Spiradenoma With Adenoid Cystic Carcinoma-like Changes: A Case Series of This Rare Variant With a Potential Diagnostic Pitfall

Spiradenomas are benign cutaneous adnexal neoplasms with sweat gland differentiation that can manifest a broad spectrum of histomorphologic appearances. While they show a characteristic histopathologic phenotype and clinical management involves surgical excision with a low risk of recurrence, there have been unusual histopathologic variants of spiradenoma reported, including cases with adenoid cystic carcinoma (ACC)-like changes. Primary cutaneous ACC is a low-grade malignancy presenting as a subcutaneous mass with the potential for local invasion, perineural invasion, and high rates of local recurrence after excision. The diagnosis of spiradenomas with ACC-like features can be challenging, especially when only the ACC-like component is present for evaluation. A retrospective analysis of 21 cases of spiradenoma with ACC-like changes were obtained from large academic institutions, was performed, and summarized below. All cases showed background of conventional spiradenoma, and the ACC-like areas represented a component in all lesions. The percentage of ACC-like component ranged from 5% to 40% in all cases. The ACC-like component was multifocal and without pleomorphism, perineural and/or vascular invasion, necrosis, or increased mitotic activity. MYB translocation and protein expression was studied in 16 cases by fluorescence in situ hybridization, polymerase chain reaction, and immunohistochemistry. All studied cases were negative for MYB / NFIB , MYB L1, and MYB F by fluorescence in situ hybridization and polymerase chain reaction and 3 cases were positive for MYB expression by immunohistochemistry. Our study expands on spiradenomas with ACC-like features that ought to be considered in the differential diagnosis of cutaneous neoplasms such as primary cutaneous ACC. Our results indicate that a thorough histopathologic inspection and strict application of well-defined histologic criteria are necessary to support the diagnosis of this unusual histopathologic variant. These tumors can be difficult to diagnose, and awareness of their histomorphologic spectrum will facilitate definitive diagnosis and avoid misdiagnosis with other conditions.

Value of Immunohistochemistry to Differentiate Digital Papillary Adenocarcinoma From Acral Hidradenoma With Papillary Structures

ABSTRACT

Digital papillary adenocarcinoma is a malignant adnexal tumor with a predilection for acral sites. Hidradenoma is a benign solid and cystic sweat gland neoplasm with focal ductal and glandular differentiation and good outcomes. Hidradenomas can occur at acral sites and show papillary structures; for this reason, they are included in the differential diagnosis of digital papillary adenocarcinoma, and immunohistochemistry is a valuable tool in this scenario. We described a case of a 43-year-old man with an epithelial tumor showing papillary structures in the intermediate phalanx of the fourth finger. There was diffuse positivity for p63 and negativity for S100 protein, suggesting that this tumor was an acral hidradenoma with papillary structures.

PIGMENTED NODULAR CYSTIC HIDRADENOMA OF THE ANKLE

Solid-cystic hidradenoma is a benign cutaneous tumor that is most commonly found in the head, neck, trunk, and upper extremity regions of patients in the middle to older aged groups. Presentation on lower extremities and in particular on the foot is uncommon. Nodular hidradenomas represent a dermatological pitfall, being difficult to differentiate from basal cell carcinoma and melanoma. We report on a 53-year-old male patient with a pigmented nodular hidradenoma on his ankle that was surgically removed. We discuss histopathology and differential diagnosis of this eccrine tumor of skin. This is the second reported case in the English literature.

[Hidradenocarcinoma of the Scrotum with Lymph Node Metastasis]

Hidradenocarcinoma is a rare neoplasm of the eccrine cells of the sweat glands, usually asymptomatic with slow growing and higher incidence between 50 and 80 years, occurring in both sexes and preferentially located in the palmar, plantar, frontal, axillary and nuchal regions. It has an aggressive behavior, with high rate of local recurrence and distance metastasis, associated with a poor prognosis. We present a case of hidradenocarcinoma of the scrotum manifested by lymph node metastasis through an exercise of clinical and histological differential diagnosis of an inguinal adenopathy in a young adult.

[Malignant transformation of an eccrine spiradenoma]

INTRODUCTION

Malignant eccrine spiradenoma is a rare and aggressive tumor, developed on the epithelium of eccrine sweat glands. Typically, it occurs after malignant transformation of benign eccrine spiradenoma, but sometimes it happens de novo.

