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Bhanvadia VM, Kathiara R, Shah A, Asari W. Endocrine mucin-producing sweat gland carcinoma of the eyelid - A diagnostic challenge. INDIAN J PATHOL MICR 2024; 67:456-458. [PMID: 38391357 DOI: 10.4103/ijpm.ijpm_278_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/22/2023] [Indexed: 02/24/2024] Open
Abstract
ABSTRACT Skin adnexal or sweat gland neoplasms are rare adnexal tumors that pose a diagnostic challenge for both ophthalmologists and pathologists. Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is an uncommon low grade carcinoma of eccrine ducts with a predilection to occur in the periocular region in the elderly female. We present a rare case of 65-year-old healthy male who presented with a lobulated mass in the left eye lower lid, clinically suspected as sebaceous gland carcinoma, diagnosed as endocrine mucin-producing sweat gland carcinoma histopathologically.
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Affiliation(s)
- Viral M Bhanvadia
- Department of Pathology, M. and J. Western Regional Institute of Ophthalmology Affiliated to B. J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Ravija Kathiara
- Ophthalmology, M. and J. Western Regional Institute of Ophthalmology Affiliated to B. J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Ami Shah
- Department of Pathology, M. and J. Western Regional Institute of Ophthalmology Affiliated to B. J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
| | - Wilhemina Asari
- Ophthalmology, M. and J. Western Regional Institute of Ophthalmology Affiliated to B. J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
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Cazzato G, Bellitti E, Trilli I, Colagrande A, Sgarro N, Scarcella VS, Lettini T, Ingravallo G, Piscitelli D, Resta L, Lospalluti L. Endocrine Mucin-Producing Sweat Gland Carcinoma: Case Presentation with a Comprehensive Review of the Literature. Dermatopathology (Basel) 2023; 10:266-280. [PMID: 37754277 PMCID: PMC10529628 DOI: 10.3390/dermatopathology10030035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
(1) Background: Endocrine Mucin-Producing Sweat Gland Carcinoma (EMPSGC) is a rare, low-grade, neuroendocrine-differentiated, cutaneous adnexal tumor, officially recognized by the World Health Organization (WHO) Skin Tumors Classification in 2018 as a separate entity and homologue of endocrine ductal carcinoma in situ (eDCIS)/solid papillary carcinoma of the breast. Although it is more frequent in the female sex, between 60 and 70 years old, in the peri-orbital region, EMPSGC has also been described in the male sex, in subjects under 60 and over 80, and in extra-eyelid localizations (cheek, temple, scalp), but also in extra-facial localizations (chest and scrotum). (2) Methods: We present the clinical case of a 71-year-old woman with an undated lesion of the scalp, which presented as a nodule, skin-colored, and 2.5 cm in maximum diameter. We also conduct a comprehensive literature review from 1997 to the end of 2022, consulting PubMed, Scopus, Web of Science (WoS), and Google Scholar using the following keywords: "Endocrine mucin-producing sweat gland carcinoma" and/or "EMPSGC" and/or "skin" and "cutaneous neoplasms". In addition, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 253 patients were recorded; 146 were females (57.7%) and 107 were males (42.2%). The vast majority of the lesions were in the eyelids (peri-ocular region), and only a minority of cases involved the cheeks, supra-auricular, retro-auricular, and occipital region, with very rare cases in the scalp, to which the present is also added. (4) Conclusions: The morphological and immunophenotypical features are essential both for the correct diagnosis and to be able to classify this lesion among the corresponding eDCIS/solid papillary carcinoma of the breast, with neuroendocrine differentiation. Recent papers have attempted to shed light on the molecular features of EMPSGC, and much remains to be conducted in the attempt to subtype the molecular profiles of these entities. Future studies with large case series, and especially with molecular biology techniques, will be needed to further add information about EMPSGC and its relationship in the PCMC spectrum.
