Malignant Chondroid Syringoma: A Report of Two Cases with a Sarcomatous Mesenchymal Component

Cutaneous Malignant Mixed Tumor With Pulmonary Metastasis: A Case Report and Literature Review

BACKGROUND

Cutaneous malignant mixed tumor (MMT) is a rare sweat gland-derived tumor characterized by admixed malignant epithelial cells and chondromyxoid stroma. Approximately 50 cases have been described in the literature. Metastasis, which may occur in more than one-third of cases, is most common in the lung.

METHODS

We summarized the clinicopathologic features of a patient with cutaneous MMT metastatic to the lungs. A literature review of similar cases was completed using Web of Science, Scopus, and PubMed databases.

RESULTS

A woman in her 70s presented with an enlarging mass on her left eyebrow; histopathologic examination showed large islands of atypical cells with increased mitotic activity, admixed with necrosis on a background of fibrotic and chondromyxoid stroma. Multiple lung nodules were identified during follow-up. Examination of a pulmonary core needle biopsy specimen was consistent with metastatic cutaneous MMT. Literature review identified 10 cases published between 1980 and 2017. Most primary tumors were large (≥4 cm). Local recurrence was uncommon, and the lung was the only metastatic site in 5 cases. Histopathologically, metastatic tumors were described as more cellular, with diminished stromal tissue compared with the primary lesion.

CONCLUSION

This is 1 of the 11 reports of cutaneous MMT with metastasis to the lungs found in the English-language literature published after 1980. Of note, most reports were published before 1990, making this case study one of the few contemporary descriptions of cutaneous MMT with pulmonary metastases. We think that the present case report will increase the awareness of this rare tumor.

Malignant chondroid syringoma: A systematic review

Malignant Chondroid Syringomas (MCS) are very rare malignant tumours arising from cutaneous sweat glands, with only 51 reported cases in the literature. These tumours can metastasize and cause death if not treated adequately. While there are histological criteria to diagnose MCS tumours, there are no established criterion to determine which tumours are more or less likely to metastasize. A systematic review was performed to establish if any features of the primary MCS tumour are associated with risk of metastasis or patient mortality, as well as the efficacy of common treatment options. The literature search was performed using the Ovid Medline and Web of Science databases from inception through March 2020. This yielded 47 case reports corresponding to 51 unique patients. Statistical analysis of the collected data revealed none of the commonly accepted malignant histopathologic findings (including nuclear atypia and/or pleomorphism, mitotic figures, an infiltrative growth pattern, presence of satellite nodules, necrosis, and vascular and/or perineural invasion) of the primary tumour to be significantly more associated with metastatic risk or death. However, gross characteristics of the tumour, including size (greater than 5 cm) and truncal location of the primary lesion, were found to be associated with a higher risk of metastasis. The most effective treatment modality was wide local excision. Overall, primary MCS tumours, especially those greater than 5 cm or located on the trunk, should be treated with a wide local excision and followed closely to confirm no lesion recurrence or distant metastasis.

Giant Mixed Tumor of the Skin Affecting the Hemiface

Mixed tumor of the skin (MTS) is a rare skin adnexal neoplasm occurring in sweat glands. It is usually benign, measures 0.5 to 3 cm, and presents as a slowly growing, painless, firm nodule commonly in the head and neck regions. Owing to its rarity and lack of distinctive clinical manifestations, confirmative diagnosis is made on the basis of its pathologic features. Malignant MTS also develops de novo or from preexisting benign MTS even though they occur rarely. It should be excised completely to exclude malignant potentials. Herein, we report a 35-year history of a giant MTS of eccrine type measuring approximately 10.5 × 6.5 cm on the right hemiface of a 91-year-old woman, which is the largest facial MTS reported in the literature so far, to the best of our knowledge.

Primary cutaneous osteosarcoma of the scalp in an immunosuppressed individual: A case report and review of the literature

We report a case of a 76-year-old man presenting with a 12-month history of a solitary lesion on his scalp. The histopathology was consistent with a grade 2/3 osteosarcoma extending to the subcutis. Full-body imaging excluded any involvement of the underlying bony tissue or solid organ malignancy, thus a diagnosis of primary cutaneous osteosarcoma (PCO) was made. Given the exceedingly rare nature of PCO, we discuss the clinico-pathological features of this case and those previously reported in the literature.