Epidermodysplasia verruciformis-associated eccrine neoplasm: a rare entity with distinctive clinical and histopathologic features

Most tumors are caused by inherited or acquired genetic changes. However, a subset of tumors is driven by viral infection including Kaposi sarcoma, nasopharyngeal carcinoma, and others. Human papillomavirus (HPV) is an especially common cause of epithelial cancers and hyperplasias. Epidermodysplasia verruciformis (EDV) is a rare type of HPV infection with characteristic histopathologic features and a unique spectrum of HPV subtypes. We report here a distinctive form of EDV-associated eccrine neoplasia. Seven tumors from two patients were analyzed and show highly uniform features including multiple clustered clinical lesions, multifocal epidermal origin, eccrine differentiation with close association with the acrosyringium, an anastomosing growth pattern, and a bland monotonous poroid-to-basaloid cytomorphology. Clinical follow-up for one patient has been benign to date. These tumors show strong similarity to two previously reported cases, suggesting that this type of EDV-associated eccrine neoplasia may represent a rare but reproducible form of skin adnexal tumor with distinctive clinicopathologic features.

Poroid Hidradenoma: Case Report and Comprehensive Review of the Literature

Poroid hidradenoma (PH) is a rare benign adnexal tumor of eccrine differentiation. It is the rarest of the four described variants of poroid neoplasms. PHs characteristically share a hybrid of the architectural features of the hidradenoma, namely, tumor cells are entirely intradermal with both solid and cystic components, and the cytologic characteristics of the poroid neoplasms, containing predominantly poroid and cuticular cells. Many published reports of PH since its original discovery in 1990 state that "very few" cases of PH can be found in the literature. Here, we have identified a total of 75 published accounts of PH, including the case presented here, as well as the associated patient demographics, lesion characteristics, treatment, and outcomes. We suggest that while uncommon, PH is likely not exceptionally rare and could be an underreported diagnosis.

Endocrine Mucin Producing Sweat Gland Carcinoma with Metastasis to Parotid Gland: Not as Indolent as Perceived?

Endocrine mucin-producing sweat gland carcinoma (EMPSCG) is a rare, low-grade cutaneous adnexal neoplasm with evidence of neuroendocrine differentiation, predominantly involving the eyelids of elderly. It has a striking resemblance to solid papillary carcinoma of breast which similarly displays neuroendocrine features. EMPSGC is considered a precursor of cutaneous mucinous carcinoma, and the term "mucinous carcinoma" is also recommended for hybrid lesions which reveal an invasive mucinous component associated with EMPSGC. While local recurrences are well- documented in EMPSGC, metastases had not been encountered until very recently; two reports in the past year have described metastases from eyelid EMPSGC to the parotid gland after a prolonged interval from the primary presentation. We report the case of a 78-year-old male with eyelid EMPSGC metastatic to the parotid gland nine years after excision of the primary tumor, which had initially been diagnosed as a poorly differentiated carcinoma. Development of metastasis after a prolonged interval is similar to both the previously described cases, and emphasizes the need to reevaluate the stated indolent nature of this neoplasm. It also aims to draw attention of pathologists to this uncommon tumor of the eyelid which is often misdiagnosed on primary presentation.

Poroid Hidradenoma: A Two-Case Report and Literature Review

Poroid hidradenoma (PH) is a rare benign tumor that shows differentiation of the eccrine sweat gland. It occurs mainly in adults, presenting as a 0.5 to 2 cm-sized intradermal nodule, mostly on the head, extremities, trunk and neck. We report two rare cases of PH, one on the face and the other on the heel. The first patient was a 50-year-old male who had a solitary, skin-colored nodule on his right temple for 6 months. The second patient was a 67-year-old female who presented with a solitary, bean-sized, tender nodule on her left heel for 1 year. The common histological examination finding was a well-circumscribed tumor composed of solid portions and large cystic spaces in the center. The tumor cells consisted of small, monomorphic poroid cells and large cuticular cells in both cases. To our knowledge, only few cases of PH have been reported. Herein, we report two rare cases of PHs with literature review.

