of a long-standing tumoral lesion of her forearm. There was no secondary lesion on the chest, abdomen or pelvis at the CT-scanner. Cutaneous biopsy of the lesion was performed and showed a carcinoma with no contact with epidermis. On this biopsy, we could not affirm if the tumor was a metastatic process or a primary tumor of the skin. Histologic examination of the surgical removal of the tumor showed an undifferentiated carcinoma with adjacent nodules of eccrine spiradenoma. Immunohistochemical assessment of Ki67 expression showed a weak expression (5%) in the benign spiradenoma nodules and a high rate expression (80%) in the malignant neoplasm. The final diagnosis was an undifferentiated carcinoma arising from preexisting benign spiradenoma. DISCUSSION Malignant eccrine spiradenoma is not frequent and is rarely described in the international literature that may lead to diagnostic difficulties.
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Affiliation(s)
- J Jacquemus
- Service de pathologie, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - S Dalle
- Service de dermatologie, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - M Faure
- Service de dermatologie, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - B Chouvet
- Service de pathologie, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - O Beatrix
- Service de chirurgie, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - B Balme
- Service de pathologie, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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12
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Ruiz-González J, Quiñones-Venegas R, Valdes-Rodriguez R, Solís-Ledezma G. Malignant Spiradenoma: a Giant Cutaneous Adnexal Tumor. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.01.019] [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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13
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Jones KJ, Jariwala N, Cusack CA. Spiradenocylindroma: an uncommon morphologic entity. Int J Dermatol 2016; 55:801-3. [PMID: 26946339 DOI: 10.1111/ijd.13233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/28/2015] [Accepted: 11/04/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Krister J Jones
- Department of Dermatology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Neha Jariwala
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Carrie A Cusack
- Department of Dermatology, Drexel University College of Medicine, Philadelphia, PA, USA
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14
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Misago N, Toda S. Sebaceous carcinoma within rippled/carcinoid pattern sebaceoma. J Cutan Pathol 2015; 43:64-70. [DOI: 10.1111/cup.12575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 04/14/2011] [Accepted: 06/01/2011] [Indexed: 01/29/2023]
Affiliation(s)
| | - Shuji Toda
- Department of Pathology, Faculty of Medicine; Saga University; Saga Japan
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15
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Ruiz-González JF, Quiñones-Venegas R, Valdes-Rodriguez R, Solís-Ledezma G. Malignant Spiradenoma: a Giant Cutaneous Adnexal Tumor. ACTAS DERMO-SIFILIOGRAFICAS 2015; 107:259-60. [PMID: 26563774 DOI: 10.1016/j.ad.2015.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 09/04/2015] [Accepted: 09/12/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- J F Ruiz-González
- Instituto Dermatológico de Jalisco «Dr. José Barba Rubio», Secretaría de Salud Jalisco, Zapopan, Jalisco, México
| | - R Quiñones-Venegas
- Instituto Dermatológico de Jalisco «Dr. José Barba Rubio», Secretaría de Salud Jalisco, Zapopan, Jalisco, México.
| | - R Valdes-Rodriguez
- Dermatology Department, Temple Itch Center, Temple University School of Medicine, Philadelphia, Estados Unidos
| | - G Solís-Ledezma
- Instituto Dermatológico de Jalisco «Dr. José Barba Rubio», Secretaría de Salud Jalisco, Zapopan, Jalisco, México
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16
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Tantcheva-Poór I, Vanecek T, Lurati MCR, Rychly B, Kempf W, Michal M, Kazakov DV. Report of Three Novel Germline CYLD Mutations in Unrelated Patients with Brooke-Spiegler Syndrome, Including Classic Phenotype, Multiple Familial Trichoepitheliomas and Malignant Transformation. Dermatology 2015; 232:30-7. [PMID: 26329847 DOI: 10.1159/000437303] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/13/2015] [Indexed: 11/19/2022] Open
Abstract
Brooke-Spiegler syndrome is a rare autosomal-dominant genetic disorder characterized by multiple adnexal tumors, including cylindromas, spiradenomas, spiradenocylindromas and trichoepitheliomas. It is caused by germline CYLD mutations commonly leading to a premature stop codon. We here report on 3 novel CYLD mutations in 3 unrelated BSS patients, including the classic phenotype, multiple familial trichoepitheliomas phenotype and malignant transformation. These included c.1821_1826+1delinsCT/L607Ffs*9, c.2666A>T/p.D889V and c.2712delT/p.905Kfs*8. By extending the spectrum of CYLD mutations, better understanding of the molecular mechanisms of BSS can be gained, which might later assist in finding new treatment options.
