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Lee YJ, Kwon SH, Lew BL. Primary cutaneous mucinous carcinoma of the face: a case report and literature review. Int J Dermatol 2024. [PMID: 38965061 DOI: 10.1111/ijd.17373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Affiliation(s)
- Yun-Ji Lee
- Department of Dermatology, Kyung Hee University Hospital at Gang-Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soon-Hyo Kwon
- Department of Dermatology, Kyung Hee University Hospital at Gang-Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, Kyung Hee University Hospital at Gang-Dong, Kyung Hee University School of Medicine, Seoul, Korea
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Corti F, Rossi RE, Cafaro P, Passarella G, Turla A, Pusceddu S, Coppa J, Oldani S, Guidi A, Longarini R, Cortinovis DL. Emerging Treatment Options for Neuroendocrine Neoplasms of Unknown Primary Origin: Current Evidence and Future Perspectives. Cancers (Basel) 2024; 16:2025. [PMID: 38893145 PMCID: PMC11171242 DOI: 10.3390/cancers16112025] [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: 04/25/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Among neuroendocrine neoplasms (NENs), a non-negligible proportion (9-22%) is represented by sufferers of NENs of unknown primary origin (UPO), a poor prognostic group with largely unmet clinical needs. In the absence of standard therapeutic algorithms, current guidelines suggest that the treatment of UPO-NENs should be based on tumor clinical-pathological characteristics, disease burden, and patient conditions. Chemotherapy represents the backbone for the treatment of high-grade poorly differentiated UPO-NENs, usually providing deep but short-lasting responses. Conversely, the spectrum of available systemic therapy options for well-differentiated UPO-NENs may range from somatostatin analogs in indolent low-grade tumors, to peptide receptor radioligand therapy, tyrosine kinase inhibitors (TKIs), or chemotherapy for more aggressive tumors or in case of high disease burden. In recent years, molecular profiling has provided deep insights into the molecular landscape of UPO-NENs, with both diagnostic and therapeutic implications. Although preliminary, interesting activity data have been provided about upfront chemoimmunotherapy, the use of immune checkpoint inhibitors (ICIs), and the combination of ICIs plus TKIs in this setting. Here, we review the literature from the last 30 years to examine the available evidence about the treatment of UPO-NENs, with a particular focus on future perspectives, including the expanding scenario of targeted agents in this setting.
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Affiliation(s)
- Francesca Corti
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Roberta Elisa Rossi
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Pietro Cafaro
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Gaia Passarella
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Antonella Turla
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Sara Pusceddu
- Gastro-Entero-Pancreatic and Neuroendocrine Unit 1, Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (S.P.); (S.O.)
| | - Jorgelina Coppa
- Hepatology and Hepato-Pancreatic-Biliary Surgery and Liver Transplantation Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy;
| | - Simone Oldani
- Gastro-Entero-Pancreatic and Neuroendocrine Unit 1, Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (S.P.); (S.O.)
| | - Alessandro Guidi
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Raffaella Longarini
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Diego Luigi Cortinovis
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
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3
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Tinguria M. Primary Mucinous Carcinoma of Skin: A Rare Cutaneous Neoplasm. Clinicopathologic Features, Differential Diagnoses, and Review of Literature. Am J Dermatopathol 2024; 46:114-120. [PMID: 38055969 DOI: 10.1097/dad.0000000000002591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
ABSTRACT Primary mucinous carcinoma of the skin (PMCS) is a rare malignant neoplasm of sweat gland origin, with an incidence of 0.07 per million. Histologically, it may be difficult to differentiate it from metastatic mucinous carcinomas of the skin. A case of PMCS is reported here in a 59-year-old woman who presented with a lesion on the right lower eyelid. Histological examination revealed features of mucinous adenocarcinoma. The main differential diagnosis was metastatic mucinous adenocarcinoma; however, the lack of colorectal and lung markers and the presence of focal in situ components were consistent with the diagnosis of PMCS. PMCS and breast mucinous carcinoma share immunohistochemical markers, such as GCDFP-15 and mammaglobin; however, focal in situ component with the presence of myoepithelial cells in the tumor ruled out metastatic mucinous carcinoma of breast origin. The subsequent mammograms did not reveal any breast lesions. Colonoscopy did not show any evidence of colonic malignancy, and imaging studies (CT scan) did not show any evidence of neoplasm in the body. These findings were in keeping with a diagnosis of PMCS. The present case emphasizes the importance of clinicopathological correlation, histopathology, and immunohistochemistry in the accurate diagnosis of PMCS and summarizes the literature on these rare cutaneous neoplasms.