Low grade malignant eccrine spiradenoma of the vulva: case report, review of the literature and discussion about the role of p53 and HPV

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.

Congenital giant orbital eccrine hidrocystoma

Purpose

To describe the clinical presentation, management, and histopathological results of a congenital eccrine hidrocystoma.

Observations

A 4-year-old healthy boy presented with left upper eyelid ptosis and superonasal painless mass since birth. Computed tomography showed a hypodense cystic lesion located in the extraconal orbital compartment medially. Following complete excision, histopathology revealed an eccrine hidrocystoma.

Conclusions and Importance

Orbital eccrine hidrocystomas should be considered in the differential diagnosis of orbital cystic masses in the pediatric age group.

Prognostic factors and survival outcomes for head and neck cutaneous adnexal cancers

OBJECTIVES

Malignant cutaneous adnexal tumors (MCAT) are rare and comprise a heterogeneous group of cancers. There have been several studies reviewing prognostic factors of these tumors, but no studies focusing on the head and neck. This study aimed to review a large population based database to evaluate prognostic factors that could impact survival.

METHODS

The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify patients with MCAT of the head and neck. Both overall and disease specific survival were the main outcome measures for the study. Univariate and multivariate analyses were performed to evaluate the association of suspected prognostic factors with survival.

RESULTS

The five-year OS and DSS were 72.6 and 95.5%, respectively. A favorable factor for OS was surgical resection ([HR] 0.324; P = 0.001), while unfavorable factors for OS include older age (1.051; P < 0.001), higher tumor grade (1.254; P = 0.049), larger tumor size (1.293; P = 0.003), and positive nodal involvement (3.323; P = 0.002). A favorable factor for DSS was surgical resection (0.026; P < 0.001). Unfavorable factors for DSS include older age (1.058; P = 0.046), larger tumor size (2.528; 1.565-4.085; P < 0.001), and positive nodal involvement (4.761; P = 0.022).

CONCLUSION

Review of the SEER database shows good 5-year OS and DSS rates, similar to those cited in other studies. We identified several prognostic factors associated with survival, while histologic sub-type does not seem to be associated with survival. Surgical resection is the mainstay of treatment.

The evolution of eccrine sweat glands in human and nonhuman primates

Sweating is an unusual thermoregulatory strategy for most mammals, yet is critical for humans. This trait is commonly hypothesized to result from human ancestors moving from a forest to a warmer and drier open environment. As soft tissue traits do not typically fossilize, this idea has been difficult to test. Therefore, we used a comparative approach to examine 15 eccrine gland traits from 35 primate species. For each trait we measured phylogenetic signal, tested three evolutionary models to explain trait variation, and used phylogenetic models to examine how traits varied in response to climate variables. Phylogenetic signal in traits varied substantially, with the two traits exhibiting the highest values being gland distribution on the body and percent eccrine vs. apocrine glands on the body. Variation in most traits was best explained by an Ornstein-Uhlenbeck model suggesting the importance of natural selection. Two traits were strongly predicted by climate. First, species with high eccrine gland glycogen content were associated with habitats exhibiting warm temperatures and low rainfall. Second, species with increased capillarization were associated with high temperature. Glycogen is a primary energy substrate powering sweat production and sodium reabsorption in the eccrine gland, and increased capillarization permits greater oxygen, glucose and electrolyte delivery. Thus, our results are evidence of natural selection for increased sweating capacity in primate species with body surface eccrine glands living in hot and dry climates. We suggest that selection for increased glycogen content and capillarization may have been part of initial increases in hominin thermoregulatory sweating capacity.

A synchronous incidence of eccrine porocarcinoma of the forearm and facial squamous cell carcinoma: A case report

INTRODUCTION

Cutaneous appendageal tumor can differentiate towards or arise from either pilosebaceous apparatus or the eccrine sweat glands. Appendageal tumors are relatively rare, their clinical appearance is non-specific, and the vast majority are not diagnosed until after excision. Eccrine porocarcinoma (EP), also known as malignant eccrine poroma is a rare adnexal tumor arising from the intraepithelial ductal parts of the sweat gland.