OBSERVATION

We report a case of malignant eccrine spiradenoma in a 62-year-old woman. The patient presented a rapid increase in size of a long-standing tumoral lesion of her forearm. There was no secondary lesion on the chest, abdomen or pelvis at the CT-scanner. Cutaneous biopsy of the lesion was performed and showed a carcinoma with no contact with epidermis. On this biopsy, we could not affirm if the tumor was a metastatic process or a primary tumor of the skin. Histologic examination of the surgical removal of the tumor showed an undifferentiated carcinoma with adjacent nodules of eccrine spiradenoma. Immunohistochemical assessment of Ki67 expression showed a weak expression (5%) in the benign spiradenoma nodules and a high rate expression (80%) in the malignant neoplasm. The final diagnosis was an undifferentiated carcinoma arising from preexisting benign spiradenoma.

DISCUSSION

Malignant eccrine spiradenoma is not frequent and is rarely described in the international literature that may lead to diagnostic difficulties.

Papillary hidradenoma of the eyelid margin: clinical and immunohistochemical observations further supporting an apocrine rather than an eccrine origin

A 46-year-old woman was evaluated for a "recurring papilloma" of the left medial upper eyelid margin. Beneath the papillary lesion medial to the punctum was a 5-mm diameter cutaneous mass thought to be cystic. After excisional biopsy, histopathologic analysis documented the presence of an epidermal keratinizing squamous papilloma surmounting a circumscribed dermal papillary hidradenoma composed of deeply eosinophilic columnar cells. Additionally, there was intraductal proliferation of tumor extending toward a subclinical poral opening through the epidermis. Immunohistochemistry proved the apocrine nature of the benign, non-cystic lesion by virtue of its nuclear androgen receptor and cytoplasmic gross-cystic disease fluid protein-15 positivity, along with its smooth muscle actin-positive myoepithelial layer. This and prior cases establish that apocrine tumors, both benign and malignant, are strictly localized at or near the eyelid margin where only apocrine glands are found. These tumors are more often papillary than solid adenomas, and most exceptionally can be malignant. We review the differential diagnosis of simulating eccrine eyelid tumors. We recommend wide local excision for benign lesions, in view of possible intraductal extension that can be eccentric to the main tumor and the miniscule potential for malignant transformation.

[Hidradenoma papilliferum. Report of two cases and review of literature]

We bring two cases of hidradenoma papilliferum, rare injury. We describe the clinical, histopathological and a review of the available literature on the condition.

Hidradenoma of the external auditory canal: clinical presentation and surgical treatment

The aim of this article is to present clinical features, diagnostic procedures and surgical treatment of a rare ear tumor. We report a case of 78 year old female with hidradenoma of the external auditory canal. Patient had a sensation of pain and fullness with permanent ottorhea from the right ear for one year Temporal bone computed tomography showed a tumor of the external ear, 6 centimeters in diameter, without bone, temporomandibular joint or intracranial invasion; the tumor was limited medially by the tympanic membrane. Biopsy was performed and pathohistology finding was: hydradenoma nodulare atypicum. Surgical intervention and wide tumor removal in general endotracheal anesthesia was performed. One year after the surgery there was no sign of tumor recurrence. Hidradenoma is rare ear tumor arising from the epithelial cells of sweat glands of the external auditory canal. Radiological evaluation and pathohistology confirmation of hidradenoma is necessary and wide excision of the tumor is the treatment of choice.

Nodular hidradenoma in a 19-year-old woman

Hidradenomas are rare adnexal tumors. Recently, two groups have been individualized: those with eccrine differentiation called poroid hidradenoma and those with apocrine differentiation called clear-cell hidradenoma or nodular hidradenoma. Herein we report a case of 19-year old woman with a nodular hidradenoma of the scapular region. Our report highlights the clinic-pathological characteristics of these tumors and emphasizes the benefit of complete local excision to prevent risk of recurrence and possible malignant potential.

Fine-needle aspiration cytology of apocrine hidradenoma

An apocrine hidradenoma is a benign adnexal neoplasm, usually covered by intact skin, but may show superficial ulceration and serous discharge. This feature is raising the possibility of malignancy as it was in our case of macroscopically suspicious tumour. We described cytomorphologic features of cutaneous nodule that might be a lead to the cytologic diagnosis of hidradenoma, but primary or secondary malignant tumour has been ruled out first.