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Affiliation(s)
- Mukund Tinguria
- Department of Pathology and Laboratory Medicine, Brantford General Hospital, Brantford, Ontario, Canada
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Freeman T, Russell AJ, Council ML. Primary Cutaneous Mucinous Carcinoma: A Review of the Literature. Dermatol Surg 2023; 49:1091-1095. [PMID: 37643246 DOI: 10.1097/dss.0000000000003921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Primary cutaneous mucinous carcinoma (PCMC) is an exceedingly rare, low-grade tumor that histologically resembles mucinous carcinoma from other primary sites, such as the breast, gastrointestinal tract, and lungs. OBJECTIVE The purpose of this article was to review the current literature on PCMC as it relates to epidemiology, clinical presentation, histopathology, immunohistochemistry, treatment, and prognosis. MATERIALS AND METHODS An extensive literature review was conducted using PubMed and Ovid MEDLINE to identify articles related to PCMC. RESULTS Several hundred cases have been reported in the medical literature, and surgical resection, whenever feasible, is the standard of care. CONCLUSION The diagnosis of primary cutaneous mucinous carcinoma is one of exclusion, requiring a metastatic work-up to rule out distant primary. Mohs micrographic surgery is a tissue sparing technique that allows complete margin control of these rare neoplasia.
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Affiliation(s)
- Timothy Freeman
- Washington University School of Medicine, St. Louis, Missouri
| | - Aaron J Russell
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - M Laurin Council
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Papanastasiou AD, De Filippo MR, Sirinian C, Selenica P, Repanti M, Reis-Filho JS, Weigelt B. Histologic and genomic characterization of a primary mucinous carcinoma of the skin. EJC SKIN CANCER 2023; 1:100011. [PMID: 38274496 PMCID: PMC10810048 DOI: 10.1016/j.ejcskn.2023.100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Aims Primary skin mucinous carcinoma is a rare sweat gland neoplasm with a high local recurrence rate after conventional excision but a low distant-metastasis rate. The genetic underpinning of skin mucinous carcinoma is presently unknown. Here, we sought to define whether the repertoire of somatic mutations of a primary mucinous carcinoma of the skin would be similar to that of mucinous breast carcinomas, given the histologic similarities between these tumor types. Methods and results The tumor was situated in the dermis and partially involved the subcutaneous fat. Tumor cells were suspended in periodic acid-Schiff diastaseresistant- positive mucin lakes and expressed cytokeratin 7, synaptophysin and estrogen receptor. DNA samples extracted from microdissected tumor and matched normal tissue were subjected to massively parallel sequencing targeting 410 cancer-related genes. The skin mucinous tumor was found to have a low tumor mutation burden, but to harbor a clonal GATA3 frameshift mutation (p. T418Hfs*89) and amplification of FOXA1, genes not uncommonly altered in breast mucinous carcinomas. Conclusions In this primary skin mucinous carcinoma, GATA3 and FOXA1 driver genetic events were identified, consistent with a possible developmental relationship between skin and breast mucinous neoplasms.