CASE PRESENTATION

We presented a 65-year-old, Asian, female with medical co-morbids, who came with both a facial squamous cell carcinoma and a long-standing lesion over her left forearm. Histopathological finding of the left forearm demonstrated eccrine porocarcinoma.

CONCLUSION

Mohs micrographic surgery is the mainstay treatment of cutaneous carcinoma. It is important to rule out associated syndromes in patient who present with multiple cutaneous appendageal tumors.

Morphological, Physiological and Ultrastructural Changes in Flowers Explain the Spatio-Temporal Emission of Scent Volatiles in Polianthes tuberosa L

Tuberose or Polianthes tuberosa L. is a horticultural crop of tropical origin, widely cultivated for its pleasant and intense floral fragrance in the evening. Here an investigation was made into the physiological and cell biological aspects of floral scent biosynthesis, tissue localization and emission that have not previously been examined. Volatiles collected from floral headspace were analyzed by gas chromatography-mass spectrometry (GC-MS) for identification of individual compounds and elucidation of emission patterns. Transcript accumulation and the amount of active enzyme were measured to understand the enzymatic route of scent volatile biosynthesis. Localization of scent volatiles was investigated by histochemical and ultrastructural studies. Scent emission was found to be rhythmic and nocturnal under normal day-night influence, peaking at night. Enhanced enzyme activities and transcript accumulation were recorded just prior to maximum emission. Through scanning electron microscopy (SEM) analysis, the presence of a large number of floral stomata on the adaxial surface of the tepal was revealed which might have bearing on tissue-specific emission. Guard cells of stomata responded significantly to histochemical tests, which also indicated that epidermal tissues are mostly involved in scent emission. High metabolic activity was found in epidermal layers during anthesis as shown by transmission electron microscopy (TEM) analysis. Further, new insight into the localization of scent compounds, the plausible tissue involved in their release along with the preceding ultrastructural changes at the cellular levels is presented. Finally, ultrastructural analysis of the tepal surface has been able to fill a major gap in knowledge of stomatal involvement during scent emission.

A case of massive porocarcinoma

A 53-year-old Cambodian woman presented with nodular masses on the right arm suggestive of a sarcoma-type malignancy. The masses were excised and identified as multiple benign eccrine poromas. The patient re-presented after two years with large relapsed tumours and axillary lymph node involvement. A forequarter amputation was undertaken. Histology confirmed the diagnosis of a porocarcinoma, which was likely to be due to malignant transformation of the original poromas. The size and multiplicity of the tumours represents a highly unusual presentation of these rare eccrine neoplasms.

Porocarcinoma: A systematic review of literature with a single case report

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Porocarcinoma is a rare but aggressive type of skin malignancy.

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Reporting new cases is mandatory to outline the course of the disease.

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We systematically reviewed the literature with a new case report.

Introduction

Eccrine porocarcinoma is a very rare type of skin cancer. It is an aggressive dermatological malignancy. We presented a 62-year-old male with long history of a mass in left forearm complicated by distant metastasis and death. A rapid review of literature has been presented.

Conclusion

Eccrine porocarcinoma is a rare but aggressive type of skin disease. It may arise de novo or complicate a benign skin lesion. Wide local resection is recommended.

Hidradenoma masquerading digital ganglion cyst: A rare phenomenon

Introduction

Mucous cyst is the commonest soft tissue tumor in the dorsum of the distal interphalangeal joint (DIPJ) of the finger. We report the first case of a recurring eccrine tumor (nodular hidradenoma), mimicking a mucous/ganglion cyst, on the dorsum of the DIPJ.

Case report

A 54 year old man presented with painless, hemispherical, colored swelling on the dorsum of his right middle finger (dominant hand), which appeared to have recurred from a previous surgery. The lesion was excised and operative findings from the medical notes showed the gross appearance to be a soft, white, glistening, smooth-surfaced, myxoid nodule resembling a “ganglion cyst”. Immunohistochemistry showed the tumour to be positive for S100, smooth muscle actin and cytokeratin 7. Ductal differentiation was confirmed by staining for epithelial membrane antigen and carcinoembryonic antigen. The histological features were that of atypical and solid cystic hidradenoma.