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Affiliation(s)
- Gerardo Cazzato
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Emilio Bellitti
- Anatomic Pathology Unit, “A. Perrino” Hospital, 72100 Brindisi, Italy;
| | - Irma Trilli
- Odontomatostologic Clinic, Department of Innovative Technologies in Medicine and Dentistry, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy;
| | - Anna Colagrande
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Nicoletta Sgarro
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Vincenza Sara Scarcella
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Teresa Lettini
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Giuseppe Ingravallo
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Domenico Piscitelli
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Leonardo Resta
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Lucia Lospalluti
- Section of Dermatology, Azienda Ospedaliero-Universitaria Policlinico di Bari, 70121 Bari, Italy;
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Froehlich MH, Conti KR, Norris II, Allensworth JJ, Ufkes NA, Nguyen SA, Bruner ET, Cook J, Day TA. Endocrine Mucin-Producing Sweat Gland Carcinoma: A Systematic Review and Meta-Analysis. J DERMATOL TREAT 2021; 33:2182-2191. [PMID: 34057875 DOI: 10.1080/09546634.2021.1937479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Endocrine Mucin-Producing Sweat Gland Carcinoma is a rare, under-reported cutaneous adnexal tumor that is often misdiagnosed and has an unknown incidence of metastasis. OBJECTIVE To determine the incidence of metastasis and tumor recurrence, as well as diagnostic accuracy and current trends in treatment modality. METHODS A search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Tumor pathology and clinical data concerning demographics, presentation, diagnosis, treatment and follow-up were assessed. RESULTS A total of 36 publications with 110 cases were identified. Initial pathological diagnosis was incorrect in 45.5% of cases. One case of metastatic disease was reported. The incidence of locoregional recurrence was 10.6% over a mean follow-up period of 21.3 months. Of cases with known methods of resection, 34.6% were resected by excisional biopsy, 42.8% were resected by wide surgical excision, and 31.3% were cleared by Mohs micrographic surgery. LIMITATIONS The low reported incidence and level of evidence was suboptimal with only case reports and retrospective case studies being reported. CONCLUSION Reported cases of this pathology demonstrate poor diagnostic accuracy. High rates of misdiagnosis and inadequate definitive treatment suggest the need for more comprehensive work-up and management of lesions suspicious for this pathology.
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Affiliation(s)
- Michael H Froehlich
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Keith R Conti
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ivy I Norris
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jordan J Allensworth
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicole A Ufkes
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Evelyn T Bruner
- Department of Pathology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joel Cook
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A Day
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Hadi R, Xu H, Barber BR, Shinohara MM, Moshiri AS. A case of endocrine mucin-producing sweat gland carcinoma with distant metastasis. J Cutan Pathol 2021; 48:937-942. [PMID: 33660318 DOI: 10.1111/cup.13999] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/01/2022]
Abstract
Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare cutaneous adnexal neoplasm typically arising on the face of older individuals, most commonly around the eyelids. Histopathologic features include a circumscribed proliferation of low-grade epithelioid cells with areas of cystic and cribriform growth, foci of intracytoplasmic and extracellular mucin, and coexpression of endocrine, neuroendocrine, and cytokeratin markers by immunohistochemistry. Given histopathologic and immunohistochemical similarities, EMPSGC is often likened to solid papillary carcinoma of the breast and endocrine ductal carcinoma in situ, and is thought by many to represent a forme fruste of mucinous carcinoma of the skin. To date, the vast majority of reported cases of EMPSGC have been described as having indolent behavior, with no cases of distant metastasis yet reported. Here we report a unique case of EMPSGC that recurred over several years following standard surgical excision and Mohs micrographic surgery, with subsequent metastasis to the parotid gland and axial skeleton.
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Affiliation(s)
- Rouba Hadi
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Haodong Xu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Brittany R Barber
- Department of Otolaryngology, University of Washington, Seattle, Washington, USA
| | - Michi M Shinohara
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.,Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Ata S Moshiri
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.,Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
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Au RTM, Bundele MM. Endocrine mucin-producing sweat gland carcinoma and associated primary cutaneous mucinous carcinoma: Review of the literature. J Cutan Pathol 2021; 48:1156-1165. [PMID: 33590507 DOI: 10.1111/cup.13983] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare, low-grade, cutaneous adnexal carcinoma with neuroendocrine differentiation. It is considered to be a precursor of invasive neuroendocrine type primary cutaneous mucinous carcinoma (PCMC). OBJECTIVE To review clinicopathological literature summary of EMPSGC and associated neuroendocrine PCMC from all reported cases and compare its behavior vs non-neuroendocrine PCMC data reported in the literature. METHODS A review of English literature of all EMPSGC cases with and without associated PCMC was carried out. RESULTS EMPSGC was associated with invasive neuroendocrine type PCMC in 35.7% of cases. We found the recurrence rate of PCMC associated with EMPSGC of about 12.3%, which is much less than the 30% recurrence rate reported for the non-neuroendocrine subtype of PCMC. The non-neuroendocrine subtype of PCMC shows a 4% and 11% rate of distant and lymph node metastasis, respectively, vs EMPSGC-associated neuroendocrine type of PCMC, which is very indolent and only one recent case of locoregional metastasis out of 190 EMPSGC cases has been reported so far. LIMITATION Limitation of our study includes data derivation from case reports and case series in the literature. CONCLUSION The prognostic benefits for this cohort of patients may be considered in their overall management.
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Affiliation(s)
| | - Manish M Bundele
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
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