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Affiliation(s)
| | - Maria R. De Filippo
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chaido Sirinian
- Department of Biomedical Sciences, University of West Attica, Athens, Greece
| | - Pier Selenica
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Repanti
- Department of Pathology, Patras General Hospital, Patras, Greece
| | - Jorge S. Reis-Filho
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Recurrent Neuroendocrine Primary Cutaneous Mucinous Carcinoma of the Scalp After Complete Excision. Am J Dermatopathol 2023; 45:123-126. [PMID: 36669077 DOI: 10.1097/dad.0000000000002338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
ABSTRACT Primary cutaneous mucinous carcinoma is a rare, indolent malignancy with a debated history regarding cell of origin. Recurrence is rare but has been documented in up to a third of cases. Recent literature reviews have recognized 2 possible subtypes-neuroendocrine and nonneuroendocrine- with different possible prognostic implications for patients. We describe a case of recurrent primary cutaneous mucinous carcinoma in a 50-year-old man with subtle neuroendocrine features not initially recognized on routine H&E staining but highlighted by immunohistochemical studies. We underscore the importance of immunohistochemical use in these rare cases and emphasize that awareness of these neuroendocrine and nonneuroendocrine subtypes is essential for a complete diagnosis.
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Duran J, Plaza JA. Update on Immunohistochemical Techniques in Dermatopathology. A focus on Adnexal Neoplasms. Semin Diagn Pathol 2022; 39:265-287. [DOI: 10.1053/j.semdp.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 11/11/2022]
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Plaza JA, Pootrakul L, Raghavan SS, Sangueza M, Gru AA. Reproducible Histopathologic Features in Cases of Basal Cell Carcinoma With Neuroendocrine Expression: A Clinicopathologic Study of 24 Cases With a Potential Diagnostic Pitfall. Am J Dermatopathol 2021; 43:903-907. [PMID: 34783706 DOI: 10.1097/dad.0000000000002082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
ABSTRACT Basal cell carcinomas (BCCs) are common malignancies that usually show clear histomorphologic features, but in certain instances, it can display different patterns of differentiation leading to potential diagnostic confusion. BCCs with neuroendocrine differentiation/expression have been mentioned only briefly in the literature. In this study, we present cases of BCCs with neuroendocrine differentiation/expression that demonstrate reproducible histopathological features. Twenty-four cases were included in the study. All tumors showed conventional histopathologic features that are seen in BCCs, but in addition, all the tumors showed large, hyperchromatic, pleomorphic, mononuclear, and multinucleate cells with intracytoplasmic inclusions and intranuclear cytoplasmic invaginations, with rare cases showing stippled nuclei (salt-and-pepper appearance). These histologic features were somewhat concerning for a neuroendocrine carcinoma; thus, immunohistochemistry studies were performed in all cases at the time of diagnosis. By immunohistochemistry, all tumors showed expression of neuroendocrine markers. CD56 was expressed in all cases 24/24, chromogranin was positive in 17/24 cases, and synaptophysin 8/24 was positive in cases. This study confirms a subset of histopathologic features that are present in cases of BCC that are associated with neuroendocrine expression that can potentially be interpreted differently and can create a diagnostic pitfall. Neuroendocrine expression in BCCs is yet uncertain, and further studies are required to fully understand this phenomenon. To avoid diagnostic pitfalls, dermatopathologists must be aware of these unusual histopathologic features and aberrant immunostaining in such tumors; hence, it is advised to perform a thorough histologic inspection.
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Affiliation(s)
- Jose A Plaza
- Department of Pathology and Dermatology, Division of Dermatopathology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
- Department of Pathology, Division of Dermatopathology, Hospital Obrero, La Paz, Bolivia ; and
- Department of Pathology, Division of Dermatopathology, The University of Virginia, Charlottesville, VA
| | - Llana Pootrakul
- Department of Pathology and Dermatology, Division of Dermatopathology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
- Department of Pathology, Division of Dermatopathology, Hospital Obrero, La Paz, Bolivia ; and
- Department of Pathology, Division of Dermatopathology, The University of Virginia, Charlottesville, VA
| | - Shyam S Raghavan
- Department of Pathology and Dermatology, Division of Dermatopathology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
- Department of Pathology, Division of Dermatopathology, Hospital Obrero, La Paz, Bolivia ; and
- Department of Pathology, Division of Dermatopathology, The University of Virginia, Charlottesville, VA
| | - Martin Sangueza
- Department of Pathology and Dermatology, Division of Dermatopathology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
- Department of Pathology, Division of Dermatopathology, Hospital Obrero, La Paz, Bolivia ; and
- Department of Pathology, Division of Dermatopathology, The University of Virginia, Charlottesville, VA
| | - Alejandro A Gru
- Department of Pathology and Dermatology, Division of Dermatopathology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
- Department of Pathology, Division of Dermatopathology, Hospital Obrero, La Paz, Bolivia ; and
- Department of Pathology, Division of Dermatopathology, The University of Virginia, Charlottesville, VA
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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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Abstract
Neuroendocrine differentiation is characterized by endocrine and neuronal features with prominent dense secretory granules and neuropeptides. Neuroendocrine differentiation of skin tumors is of unknown clinical significance. Nonetheless, the acknowledgment of this line of differentiation is important to prevent diagnostic pitfalls and subsequent inappropriate management. This review aims at summarizing the skin neoplasms that can express neuroendocrine markers.
