Sclerosing sweat duct (syringomatous) carcinoma

Cooper, Philip H.; Mills, Stacey E.; Leonard, Donald D.; Cruz, Daniel J. Santa; Headington, John T.; Barr, Ronald J.; Katz, David A.

doi:10.1097/00000478-198506000-00004

Cited by 164 publications

(217 citation statements)

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“…Briefly, these include sweat gland carcinoma with syringomatous features, malignant syringoma, sclerosing sweat duct carcinoma and syringomatous carcinoma. [2][3][4][5] Clinically, microcystic adnexal carcinoma has a predilection for the head and neck area and is slow growing but locally aggressive. [6][7][8] From a histopathologic perspective, the main differential diagnosis for microcystic adnexal carcinoma, a stratified, infiltrating neoplasm characterized by a superficial component of keratinous cysts and a deeper component of smaller nests and strands of cells embedded in a markedly hyalinized stroma, is sclerosing/infiltrative basal cell carcinoma and desmoplastic trichoepithelioma.…”

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confidence: 99%

“…While local recurrence is reported in 50% of cases of microcystic adnexal carcinoma with positive margins, 40-60% of patients experience one or more local recurrences anywhere from 6 months to 30 years after standard wide local excision. 4,6,7,[9][10][11] Thus, while the standard of care for microcystic adnexal carcinoma is wide local excision, no further management is mandated for a desmoplastic trichoepithelioma.…”

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Microcystic adnexal carcinoma: an immunohistochemical reappraisal

Hoang

Dresser

Kapur³

et al. 2008

Modern Pathology

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Even though immunohistochemical comparisons of microcystic adnexal carcinoma vs infiltrative basal cell carcinoma and desmoplastic trichoepithelioma exist, they are mostly restricted to the use of a single stain. In addition, a comparison with squamous cell carcinoma has not been reported previously. In this study, we compare the expression of cytokeratin (CK) 15, CK7, CK20, CK903, carcinoembryonic antigen (CEA), CD10, CD15 and BerEP4 in 13 microcystic adnexal carcinoma, eight desmoplastic trichoepithelioma, 10 infiltrative basal cell carcinoma, and eight squamous cell carcinoma of which five exhibited ductal differentiation. We found that the majority of microcystic adnexal carcinoma (92%) and desmoplastic trichoepithelioma (100%) cases expressed CK15 while the infiltrative basal cell carcinoma and squamous cell carcinoma cases were all negative. Forty percent of infiltrative basal cell carcinoma expressed CK7; while only two microcystic adnexal carcinoma cases (15%) and one squamous cell carcinoma with ductal differentiation (12%) expressed CK7 in the remaining three tumor categories. None of the desmoplastic trichoepithelioma expressed CK7. All tumors were strongly positive for CK903. While the neoplastic cells were negative, luminal staining of ductal structures was noted for CK7, CD15 and CEA in some of the microcystic adnexal carcinoma, desmoplastic trichoepithelioma and squamous cell carcinoma with ductal differentiation cases. Sixty percent of infiltrative basal cell carcinoma, 31% of microcystic adnexal carcinoma, and 25% of squamous cell carcinoma express CD10. BerEP4 expression was noted in 38% of microcystic adnexal carcinoma, 57% of desmoplastic trichoepithelioma, 100% of infiltrative basal cell carcinoma, and 38% of squamous cell carcinoma. In conclusion, we found CK15 to be a useful marker in distinguishing microcystic adnexal carcinoma from infiltrative basal cell carcinoma and squamous cell carcinoma with ductal differentiation. Our experience indicates that microcystic adnexal carcinoma and desmoplastic trichoepithelioma have a similar immunohistochemical profile that is, CK15 þ and BerEP4 þ /À; thus, additional studies are needed to separate these two entities.