Poromatosis: the occurrence of multiple eccrine poromas

Eccrine poromas are rare, benign adnexal tumors derived from the intraepidermal portion of sweat ducts. Historically they were thought to arise from eccrine ducts although today it is thought that they may also have an apocrine origin. They usually appear as solitary, slow-growing, skin-colored papules on acral surfaces. Here we present the unusual situation of a patient with multiple poromas only three of which are located near the distal extremities.

[Malignant eccrine poroma]

INTRODUCTION

Malignant eccrine poroma is a very rare tumour of the sweat glands with high malignancy and presenting with a polymorph clinical and histological picture.

CASE REPORT

We describe the case of a 99-year-old patient with a malignant poroma on the buttock. Despite the large size of the tumour, no metastasis was found with standard examination techniques. Radical excision and defect closure with a Limberg flap was performed.

RESULT

The healing course was uneventful and without complications.

CONCLUSION

The malignant poroma is a tumour of high malignancy which can easily be misdiagnosed because of its different forms of presentation. Radical surgical therapy is the only known effective treatment.

[Eccrine poroma of the scalp: A study of three cases]

The eccrine poroma is a rare benign sudoral tumour, which creates a fleshy formation. The diagnosis is made according to the anatomopathological study. The usual site is the sol, but in rare cases, other sites have also been reported. The authors report three cases of eccrine poroma localised in the scalp with literature review.

Eccrine acrospiroma of inguinal area: Computed tomography findings

Eccrine acrospiroma is a tumor originating from the sweat glands. The computed tomography findings of eccrine acrospiroma in the right inguinal area are presented. In our case, the tumor was seen as a well-defined and ovoid-shaped cystic mass with an internal enhancing solid portion and containing calcifications. Eccrine acrospiroma should be considered in the differential diagnosis of a subcutaneous cystic mass with an internal solid nodule.

Malignant eccrine poroma invading the parotid gland

Malignant eccrine poroma was first described by Pinkus and Mehregon in 1963. Because of the histologic characteristics of the tumor, these authors concluded that the tumor was likely of eccrine origin. Malignant eccrine poroma originates from the intraepidermal ductal portion of the eccrine gland. Like other tumors of skin adnexa, malignant eccrine poroma is a rare tumor. It mostly affects older persons. Clinical diagnosis is difficult, and lesions are often mistakenly identified as squamous cell carcinoma or pyogenic granuloma. We report a case of malignant eccrine poroma invading the parotid gland. A 65-year-old man presented with an ulcerated mass (2x3 cm) below the ear lobule of 3 months' duration. The mass was fixed to the skin and underlying parotid gland. The lesion was treated using a superficial parotidectomy approach including the overlying skin. Simultaneous neck dissection was performed. The diagnosis was malignant eccrine poroma invading the parotid gland.

Eccrine porocarcinoma arising in two African American patients: distinct presentations both treated with Mohs micrographic surgery

Abstract Background Eccrine porocarcinoma (EPC) is a rare, malignant adnexal tumor that has been reported only three times specifically in African American individuals. Diagnosis and treatment of EPC is important, given the 20% local recurrence and regional metastatic rates. However, no standard of care has been developed to guide effective treatment. Methods We report two distinct clinical presentations of EPC, both in African Americans, and discuss a review of the literature. Results The neoplasms were successfully removed from both patients by Mohs micrographic surgery. Conclusions These two cases illustrate that EPC can have a variety of presentations and can occur in African Americans. Although there is no standard of care for treating EPC, Mohs is becoming a common technique of removing these lesions.

Eccrine porocarcinoma

We present an unusual case of eccrine porocarcinoma in that diagnosis was delayed for many years after the initial lesion appeared, resulting in relatively large tumor.

Eccrine porocarcinoma: a case report

Eccrine porocarcinoma is a rare malignant sweat gland tumour. Clinical presentation can vary from an indurated plaque to a polypoid ulcerated and bleeding lesion. Diagnosis of eccrine porocarcinoma on clinical observation only is quite impossible. Here we present the case of a 64-year-old female patient with a small reddish nodule of the knee that, on histological evaluation, proved to be an eccrine porocarcinoma.