Discussion

This is the first reported case of this rare tumour presenting as mucous cyst. We conduct a review of the literature of nodular hidradenomas, illustrating the immunohistologic findings in this tumour to emphasise the atypical features.We emphasise the importance of considering hidradenoma in the differential diagnosis of such lesions of the finger, in view of its high recurrence rate and the possibility of malignant transformation.

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We describe the rare phenomenon of an atypical cystic hidradenoma mimicking in presentation a mucous ganglion cyst on the DIPJ of the finger.

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We put this rarity into context by performing a literature review of reported presentations of such tumours.

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We emphasise the importance of a thorough and systematic assessment in patients presenting with such lesions.

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Also highlighted is the importance of considering these tumours in the differential diagnosis of lesions of the DIPJ.

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Thorough immunohistochemistry of resulting biopsies is invaluable in aiding diagnosis in these scenarios of ambiguous soft tissue swellings.

Primary Axillary Porocarcinoma: A Rare Cutaneous Tumour

Eccrine porocarcinoma, a rare cutaneous malignant tumour accounts for a fraction of sweat gland tumours. This tumour is found to originate from the intraepithelial parts of the sweat glands. It commonly involves the lower extremities in elderly patients and carries an aggressive behaviour. Cutaneous and visceral metastasis can occur and hence prompt treatment is mandatory. Surgical excision is the mainstay of treatment modality. We hereby present a case of eccrine porocarcinoma in a 50-year-old male in the right axillary region presenting as a verrucous lesion.

Reactive Eccrine Syringofibroadenomatosis Presenting as Bilateral Plantar Hyperkeratosis

Eccrine syringofibroadenoma (ESFA) is a rare cutaneous tumor with eccrine differentiation with varied clinical manifestations. We report a case of reactive eccrine syringofibroadenomatosis associated with chronic bilateral plantar ulcers in a patient with diabetes mellitus presenting as plantar hyperkeratosis and verrucous growth at margins.

[Cutaneous chondroid syringoma]

INTRODUCTION

Chondroid syringoma (CS) is a rare cutaneous tumor characterized by mixte epithelial and mesenchymal component. The confident histological diagnosis can be obtained by immuno-histochemistry study. Here we present 10 new cases with their clinico-hystological characteristics.

METHODS

The 10 cases were observed between January 2000 and august 2013, in Fort-de-France and Louis-Mourier universitary hospitals. For all the cases a controlled histological study was performed by a dermatopathologist expert and immuno-histochemistry was added. Clinical and immuno-histological data were analyzed.

RESULTS

The lesions were almost localized on the face (3/10) and the extremities (3/10). The size was about 1.2 to 5.2cm. Every case was treated by surgery, no malignant case was diagnosed. Histologically, all the 10 cases presented as a well-limited dermic tumor with a mixte epithelial and mesenchymal component. The stroma was myxo-chondroid, and the epithelial component consisted in epithelial cavities lined by one or two cell layers with eccrine (4/10) or apocrine (5/10) features. Immuno-chemistry study reveals positivity for EMA, ACE and CK7 for the internal cells, and positivity for S100 protein and vimentin of the extern cell layer.

DISCUSSION

Chondroid syringoma is characterized by a mixte epithelial with eccrine and apocrine cells and a myxo-chondroid stroma. Our study has some clinical and histological particularities (lesions on the extremities, epidermic connecting…). The main differentials diagnoses are the other annexial tumors. The treatment is surgical.

CONCLUSION

The histological diagnosis of CS is quite easy, but in case of doubt, immuno-chemistry will help, showing a double mesenchymal and epithelial differentiation.

Primary mucinous adenocarcinoma of the scalp: A case report and literature review

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Primary mucinous adenocarcinoma of the skin is a rare tumour.