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confidence: 99%

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confidence: 99%

Microcystic adnexal carcinoma: an immunohistochemical reappraisal

Hoang

Dresser

Kapur³

et al. 2008

Modern Pathology

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“…Surmounting the vertically oriented tubules in the papillary dermis are microcysts comprising keratinizing stratified squamous epithelia with a granular cell layer and encompassing central keratin (Figure 18). The so-called sclerosing sweat duct carcinoma lacks these putative pilar microcysts 218,219 and, in their absence, that designation, or in the presence of high-grade cytologic anaplasia, the terms anaplastic syringoma or syringoid carcinoma have also been applied. 220,221 Neoplastic cells may infiltrate blood vessels, skeletal muscle and perineural spaces.…”

Section: Histopathologymentioning

confidence: 99%

“…229 Inspisated secretory material and an internal lining cuticle expressing CEA (Figure 20) give evidence to eccrine differentiation in these neoplasms. 218 Expression of mutant p53, c-erbB-2, bcl2, and Ki-67 is typically not observed. 230 …”

Section: Histopathologymentioning

confidence: 99%

“…The desmoplastic trichoepithelioma typically presents as a small mid-facial papule or as multiple small firm papules as distinct from the ill-defined plaque of microcystic adnexal carcinoma. 218,231,232 This clinical morphology has a histologic analog; in particular, the microcystic adnexal carcinoma is widely invasive to the edges of a 5-mm punch biopsy specimen, whereas the desmoplastic trichoepithelioma might well be completely encompassed by a biopsy of this size. Put another way, the desmoplastic trichoepithelioma is a shallow tumor, whereas the microcystic adnexal carcinoma invades deeply.…”

Section: Differential Diagnosismentioning

confidence: 99%

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Malignant adnexal neoplasms

2006

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Malignant cutaneous adnexal neoplasms are one of the most challenging areas of dermatopathology. Tumors of the pilosebaceous apparatus can occur as single-lineage neoplasms or may manifest as complex proliferations with multilineal differentiation patterns including not only the germinative component of the hair bulb, the inner or outer root sheath epithelium and the sebaceous gland and duct, but also the sweat duct components that relate to the apocrine secretory apparatus which empties into the follicle near the follicular bulge. Eccrine and apocrine neoplasms present a bewildering array of morphologies, which often defy precise classification. The purpose of this review is to discuss in detail the malignant neoplasms of the cutaneous adnexae and their benign and prognostically indeterminate mimics. Modern Pathology (2006) 19, S93-S126. doi:10.1038/modpathol.3800511Keywords: eccrine carcinoma; sebaceous neoplasia Malignant tumors of the pilosebaceous apparatus, their mimics and precursors IntroductionTumors of the pilosebaceous unit can occur in isolation or in combination with complex proliferations showing multilineal differentiation patterns encompassing those of sweat ducts, epidermis and stroma with its varied components. In this review, we will focus upon the malignant adnexal proliferations, considering benign entities mainly insofar as they impact the diagnostic approach to adnexal carcinoma. We will first turn to the malignant sebaceous neoplasms, their precursors and their mimics. Sebaceous adenoma Clinical FeaturesThe sebaceous adenoma is a benign neoplasm that manifests clinically as a pale yellow nodular lesion, typically of the face, that expresses itself clinically after the age of 50. Tumors range in size from o1 to 45 cm. [1][2][3][4][5][6] These lesions are associated with the Muir-Torre syndrome, comprising the coexpression of cutaneous neoplasms, including those of sebaceous type with well-differentiated squamous epithelial neoplasms, and visceral malignancies, including carcinomas of the breast, ovary, gastrointestinal tract and larynx. [7][8][9][10][11][12][13][14] An occasional patient may manifest a malignant lymphoma of nodal or extranodal type. 10,12,14 Sebaceous neoplasms in the setting of Muir-Torre syndrome are often difficult to classify, showing overlap features between all of the prototypic forms of sebaceous neoplasm ranging from hyperplasia to carcinoma. 13 HistologyThe prototypic sebaceous adenoma manifests 1-2 layers of germinitive cells which mature to form central sebocytes, and have an architecture comprising a sharply circumscribed sebaceous lobule surrounded by a compressed pseudocapsule of dermal stroma ( Figure 1a). The overlying epidermis may be attenuated, but sometimes forms a collarette around the peripheral aspect of the neoplasm. Unlike sebaceous hyperplasia, occasional mitoses may be seen in the lobules of a sebaceous adenoma and in concert with this nucleoli may be somewhat prominent, but the pleomorphism, hyperchromasia and individual cell necrosis of the se...

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