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Matthiesen J, Chiu R, Do TT, Bamdad S, Lee J, Peng SK. When to sweat: A history of chemotherapy in malignant sweat gland tumors. A unique case report and literature review. Clin Case Rep 2023; 11:e7182. [PMID: 37180317 PMCID: PMC10167622 DOI: 10.1002/ccr3.7182] [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: 08/01/2022] [Revised: 01/26/2023] [Accepted: 02/13/2023] [Indexed: 05/16/2023] Open
Abstract
Sarcomatoid sweat gland carcinomas are rare among cutaneous cancers, with less than 20 cases described. A 54-year-old woman with sarcomatoid sweat gland carcinoma of the right upper extremity suffered extensive recurrence at 15 months, unresponsive to chemotherapy. There is no standard treatment or chemotherapy regimens for metastatic sweat gland carcinoma.
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Affiliation(s)
| | - R. Chiu
- Harbor UCLA Medical CenterTorranceCaliforniaUSA
| | - T. T. Do
- Harbor UCLA Medical CenterTorranceCaliforniaUSA
| | - S. Bamdad
- Harbor UCLA Medical CenterTorranceCaliforniaUSA
| | - J. Lee
- Harbor UCLA Medical CenterTorranceCaliforniaUSA
| | - S. K. Peng
- Harbor UCLA Medical CenterTorranceCaliforniaUSA
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2
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Buffo TH, Stelini RF, Serrano JYM, Pontes LT, Magalhães RF, de Moraes AM. Mohs micrographic surgery in rare cutaneous tumors: a retrospective study at a Brazilian tertiary university hospital. An Bras Dermatol 2023; 98:36-46. [PMID: 36369200 PMCID: PMC9837646 DOI: 10.1016/j.abd.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mohs micrographic surgery is an established technique in the treatment of cutaneous neoplasms. It offers higher cure rates and the main indications are non-melanoma malignant skin tumors. Few studies have been performed on the treatment of rare tumors through this technique. OBJECTIVE To study rare skin tumors and rare variants of basal cell carcinoma and squamous cell carcinoma submitted to Mohs micrographic surgery in a tertiary service in relation to frequency, disease-free evolution, and applicability of this surgical procedure for this group of tumors. METHODS This was a retrospective observational study including rare skin tumors and less common variants of basal cell carcinoma and squamous cell carcinoma treated using Mohs micrographic surgery, between October 2008 and April 2021. RESULTS During the study period, 437 tumors were treated using Mohs micrographic surgery, and 22 (5%) rare skin tumors were selected. The tumors comprised three dermatofibrosarcomas protuberans, two atypical fibroxanthomas, two spiradenomas, two hypercellular fibrohistiocytomas, one primary cutaneous adenocarcinoma, one trichoblastoma, one porocarcinoma, one chondroid syringoma, one cutaneous angiosarcoma, one Merkel cell carcinoma, and one sebaceous carcinoma. Six other cases of rare basal cell carcinoma variants with trichoepitheliomatous differentiation, metatypical basal cell carcinoma, and clear cell squamous cell carcinoma were included. There were no cases of recurrence after an average of six years of follow-up. STUDY LIMITATIONS This is a retrospective study on rare neoplasms carried out in a single referral center, and this surgical technique isn't widely available in the public service. CONCLUSION This retrospective case series showed that Mohs micrographic surgery is an appropriate treatment for rare skin tumors. They corresponded to 5% of the tumors treated by the technique during a 12-year-period, with no recurrences identified.