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Distinguishing between this primary neoplasm and the more frequently encountered metastatic mucinous deposits on the skin from primaries elsewhere is a diagnostic dilemma.

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Because of the high rate of recurrence, adequate excision with wide margins is advocated. Moh’s micrographic surgery can be a particularly advantageous treatment modality in this setting.

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Proper patient counselling and follow-up are important in treating this low-grade, indolent and frequently recurring tumour.

Introduction

Primary mucinous adenocarcinoma or mucinous eccrine carcinoma of the skin is a rare malignant neoplasm showing predilection to the head and neck. Distinguishing between these primary neoplasms and the more frequent metastatic mucinous deposits on the skin from primaries in the breast and gastrointestinal tract constitutes a diagnostic dilemma.

Presentation of case

We report a case of a 61-year-old lady who presented with a slow-growing, painless scalp nodule. Upon excision, it was diagnosed as “primary mucinous adenocarcinoma”. An extensive work-up in search for another primary tumour failed to show a primary malignancy elsewhere and the diagnosis of a primary eccrine mucinous adenocarcinoma of the skin was rendered.

Discussion

A review of the literature on this entity is presented, discussing diagnostic challenges and therapeutic options that of interest to surgeons, pathologists and dermatologists.

Conclusion

These tumours are indolent and low-grade, with a tendency for local, sometimes multiple, recurrences. Proper patient counselling and follow-up are important in treatment. Sound collaboration between clinicians and pathologists, for good therapeutic results, is of utmost importance.

Primary mucinous eccrine adenocarcinoma - a rare malignant cutaneous adnexal neoplasm at an unconventional site

Primary mucinous eccrine adenocarcinoma, a rare malignant neoplasm of the skin adnexa usually occurs in the head and neck region. The most common sites for its occurrence are the eyelid, the peri-orbital region and the scalp. We report the rare occurrence of primary mucinous eccrine adenocarcinoma of the inguinal region which has been reported in only 1% of cases according to literature search. Since the differentiation from metastatic mucinous carcinomas is difficult, a careful search for primary in the breast, gastrointestinal tract and prostate is mandatory. This case report highlights the importance of precise diagnosis and accurate histological typing of mucinous carcinomas with an emphasis on their role in appropriate patient management along with a brief review of literature.

Eccrine angiomatous naevus revisited

Hamartomatous, circumscribed swellings of the extremities make an interesting study. Presentations are manifold and the naevi are not always present from birth. Excessive growth of hairs leads to remarkable appearance of such swellings. A young woman presented to the dermatology department, complaining of tenderness over 4^th finger of her left hand. The defect was present for the last couple of years and was typified by visible hyperhidrosis on gentle tapping. Counseling of the affected lady made her agree for a skin biopsy. The histopathology revealed it to be of the nature of eccrine angiomatous hamartoma. Blood vessels were scarce. Eccrine ducts were plentiful without other associated anomalies. The deformity was removed by simple excision with good result.

Syringoid eccrine carcinoma: Case report of a rare tumor occasionally detected in the vulva

► Syringoid eccrine carcinoma (SEC) is a rare tumor. ► There are no published reports describing diagnosis of this tumor on the vulva. ► We report a case of a 58-year-old female with a SEC of left labia majora.

Apocrine hidradenocarcinoma of the scalp: a classification conundrum

INTRODUCTION

The classification of malignant sweat gland lesions is complex. Traditionally, cutaneous sweat gland tumors have been classified by either eccrine or apocrine features.

METHODS

A case report of a 33-year-old Hispanic man with a left scalp mass diagnosed as a malignancy of adnexal origin preoperatively is discussed. After presentation at our multidisciplinary tumor board, excision with ipsilateral neck dissection was undertaken.

RESULTS

Final pathology revealed an apocrine hidradenocarcinoma. The classification and behavior of this entity are discussed in this report.

CONCLUSION

Apocrine hidradenocarcinoma can be viewed as an aggressive malignant lesion of cutaneous sweat glands on a spectrum that involves both eccrine and apoeccrine lesions.