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17
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Hayashi T, Haba R, Katsuki N, Kushida Y, Kadota K, Bando K, Moriue J, Yokoi I, Izumi M, Kubota Y. Low-grade cylindromatous adnexal carcinoma with unusual histopathological features: report of a case with comparative immunohistochemical study and meta-analysis of the literature. J Cutan Pathol 2015; 42:1000-1011. [PMID: 26269423 DOI: 10.1111/cup.12597] [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: 02/26/2010] [Revised: 12/21/2010] [Accepted: 05/23/2011] [Indexed: 11/26/2022]
Abstract
We present an extremely rare case of low-grade cylindromatous adnexal carcinoma (CAC) on the right chest wall of a 77-year-old man. Histopathologically, the neoplasm was initially diagnosed as a cylindroma that developed over the course of 13 years. A diagnosis of low-grade CAC was rendered after the documentation of a local recurrence and histopathology of the recurrent tumor. To further assess the evolution of low-grade CAC over time, we compared the morphology, mitotic account, proliferative markers and adhesion molecule immunoreactivity among paired primary and recurrent tumors. Unlike those earlier reported, our case showed the maintenance of tumor morphology after a recurrence without areas of obvious malignant transformation or metaplastic change. We showed here for the first time the expression of adhesion molecules of CAC/spiradenoma and a comparison of proliferation indices between a primary tumor and its local recurrence. This peculiar tumor differs from previously reported cases and harbors a malignant potential although the histopathological features of malignancy are subtle. Our meta-analysis of the literature provided background information regarding this rare entity. Alterations of E-cadherin and GCDFP-15 expression may provide additional helpful clues in differential diagnosis and determining the clinical behavior of this unusual neoplasm. Further studies are warranted to confirm the potential discriminative role of these markers.
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Affiliation(s)
- Toshitetsu Hayashi
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Reiji Haba
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Naomi Katsuki
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshio Kushida
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kyuichi Kadota
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kenji Bando
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Junko Moriue
- Department of Dermatology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Ikumi Yokoi
- Department of Dermatology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Miki Izumi
- Department of Diagnostic Pathology and Medical Education, Tokyo Medical University, Tokyo, Japan
| | - Yasuo Kubota
- Department of Dermatology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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18
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van der Horst MPJ, Marusic Z, Hornick JL, Luzar B, Brenn T. Morphologically low-grade spiradenocarcinoma: a clinicopathologic study of 19 cases with emphasis on outcome and MYB expression. Mod Pathol 2015; 28:944-53. [PMID: 25857824 DOI: 10.1038/modpathol.2015.48] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/03/2015] [Indexed: 01/18/2023]
Abstract
Spiradenocarcinoma is a rare skin adnexal neoplasm with potential for aggressive behavior, classified histologically into low- and high-grade tumors. Morphologically, low-grade tumors are thought to behave more favorably. Limited information is available, however, with only 18 published cases. To study their clinical behavior, histological features, and the diagnostic value of immunohistochemistry, 19 morphologically low-grade spiradenocarcinomas were retrieved and compared with 21 spiradenomas and cylindromas. H&E-stained sections were reviewed, follow-up was obtained, and immunohistochemistry for Ki-67, p53 and, MYB was performed. The tumors were solitary, measuring 0.8-7 cm (median: 2.7 cm), with a predilection for the head and neck of elderly patients (median age: 72 years; range 53-92) without gender bias. Histologically, the tumors were multinodular and located in deep dermis and subcutis. A pre-existing spiradenoma was present in all cases. The malignant component was characterized by expansile growth with loss of the dual cell population, up to moderate cytological atypia and increased mitotic activity (median: 10/10 HPF; range 1-28). Additional findings included squamoid differentiation (n=9), necrosis (n=7), and ulceration (n=5). P53 expression was variable and no significant differences were noted in the benign compared with the malignant parts of the tumors. In contrast, in the malignant components the Ki-67 proliferative index was slightly increased, and MYB expression was lost. Follow-up (median: 67 months; range: 13-132) available for 16 patients (84%) revealed a local recurrence rate of 19% but no metastases or disease-related mortality. In this large study with long-term follow-up, we demonstrate that spiradenocarcinomas with low-grade morphology pursue an indolent course, characterized by local recurrence only. Metastases and disease-related mortality appear to be exceptional. Lack of MYB expression may be useful as an additional aid in the diagnosis of these challenging tumors.