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Affiliation(s)
- Thais Helena Buffo
- Discipline of Dermatology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil,Corresponding author.
| | - Rafael Fantelli Stelini
- Department of Pathological Anatomy, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | - Luciana Takata Pontes
- Discipline of Dermatology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Renata Ferreira Magalhães
- Discipline of Dermatology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Aparecida Machado de Moraes
- Discipline of Dermatology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil
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3
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Current Treatment Options for Cutaneous Adnexal Malignancies. Curr Treat Options Oncol 2022; 23:736-748. [DOI: 10.1007/s11864-022-00971-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
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4
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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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5
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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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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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Ishtiaq H, Abdulwaasey M, Tariq MU, Fatima S. Malignant Eccrine Adenoma With Sarcomatous (Heterologous) Components: Report of a Rare Skin Adnexal Neoplasm With Literature Review. Cureus 2020; 12:e12390. [PMID: 33532153 PMCID: PMC7845752 DOI: 10.7759/cureus.12390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Malignant eccrine spiradenoma (MES) is an exceedingly rare skin adnexal tumor that arises from pre-existing benign eccrine spiradenoma (BES). MES tumors show a wide spectrum of morphological features, posing a diagnostic challenge to the pathologist. Sarcomatous (heterologous) elements are seen in a few of these tumors, further complicating the morphological picture. We herein describe a case of a 66-year-old male who presented with a recently enlarging, ulcerated, nodular skin lesion over the right leg that had been present for the last 25 years. The patient underwent wide local excision of the tumor. Microscopic examination revealed a neoplastic lesion comprising benign and malignant components. The carcinomatous component showed features of infiltrating adenocarcinoma, not otherwise specified, whereas the sarcomatous component showed predominant osteosarcomatous and focal chondrosarcomatous differentiation. The benign component showed morphological and immunohistochemical features of BES. No adjuvant treatment was administered. The patient was alive and disease-free for 14 months, after which he was lost to follow-up. Careful identification and knowledge related to histological diversity are keys to the correct diagnosis of this rare tumor. MESs are potentially aggressive tumors, and therefore, close long-term follow-up should be maintained.
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Affiliation(s)
- Hira Ishtiaq
- Histopathology, Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Muhammad Abdulwaasey
- Histopathology, Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Muhammad Usman Tariq
- Histopathology, Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Saira Fatima
- Histopathology, Aga Khan University Hospital, Karachi, PAK
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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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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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10
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Ulcerating Tumor of the Scalp: Answer. Am J Dermatopathol 2017; 39:943-944. [PMID: 29189319 DOI: 10.1097/dad.0000000000000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Verhoeft KR, Ngan HL, Lui VWY. The cylindromatosis ( CYLD) gene and head and neck tumorigenesis. CANCERS OF THE HEAD & NECK 2016; 1:10. [PMID: 31093340 PMCID: PMC6460526 DOI: 10.1186/s41199-016-0012-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/09/2016] [Indexed: 12/19/2022]
Abstract
Germline CYLD mutation is associated with the development of a rare inheritable syndrome, called the CYLD cutaneous syndrome. Patients with this syndrome are distinctly presented with multiple tumors in the head and neck region, which can grow in size and number over time. Some of these benign head and neck tumors can turn into malignancies in some individuals. CYLD has been identified to be the only tumor suppressor gene reported to be associated with this syndrome thus far. Here, we summarize all reported CYLD germline mutations associated with this syndrome, as well as the reported paired somatic CYLD mutations of the developed tumors. Interestingly, whole-exome sequencing (WES) studies of multiple cancer types also revealed CYLD mutations in many human malignancies, including head and neck cancers and several epithelial cancers. Currently, the role of CYLD mutations in head and neck carcinogenesis and other cancers is poorly defined. We hope that this timely review of recent findings on CYLD genetics and animal models for oncogenesis can provide important insights into the mechanism of head and neck tumorigenesis.