Unusual case of porocarcinoma of the foot with no clinically evident dermatologic manifestations

Eccrine poromas are solitary nodules that predilect the soles of the foot. Rarely, malignancies may arise within these tumors. When this occurs, the growth is classified as a malignant eccrine poroma, or porocarcinoma. A case of a 39-year-old woman who originally presented with an incidental plantar skin lesion that was later diagnosed as a porocarcinoma is reported. The patient underwent local excision of the lesion and a sentinel node biopsy. At 18 months postoperative there were no signs of recurrence. This case has been presented to demonstrate that skin lesions with minimal abnormalities of skin texture or color, and slight elevation as the only dermatologic manifestation, can represent a malignancy.

Mohs surgery for malignant eccrine neoplasms

BACKGROUND

Eccrine carcinomas (ECs) are rare tumors with potentially aggressive clinical behavior and a high recurrence rate following conventional surgical excision. With the exception of microcystic adnexal carcinoma (MAC), there have been few reports on the use of Mohs micrographic surgery (MMS) as a primary treatment for EC.

OBJECTIVE

To review the use of MMS for EC and compare treatment outcomes with those of conventional surgical excision.

METHODS

We report our use of MMS in 7 cases of EC and review the literature regarding the use of MMS for EC excluding microcystic adnexal carcinoma (MAC), which has been described elsewhere.

RESULTS

A total of 19 case reports describing MMS for non-MAS malignant eccrine neoplasms were reviewed. There were no reported recurrences over an average follow-up period of 29 months, whereas the local recurrence rate following conventional surgical excision of these neoplasms from 10-70%.

CONCLUSIONS

While the clinical experience is limited, the use of MMS appears to decrease recurrence rates when compared to conventional surgical excision. Further experience and longer follow-up intervals will be necessary to demonstrate superior efficacy and recommended surgical margins.

[Recurrent highly-differentiated eccrine carcinoma of the thumb -- a case report]

The eccrine carcinoma is a rare tumour originating from the sweat glands. They are mainly located in the palm of the hand and the sole of the foot, the digits, the head and the trunk. We report on a now 68-year-old male, who underwent partial amputation of the thumb at the level of the proximal phalanx due to an eccrine carcinoma in 1990. In the following years, three local recurrences were excised. After the exclusion of metastases an amputation at the MP I level was performed at our institution. To restore grip function, we performed a distraction of the first metacarpal bone followed by deepening of the first web space. So far, there are no defined treatment recommendations due to the rarity of the tumor. In some cases, metastatic disease has been reported, and in most cases, a high rate of local recurrence. After diagnostic biopsy, we recommend staging to exclude metastatic spread of the tumor followed by aggressive local surgical treatment.

Nodular Hidradenocarcinoma on the Scalp of a Young Woman: Case Report and Review of Literature

BACKGROUND

Nodular hidradenocarcinoma was first reported as clear-cell eccrine carcinoma by Keasby and Hadley in 1954 (Cancer 1954;7:934-52) and rare malignant tumor. Several synonyms and related terms for nodular hidradenocarcinoma have appeared in the literature.

OBJECTIVE

They have potential for uncontrollable local recurrence, tend to metastasize, and often cause death. Most cases have been reported in the pathology literature with limited clinical information.

METHODS

We report a 27-year-old woman with nodular hidradenocarcinoma on the scalp.

RESULT

The management of rare cases is not well defined. In our case, she was only treated with a wide local excision, and no recurrence was observed 2 years after excision.

CONCLUSION

Most authors have concluded that early wide surgical excision of the tumor is the treatment of choice. The efficiency of adjuvant therapy generally has not established.

Applicability of lymphoscintigraphy with sentinel node biopsy to eccrine carcinoma of the head and neck

BACKGROUND

Eccrine carcinoma of the head and neck has the propensity to metastasize both to regional and distant sites. When associated with nodal metastasis, there is a high incidence of distant spread of disease, ultimately being associated with the death of the patient. Management of the patient with clinically negative nodes remains controversial. Although elective nodal dissection has been performed, the impact of this intervention remains indeterminate. This case series serves as a feasibility study for use of the technique of lymphoscintigraphy with sentinel node biopsy for eccrine carcinoma arising in the head and neck.

METHODS

Two patients with eccrine carcinoma underwent sentinel node biopsy by way of the standard, three-part technique using lymphoscintigraphy, 1% isosulfan blue dye, and intraoperative use of the gamma probe.