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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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Abstract
BACKGROUND Adnexal carcinomas (ACs) are rare cutaneous malignancies of sweat gland or pilosebaceous origin. Optimal treatment and metastatic potential of AC are poorly defined. Mohs micrographic surgery (MMS) has been increasingly used to treat AC. OBJECTIVE To review selected primary cutaneous AC and their treatment outcomes with MMS. MATERIALS AND METHODS Literature review using PubMed search for articles related to primary cutaneous ACs. RESULTS Sebaceous carcinoma treated with MMS recurred and metastasized in 6.4% and 3.7%, respectively. Primary cutaneous mucinous carcinoma treated with MMS recurred and metastasized in 9.6% and 6.4%, respectively. After MMS, 4.7% of microcystic AC recurred with no reported metastases. After MMS, recurrences and metastases of trichilemmal carcinoma or hidradenocarcinoma have not been reported. Two (4.2%) regional lymph node metastases but no distant metastases or local recurrences have been reported in eccrine porocarcinoma. Squamoid eccrine duct tumor, pilomatrix carcinoma, and spiradenocarcinoma treated with MMS are also reviewed. CONCLUSION The rarity of ACs and the lack of comparative data on treatment makes conclusive recommendations on treatment difficult. Recent large case series and reviews suggest MMS is a useful and possibly superior treatment for AC and should be considered if primary cutaneous disease is suspected.
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Imamura T, Kuwahara F, Saruta H, Nakama T, Ohata C. Apocrine carcinoma with neuroendocrine differentiation. J Cutan Pathol 2017; 44:810-812. [DOI: 10.1111/cup.12977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/29/2017] [Accepted: 06/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Taichi Imamura
- Department of Dermatology; Kurume University School of Medicine; Kurume Japan
| | - Fumi Kuwahara
- Department of Dermatology; Kurume University School of Medicine; Kurume Japan
| | - Hiroshi Saruta
- Department of Dermatology; Kurume University School of Medicine; Kurume Japan
| | - Takekuni Nakama
- Department of Dermatology; Kurume University School of Medicine; Kurume Japan
| | - Chika Ohata
- Department of Dermatology; Kurume University School of Medicine; Kurume Japan
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Ishida M, Kashu I, Morisaki T, Takenobu M, Moritani S, Uemura Y, Tsuta K. Mucinous carcinoma occurring in the ceruminous gland. Pathol Int 2016; 66:710-712. [PMID: 27796083 DOI: 10.1111/pin.12475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/03/2016] [Accepted: 10/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Mitsuaki Ishida
- Division of Diagnostic Pathology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Ippei Kashu
- Division of Diagnostic Pathology, Kusatsu General Hospital, Kusatsu, Shiga, Japan
| | - Tsuyoshi Morisaki
- Department of Otolaryngology and Head and Neck Surgery, Kusatsu General Hospital, Kusatsu, Shiga, Japan
| | - Masao Takenobu
- Department of Otolaryngology and Head and Neck Surgery, Kusatsu General Hospital, Kusatsu, Shiga, Japan
| | - Sueyoshi Moritani
- Department of Otolaryngology and Head and Neck Surgery, Kusatsu General Hospital, Kusatsu, Shiga, Japan
| | - Yoshiko Uemura
- Division of Diagnostic Pathology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Koji Tsuta
- Division of Diagnostic Pathology, Kansai Medical University, Hirakata, Osaka, Japan
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