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Affiliation(s)
- Krista Roberta Verhoeft
- 1Department of Clinical Oncology, Li-Ka Shing Faculty of Medicine, the University of Hong Kong, Hongkong, SAR Hong Kong
| | - Hoi Lam Ngan
- 2School of Biomedical Sciences, Li-Ka Shing Faculty of Medicine, the University of Hong Kong, Hongkong, SAR Hong Kong
| | - Vivian Wai Yan Lui
- 3School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hongkong, SAR Hong Kong
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12
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Grigoryan KV, Barlev D. Multiple fungating exophytic nodules secondary to metastatic spiradenocarcinoma with direct spinal cord invasion. Int J Dermatol 2015; 55:e552-4. [DOI: 10.1111/ijd.13052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/14/2015] [Accepted: 02/23/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Danny Barlev
- Department of Dermatology; University of Cincinnati; College of Medicine; Cincinnati OH USA
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13
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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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Ren F, Hu Z, Kong Q, Sang H. Multiple Segmental Eccrine Spiradenoma with a Zosteriform Pattern: A Case Report and Literature Review. Ann Dermatol 2015; 27:435-8. [PMID: 26273161 PMCID: PMC4530155 DOI: 10.5021/ad.2015.27.4.435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 12/27/2022] Open
Abstract
Eccrine spiradenoma usually occurs as solitary tender nodules. However, it rarely occurs as multifocal localized tumors or has zosteriform distribution. We report the case of a 32-year-old woman with a 20-year history of itchy lesions on the left side of the back and forearm with a zosteriform distribution. Before disease onset, almost no patients have inducing factors, but our patient received an injection beforehand; however, whether this was coincidental or causative remains unknown. The lesions became very itchy after perspiration or eating spicy food, which has never been reported. A literature search revealed 22 cases of multiple segmental eccrine spiradenoma; we summarized the clinical characteristic in order to aid diagnosis and treatment selection.
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Affiliation(s)
- Fang Ren
- Southern Medical University, Nanjing, China. ; Department of Dermatology, Jinling Hospital, Nanjing University of Medicine, Nanjing, China
| | - Zhili Hu
- Department of Dermatology, Jinling Hospital, Nanjing University of Medicine, Nanjing, China
| | - Qingtao Kong
- Department of Dermatology, Jinling Hospital, Nanjing University of Medicine, Nanjing, China
| | - Hong Sang
- Southern Medical University, Nanjing, China. ; Department of Dermatology, Jinling Hospital, Nanjing University of Medicine, Nanjing, China
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Nagy N, Farkas K, Kemény L, Széll M. Phenotype-genotype correlations for clinical variants caused by CYLD mutations. Eur J Med Genet 2015; 58:271-8. [PMID: 25782638 DOI: 10.1016/j.ejmg.2015.02.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 02/18/2015] [Indexed: 11/29/2022]
Abstract
Brooke-Spiegler syndrome (BSS; OMIM 605041) is an autosomal dominant condition characterized by skin appendageal neoplasms including cylindromas, trichoepitheliomas, and/or spiradenomas. In 1996, the gene locus for BSS was mapped to 16q12-13, and, in 2000, mutations in the cylindromatosis (CYLD) gene were determined to cause BSS, familial cylindromatosis (FC; OMIM 132700) and multiple familial trichoepithelioma type 1 (MFT1; OMIM 601606). The CYLD gene encodes an enzyme with deubiquitinase activity. To date, a total of 95 different diseases-causing mutations have been published for the CYLD gene. A summary of mutations identified in Hungarian patients and a review of previously published mutations are presented in this update. The majority of the sequence changes are frameshift (48%), nonsense (27%), missense (12%) and splice-site (11%) mutations; however, two in-frame deletions have also been reported. Most mutations are located in exons 9-20. Analysis of the identified CYLD gene mutations and the observed BSS, FC and MFT1 clinical phenotypes of the patients revealed significant genotype-phenotype correlations. Elucidation of these genotype-phenotype correlations is critical for the diagnosis of these rare monogenic skin diseases. In addition, characterizing these correlations may promote the understanding of their mechanisms and may hopefully contribute to the development of future therapeutic modalities.