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Affiliation(s)
| | - Zlatko Marusic
- Clinical Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Jason L Hornick
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Thomas Brenn
- Department of Pathology, Western General Hospital and The University of Edinburgh, Edinburgh, UK
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19
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Dai B, Kong YY, Cai X, Shen XX, Kong JC. Spiradenocarcinoma, cylindrocarcinoma and spiradenocylindrocarcinoma: a clinicopathological study of nine cases. Histopathology 2014; 65:658-66. [PMID: 24796384 DOI: 10.1111/his.12448] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 04/29/2014] [Indexed: 11/26/2022]
Abstract
AIMS To elucidate diagnostic criteria for spiradenocarcinoma, cylindrocarcinoma and spiradenocylindrocarcinoma, and to emphasize correlations between clinical behaviour and variable morphological patterns. METHODS AND RESULTS We investigated the clinicopathological and immunophenotypic features of nine cases. There were five men and four women, with ages ranging from 58 years to 82 years. The tumour size varied from 10 mm to 50 mm. The head and neck were most commonly involved. Three cases of spiradenocarcinoma and three cases of cylindrocarcinoma showed a salivary gland-type basal cell adenocarcinoma-like pattern, low-grade (BCAC-LG) and/or high grade (BCAC-HG). The remaining three cases of spiradenocarcinoma showed adenocarcinoma in situ, with invasive adenocarcinoma being seen in one of these cases. PAS staining revealed loss of the PAS-positive hyaline sheath in malignant zones of cylindrocarcinoma. p53 staining was variably positive in the malignant components of all cases. Follow-up was available for all patients, ranging from 5 months to 107 months. Two patients died of disease, one experienced recurrence, and one died of an unrelated cause. CONCLUSIONS Patients with BCAC-LG have a better prognosis. BCAC-HG is more likely to be found in cylindrocarcinoma, and its clinical behaviour seems to be more aggressive. Close follow-up for early detection of recurrence and metastases is strongly recommended.
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Affiliation(s)
- Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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20
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Jiang LC, Huang SY, Zhang DS, Zhang SH, Li WG, Zheng PH, Chen ZW. Expression of beclin 1 in primary salivary adenoid cystic carcinoma and its relation to Bcl-2 and p53 and prognosis. ACTA ACUST UNITED AC 2014; 47:252-8. [PMID: 24554038 PMCID: PMC3982947 DOI: 10.1590/1414-431x20133231] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/25/2013] [Indexed: 01/08/2023]
Abstract
Beclin 1 plays a critical role in autophagy and functions as a haploinsufficient tumor suppressor. The expression and prognostic significance of beclin 1 in head and neck adenoid cystic carcinoma (ACC) are largely unexplored. Therefore, we investigated the expression of beclin 1, Bcl-2, and p53 in head and neck ACC tissue. Tissue samples from 35 cases (15 females, 20 males) of head and neck ACC were utilized for immunohistochemistry. Beclin 1 expression was observed in 32 cases (91.4%) and considered to be high in 15 cases (42.9%) and low in 20 cases (57.1%). Beclin 1 expression was significantly correlated with a histological growth pattern (P=0.046) and histological grade (P=0.037). Beclin 1 expression was inversely correlated with Bcl-2 expression (P=0.013) and significantly associated with overall survival (P=0.006). Bcl-2 and p53 expression were observed in 21 cases (60.0%) and 16 cases (45.7%). Bcl-2 expression was significantly correlated with perineural invasion (P=0.041) and not associated with overall survival (P=0.053). p53 expression was directly correlated with beclin 1 expression (P=0.044). Our results indicated that beclin 1 may be a novel, promising prognostic factor for clinical outcome in head and neck ACC patients and may play a part in the development of head and neck ACC by interacting with Bcl-2 and p53.
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Affiliation(s)
- L C Jiang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - S Y Huang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - D S Zhang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - S H Zhang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - W G Li
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - P H Zheng
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Z W Chen
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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21
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p53 staining correlates with tumor type and location in sebaceous neoplasms. Am J Dermatopathol 2012; 34:129-35; quiz 136-8. [PMID: 22441365 DOI: 10.1097/dad.0b013e3181ed39f9] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Sebaceous neoplasms are commonly considered in their relationship to the Muir-Torre syndrome and the now well-documented loss of DNA mismatch repair proteins leading to microsatellite instability. However, sebaceous neoplasms showing microsatellite instability comprise only a subset of this group of tumors, and thus, alternative tumorigenic mechanisms must exist. This article explores the relationship of p53, a tumor suppressor implicated in other cutaneous malignancies, and sebaceous neoplasia. We examined 94 sebaceous tumors from 92 patients. Tumors with strong nuclear p53 staining were significantly associated with the diagnosis of sebaceous carcinoma compared with benign sebaceous lesions, most notably for periocular carcinomas. Importantly, nuclear mismatch repair protein expression was intact in all lesions showing p53 alterations, suggesting that p53 dysfunction may represent a divergent pathway in the molecular pathogenesis of these tumors.
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22
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Petersson F, Nga ME. Spiradenocarcinoma with low-grade basal cell adenocarcinoma pattern: report of a case with varied morphology and wild type TP53. J Cutan Pathol 2011; 39:372-6. [DOI: 10.1111/j.1600-0560.2011.01810.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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