RESULTS

In each of these cases, the lymphoscintigram successfully identified sentinel lymph nodes. Intraoperative findings were significant for confirmation of sentinel nodes with the presence of blue dye in the lymph node. In one case, frozen section identified a positive sentinel lymph node, and the patient underwent definitive nodal dissection and postoperative radiotherapy. In the second case, immunohistochemistry as part of final pathology identified a single microscopic foci of metastatic eccrine carcinoma, for which the patient elected to receive definitive radiation therapy.

CONCLUSIONS

This report documents the efficacy of lymphoscintigraphy with sentinel lymph node biopsy in identifying microscopic metastasis eccrine carcinoma in primary lesions arising in the head and neck.

[Diagnostic image (152). A man with a swelling in the groin. Malignant eccrine poroma]

A malignant eccrine poroma (porocarcinoma) was excised from the right groin of a 78-year-old man.

A case of porocarcinoma from pre-existing hidroacanthoma simplex: need of early excision for hidroacanthoma simplex?

BACKGROUND

Hidroacanthoma simplex (HAS) is an uncommon eccrine neoplasm of the skin. It is a benign neoplasm, but some cases of malignant change were reported in the literature.

OBJECTIVE

To describe a rare case of porocarcinoma in a relatively short period from pre-existing HAS on the abdomen.

METHODS

Wide local excision was performed on this neoplasm.

RESULTS

There was no recurrence for 72 months after wide excision. CONCLUSION. : We recommend an early excision and careful attention in the case of HAS because of its potential malignant change.

Aberrant expression of p16 and RB protein in eccrine porocarcinoma

BACKGROUND

Eccrine porocarcinoma is a rare malignant tumor of the sweat gland and very little is known about its etiology and molecular basis.

METHODS

To investigate the expression of p16 and retinoblastoma (RB) protein and their relationship, an immunohistochemical method was performed on nine eccrine porocarcinomas and five eccrine poromas. Furthermore, one case of eccrine porocarcinoma was analyzed for p16 gene mutation.

RESULTS

A striking inverse correlation between p16 and RB expression was noted in all of the eccrine porocarcinomas and poromas. Strong immunoreactivity for p16 protein was observed in both nuclei and cytoplasm of the tumor cells in eight out of nine cases of eccrine porocarcinomas, while RB expression was negative in these cases. Conversely, one case of eccrine porocarcinoma did not show immunoreactivity for p16 protein, whereas RB protein was positive in the scattered nuclei. On the other hand, immunostaining of p16 was negative in all cases of five poromas, whereas RB-positive nuclei were sparse. No p16 gene mutation was detected in the investigated eccrine porocarcinoma case.

CONCLUSIONS

These results indicate that detectable p16 protein and loss of RB protein are common occurrences in eccrine porocarcinoma lesions. Moreover, overexpression of p16 protein may be an additional, simple and useful diagnostic marker for eccrine porocarcinoma on routine laboratory screening.

In vivo confocal imaging of pigmented eccrine poroma

BACKGROUND

Near-infrared reflectance confocal microscopy (CM) imaging is a noninvasive technique that can be utilized to evaluate histologic features of cutaneous lesions in vivo.

OBJECTIVE

A case of pigmented eccrine poroma was examined with CM.

METHODS

Confocal images were taken to define the features of the lesion and correlated with transverse hematoxylin-eosin (HE)-stained sections.

RESULTS

In CM imaging, a well-demarcated homogeneous nest consisting of small uniform cells was seen. The nest contained nonrefractile dark spaces that may represent cuticuli. Many dendritic melanocytes containing melanin were intermingled with the tumor cells, and numerous melanophages were present in the upper dermis. A marked prominence of surrounding vessels was also demonstrated.

CONCLUSIONS

CM could well demonstrate the features of a pigmented eccrine poroma, as correlated with transverse HE-stained sections. However, high reflectance signals from melanin had to be carefully considered before a definitive diagnosis could be made.

Eccrine nevus presenting as a perianal skin tag: a case report and review of the literature

We present the case of a 9-year-old girl with a perianal skin tag. This asymptomatic lesion was removed for cosmetic reasons and demonstrated a polypoid lesion with a slightly acanthotic epidermis. The dermis was filled with mature-appearing eccrine ducts and glands but with no other cutaneous appendages, adipocytes, or abnormal vascularity. We believe this to represent a polypoid eccrine nevus and that its presentation is unique.