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Affiliation(s)
- Nikoletta Nagy
- Department of Medical Genetics, University of Szeged, Szeged, Hungary; Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary; Dermatological Research Group of the Hungarian Academy of Sciences, University of Szeged, Szeged, Hungary.
| | - Katalin Farkas
- Dermatological Research Group of the Hungarian Academy of Sciences, University of Szeged, Szeged, Hungary
| | - Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary; Dermatological Research Group of the Hungarian Academy of Sciences, University of Szeged, Szeged, Hungary
| | - Márta Széll
- Department of Medical Genetics, University of Szeged, Szeged, Hungary; Dermatological Research Group of the Hungarian Academy of Sciences, University of Szeged, Szeged, Hungary
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Miedema JR, Burgon E, Burkhart C, Stitzenberg K, Hipps J, Zedek D. Metastatic spiradenocarcinoma occurring in an 8-year-old boy. Pediatr Dermatol 2015; 32:122-7. [PMID: 23581574 DOI: 10.1111/pde.12136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We recently saw the case of an 8-year-old boy with histologic findings of spiradenocarcinoma. Malignant adnexal tumors in children are exceedingly rare, and cases of spiradenocarcinoma in children are absent in the literature. We report the case of an 8-year-old boy with metastatic spiradenocarcinoma. A biopsy 2 years before his presentation at our institution was interpreted as a benign lesion, but when the lesion regrew, a repeat biopsy was performed that demonstrated ominous findings, prompting a reexcision. This reexcision demonstrated an area with significant necrosis, many mitoses, and cellular pleomorphism apparently arising out of a sharply demarcated, adjacent, lower-grade area. The histologic features of this patient's biopsies were those of spiradenocarcinoma, potentially arising out of a preexisting spiradenoma, a finding that has not been documented previously in this age group. Staging studies demonstrated multiple bilateral pulmonary nodules, which were confirmed using thoracoscopic biopsy to be metastatic disease. His chemotherapy regimen has included several cycles of cisplatin and 5-flourouracil, with ongoing disease progression of pulmonary disease. It has been 16 months since he presented to our institution (>3 years since the appearance of his initial lesion). Imaging studies demonstrate a slowly increasing size and number of pulmonary lesions. The long-term prognosis is guarded.
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Affiliation(s)
- Jayson R Miedema
- Department of Pathology, University of North Carolina, Chapel Hill, North Carolina
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17
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Wenzel E, Sandhu J, Kajgana Z, Ganta V, Rouweyha R. Malignant eccrine acrospiroma: a case report. J Am Podiatr Med Assoc 2012; 102:247-51. [PMID: 22659768 DOI: 10.7547/1020247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors present a case of seemingly textbook digital osteomyelitis with draining ulceration. Per protocol, specimens were sent to pathology with the intent to verify and identify the offending organisms. Surprisingly, the textbook osteomyelitis returned with a pathological diagnosis of rare sweat gland tumor, malignant eccrine acropsiroma, prompting immediate systemic medical workup and treatment. This case emphasizes the importance of proper laboratory workup of all surgically removed specimens, despite having a "typical" presentation.
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Affiliation(s)
- Ellen Wenzel
- Podiatric Medicine and Surgery Program, Forum Health/WRCS, Youngstown, OH, USA.
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Gómez Oliveira G, Fernández-Alba J, Martín Sastre R, Carro Rey E. Malignant eccrine spiradenoma of the nasolabial fold. A case report. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.maxilo.2011.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Andreoli MT, Itani KMF. Malignant eccrine spiradenoma: a meta-analysis of reported cases. Am J Surg 2010; 201:695-9. [PMID: 20851376 DOI: 10.1016/j.amjsurg.2010.04.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 04/07/2010] [Accepted: 04/07/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Malignant eccrine spiradenoma is an aggressive sweat gland tumor with poorly understood behavior and no currently accepted therapeutic regimen. METHODS An individual patient data meta-analysis with Kaplan–Meier survival curves was performed on 72 reported cases of malignant eccrine spiradenoma. RESULTS In 35 patients with no distant metastasis, local resection resulted in 100% disease-free survival. Of 7 patients with lymph node but no distant metastasis treated with surgical resection and lymph node dissection, 6 patients remained disease-free at final follow-up evaluation. For the 24 cases with confirmed distant metastatic disease, patient survival did not significantly differ between local resection and surgery with adjuvant chemoradiotherapy (P = .8763). CONCLUSIONS Heightened awareness is recommended among surgeons likely to treat this entity. An aggressive surgical approach is supported in the absence of metastasis. When lymph nodes are not clinically involved, sentinel node may have a role followed by lymph node dissection in patients with a positive node.
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Blake PW, Toro JR. Update of cylindromatosis gene (CYLD) mutations in Brooke-Spiegler syndrome: novel insights into the role of deubiquitination in cell signaling. Hum Mutat 2009; 30:1025-36. [PMID: 19462465 DOI: 10.1002/humu.21024] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Germline mutations in the cylindromatosis (CYLD) gene have been described in families with cylindromas, trichoepitheliomas, and/or spiradenomas. Brooke-Spiegler syndrome (BSS) is the autosomal dominant predisposition to skin appendageal neoplasms including cylindromas, trichoepitheliomas, and/or spiradenomas. We review the clinical features, molecular genetics, and the animal models of BSS. To date, a total of 51 germline CYLD mutations have been reported, occurring in exons 9-20, in 73 families with diverse ethnic and racial backgrounds. Of 51 mutations, 86% are expected to lead to truncated proteins. The seven missense mutations reported to date occur only within the ubiquitin (Ub)-specific protease (USP) domain of the CYLD protein and most are associated exclusively with multiple familial trichoepithelioma (MFT). CYLD functions as a tumor suppressor gene. CYLD encodes a deubiquitinating (DUB) enzyme that negatively regulates the nuclear factor (NF)-kappaB and c-Jun N-terminal kinase (JNK) pathways. CYLD DUB activity is highly specific for lysine 63 (K63)-linked Ub chains but has been shown to act on K48-linked Ub chains as well. In 2008, the CYLD USP domain was crystallized, revealing that the truncated Fingers subdomain confers CYLD's unique specificity for K63-linked Ub chains. Recent work using animal models revealed new roles for CYLD in immunity, lipid metabolism, spermatogenesis, osteoclastogenesis, antimicrobial defense, and inflammation.
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Affiliation(s)
- Patrick W Blake
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Rockville, Maryland 20892-4562, USA
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Pedamallu SB, Murphy J, Boyd D, Martin-Hirsch D, Al-Zwae K. Direct intracranial extension of malignant eccrine spiradenoma of the face. J Clin Med Res 2009; 1:181-3. [PMID: 22493654 PMCID: PMC3318883 DOI: 10.4021/jocmr2009.07.1249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2009] [Indexed: 11/03/2022] Open
Abstract
UNLABELLED Malignant eccrine spiradenomas are exceedingly rare tumours. They are aggressive tumours normally arising in long-standing benign eccrine spiradenomas. We present a case of malignant eccrine spiradenoma of the right side of the face with direct intracranial extension without distant metastasis. A 48 years old woman presented with a large exophytic tumour on the right side of her face. Radiological imaging of the head and neck region revealed extensive invasion of the facial tissues around right orbit, maxilla and extension into the middle cranial fossa involving the right temporal lobe. She underwent craniotomy and debulking of the right temporal lobe and biopsy of the facial tumour. Histopathological findings were consistent with malignant eccrine spiradenoma. This is a rare case of facial malignant eccrine spiradenoma with direct intracranial extension with no distant metastasis. A literature search revealed that it is first case to be reported of this kind. KEYWORDS Eccrine carcinoma; Spiradenoma; Adnexal carcinoma; Malignant eccrine spiradenoma.
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Ben Brahim E, Sfia M, Tangour M, Makhlouf R, Cribier B, Chatti S. Malignant eccrine spiradenoma: a new case report. J Cutan Pathol 2009; 37:478-81. [PMID: 19614990 DOI: 10.1111/j.1600-0560.2009.01320.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Malignant eccrine spiradenoma is an extremely rare skin tumor of sweat gland origin. In most cases, it arises in pre-existing benign eccrine spiradenoma. We report an additional case of malignant eccrine spiradenoma. The present case is of a 75-year-old man with malignant eccrine spiradenoma developed in the right shoulder. He had a 6-year history of a recurrent mass that was removed 2 years ago. The patient then underwent a complete excision. The gross pathologic specimen showed a large cutaneous and subcutaneous multinodular tumor, measuring 6 cm in maximal dimension. Microscopically, there were two distinct morphological components: a benign eccrine spiradenoma and a malignant eccrine spiradenoma of low grade with extensive necrosis. Different histologic patterns were observed such as cylindromatous features. Morphological differentiation in malignant eccrine spiradenoma is variable, sometimes with almost complete loss of eccrine differentiation. Extensive sampling to look for a probable previously benign component is necessary. In the other hand, malignant changes can be easily missed without adequate sampling.
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Affiliation(s)
- Ehsen Ben Brahim
- Department of Pathology, Mohamed Tahar Mamouri Hospital, Nabeul, Tunisia.
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Morphologic diversity of malignant neoplasms arising in preexisting spiradenoma, cylindroma, and spiradenocylindroma based on the study of 24 cases, sporadic or occurring in the setting of Brooke-Spiegler syndrome. Am J Surg Pathol 2009; 33:705-19. [PMID: 19194280 DOI: 10.1097/pas.0b013e3181966762] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The authors present a series of 24 malignant neoplasms arising in preexisting benign spiradenoma (20), cylindroma (2), and spiradenocylindroma (2). Nineteen patients (12 females, 7 males; age range, 41 to 92 y) had a solitary neoplasm (size range, 2.2 to 17.5 cm; median 4 cm), whereas the remaining 5 (4 females, 1 male; age range, 66 to 72 y) manifested clinical features of Brooke-Spiegler syndrome (BSS), an autosomal dominantly inherited disease characterized by widespread, small, benign neoplasms on which background larger malignant lesions appeared. Microscopically, all cases showed the residuum of a preexisting benign neoplasm. The malignant components of the lesions were variable and could be classified into 4 main patterns, occurring alone or in combination: 1) salivary gland type basal cell adenocarcinoma-like pattern, low-grade (BCAC-LG); 2) salivary gland type basal cell adenocarcinoma-like pattern, high-grade (BCAC-HG); 3) invasive adenocarcinoma, not otherwise specified (IAC-NOS); and 4) sarcomatoid (metaplastic) carcinoma. In 1 case of IAC-NOS, an in situ adenocarcinoma was also found, presumed to have evolved from an adjacent adenomatous and atypical adenomatous component. Cases harboring a sarcomatoid carcinoma featured a malignant epithelial component composed of varying combinations of BCAC-HG, BCAC-LG, IAC-NOS, or squamous cell carcinoma, whereas the sarcomatoid component appeared as either a pleomorphic or spindle-cell sarcoma. Additionally, in 2 cases there were foci of heterologous chondrosarcomatous differentiation and in 1 case there was rhabomyosarcomatous differentiation. Of the 21 patients with available follow-up (range, 3 mo-15 y; average 4.8 y; median 3.5 y), 10 were without evidence of disease, 1 was alive with metastatic disease, 1 was alive with BSS, 3 developed local recurrences, 4 had died of disease, and 2 were dead of other causes. The histologic pattern of the malignant neoplasm correlated to some extent with the clinical course. BCAC-LG neoplasms showed a less aggressive course, with local recurrences but no distant metastases, whereas the BCAC-HG neoplasms typically followed a highly aggressive course resulting in the death 3 of 6 patients with BCAC-HG. Patients with sarcomatoid carcinoma had a relatively good survival. Molecular genetic investigations revealed no mutations in the CYLD gene in the 4 sporadic cases investigated. One patient with BSS revealed a novel missense germline mutation in exon 14 (c. 1961T>A, p. V654E), whereas a living descendant of another deceased patient demonstrated a recurrent nonsense germline mutation in exon 20 (c. 2806C>T, p. R936X). Given the morphologic diversity and complexity of the neoplasms in question, we propose using a more specific terminology with the precise description of the neoplasm components, rather than generic and less informative terms such as "spiradenocarcinoma" or "carcinoma ex cylindroma."
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Tanese K, Sato T, Ishiko A. Malignant eccrine spiradenoma: case report and review of the literature, including 15 Japanese cases. Clin Exp Dermatol 2009; 35:51-5. [PMID: 19222500 DOI: 10.1111/j.1365-2230.2008.03072.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Malignant eccrine spiradenoma (MES) is an extremely rare cutaneous malignant tumour. An 86-year-old man presented at our hospital with an enlarging tumour on the dorsum of the left hand. An excisional biopsy was taken and histological examination showed a solid island of cells of two distinct types: cells with abundant cytoplasm and oval vesicular nuclei, and small round cells with less cytoplasm and hyperchromatic nuclei with a high frequency of mitosis. We diagnosed this tumour as MES. Although we did not perform further treatment because of the patient's age, there was no sign of recurrence or metastasis in the 2 years of follow-up after excisional biopsy. We reviewed cases of malignant eccrine spiradenoma in the English and Japanese literature and found that 'sarcomatous' or 'squamous' change in histopathology was significantly correlated with a poorer prognosis. It is therefore important for treatment planning to evaluate the entire specimen histologically.
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Affiliation(s)
- K Tanese
- Department of Dermatology, School of Medicine, Keio University, Tokyo, Japan.
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Hantash BM, Chan JL, Egbert BM, Gladstone HB. De novo malignant eccrine spiradenoma: a case report and review of the literature. Dermatol Surg 2006; 32:1189-98. [PMID: 16970705 DOI: 10.1111/j.1524-4725.2006.32265.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Basil M Hantash
- Department of Dermatology, Stanford University Medical Center, Stanford, California 94305-5334, USA
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De Novo Malignant Eccrine Spiradenoma. Dermatol Surg 2006. [DOI: 10.1097/00042728-200609000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chase DM, Basu T, Saffari B, Ries S, Berman ML. Malignant eccrine spiradenoma of the vulva: a case report and review of the literature. Int J Gynecol Cancer 2006; 16:1465-9. [PMID: 16803551 DOI: 10.1111/j.1525-1438.2006.00608.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Malignant eccrine spiradenoma is a rare skin tumor of sweat gland origin. We present the first reported case of this tumor in the female genitalia. Due to the rarity of this tumor, there has yet to be an established standard of care. The present case is that of a 41-year-old woman with malignant eccrine spiradenoma of the periclitoral region. She had an 18-month history of a recurrent, painful mass adjacent to the clitoris. Her diagnosis was made after excision of the cystic tumor. The patient then underwent a partial radical vulvectomy with bilateral sentinel lymph node sampling. As malignant eccrine spiradenoma is a rare tumor, no standard care exists for treatment and postoperative management. Based on our review of the literature, wide local excision appears to be the preferred initial treatment. Furthermore, adjuvant chemotherapy and/or radiation does not seem to improve survival in patients with advanced or recurrent cancer. Although lymph node sampling and/or lymphadenectomy is frequently reported in the treatment of this tumor, hematogenous metastasis can also occur. Therefore, these patients require close postoperative follow-up for recurrent disease.
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Affiliation(s)
- D M Chase
- Department of Obstetrics & Gynecology, University of California-Irvine Medical Center, 101 The City Drive South, Orange, CA 92868, USA
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