Difference between revisions of "Dermatologic neoplasms"

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This article deals with '''dermatologic neoplasms'''.  It includes '''dermatologic cancer''', which can be deadly.  Collectively, dermatologic cancers are the most common form of cancer.   
This article deals with '''dermatologic neoplasms''', also known as '''skin tumours'''.  It includes '''dermatologic cancer''', which can be deadly.  Collectively, dermatologic cancers are the most common form of cancer.   


An introduction to dermatopathy is found in the ''[[dermatopathology]]'' article.  Non-malignant disease is covered in the ''[[non-malignant skin disease]]'' article.
An introduction to dermatopathy is found in the ''[[dermatopathology]]'' article.  Non-malignant disease is covered in the ''[[non-malignant skin disease]]'' article.
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=The Big Three malignant=
=The Big Three malignant=
==Basal cell carcinoma==
==Basal cell carcinoma==
*Abbreviated ''BCC''.
{{Main|Basal cell carcinoma}}
===General===
*Very common.
*Sun exposed skin.
*Hair bearing area; tumour derived from hair follicle - a more appropriate name might be ''trichoblastic carcinoma''.<ref name=Ref_Derm389>{{Ref Derm|389}}</ref>
*Very rarely metastasizes:
**Dermatopathologists might see a couple in their career.
**There are only ~ 300 literature reports of metastatic BCC.<ref name=pmid16208438>{{Cite journal  | last1 = Ting | first1 = PT. | last2 = Kasper | first2 = R. | last3 = Arlette | first3 = JP. | title = Metastatic basal cell carcinoma: report of two cases and literature review. | journal = J Cutan Med Surg | volume = 9 | issue = 1 | pages = 10-5 | month = Jan | year = 2005 | doi = 10.1007/s10227-005-0027-1 | PMID = 16208438 }}</ref>
 
====Clinical====
*Telangiectasias.
*Raised pearly nodule.
 
====As part of a syndrome====
*[[Nevoid basal cell carcinoma syndrome]] (NBCCS), AKA ''Gorlin syndrome''.
*[[Bazex syndrome]] (X-linked).<ref>URL: [http://emedicine.medscape.com/article/1101146-diagnosis http://emedicine.medscape.com/article/1101146-diagnosis]. Accessed on: 6 May 2010.</ref>
*[[Xeroderma pigmentosum]].
 
===Microscopic===
Features:<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref><ref name=Ref_Derm390>{{Ref Derm|390}}</ref>
#Basaloid cells - similar in appearance to basal cells:
#*Moderate blue/grey cytoplasm.
#*Dark ovoid/ellipsoid nucleus with uniform chromatin.
#Palisading of cells at the edge of the cell nests.
#Artefactual separation of cells (forming the nests) from the underlying stroma - '''key feature'''.
#Surrounded by blue [[myxoid stroma|(myxoid) stroma]] - '''key feature'''.
 
May be present:<ref name=Ref_Derm390>{{Ref Derm|390}}</ref>
*Dystrophic calcification.
*[[Amyloid]].
*Inflammation.
 
Notes:
*Palisading = the long axes of the cells are alined and the axes are perpendicular to the interface between the (basaloid cell) nests and stroma.
*Key elements in a list: Artefactual clefting (of nests), Basaloid cells, Peripheral palisading, Myxoid stroma.
**Memory device ''PAM'': palisading, artefactual clefts, myxoid stroma.
 
DDx:
*[[Trichoepithelioma]] - no artefactual cleft.<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref>
*[[Adenoid cystic carcinoma]] - no myxoid stroma, no peripheral palisading.
*[[Eccrine poroma]] - on palms & soles, BCC rarely found there.<ref>{{Ref DCHH|284}}</ref>


Images:
==Squamous cell carcinoma of the skin==
*[[WC]]:
*Abbreviated ''skin SCC'', ''SCC of the skin'', and ''SCC of skin''.
**[http://en.wikipedia.org/wiki/File:Basal_cell_carcinoma_pathology.jpg BCC - crappy (WC)].
{{Main|Squamous cell carcinoma of the skin}}
*www:
**[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/basal_cell_carcinoma_high_power.jpg BCC (ucsf.edu)].<ref>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/basal_cell_carcinoma.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/basal_cell_carcinoma.html]. Accessed on: 4 September 2011.</ref>
**[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=1&sort=0&s=20080802171910891 BCC with fibroepitheliomatous pattern / fibroepithelioma of Pinkus (surgicalpathologyatlas.com)].
**[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=930934558 BCC with fibroepitheliomatous pattern (dermatlas.med.jhmi.edu)].
 
====Basal cell carcinoma subtypes/unique features====
*Many patterns exist.
*Recurrence higher in morpheaform (sclerosing), infiltrative, micronodular, and superficial patterns.<ref>Basal cell carcinoma. eMedicine. ''Prognosis'' section. URL: [http://emedicine.medscape.com/article/276624-overview http://emedicine.medscape.com/article/276624-overview]. Accessed on: 17 September 2011.</ref>
*DG says the prognosis is similar for all BCC subtypes, except for ''sclerosing'' pattern and ''infiltrative'' pattern.<ref>DG. 14 September 2011.</ref>
 
The subtypes:<ref name=Ref_Derm392-5>{{Ref Derm|392-5}}</ref>
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
! Pattern
! Key histologic feature
! Other histologic features
| Other
|-
| Superficial pattern
| connected to epidermis
|
|
|-
| Nodular pattern
| nodules
| partial detachment from epidermis
| subgroup ''micronodular'' = nests equal size ~ 0.2 mm dia., >=25% of lesion
|-
| Morpheaform (sclerosing) pattern
| stroma sclerosis
|
| often seen with ''infiltrative pattern''
|-
| Infiltrative pattern
| small irregular cell aggregates
|
| often also sclerosing or morpheaform
|-
| Fibroepitheliomatous pattern
| cords and columns of basaloid cells
| fibrous stroma
| name of pattern comes from ''fibroepithelioma of Pinkus''
|-
| Infundibulocystic pattern
| small keratocysts (keratin cysts)
| usu. small, often in cords
| usu. indolent
|-
| Adenoidal pattern
| cribriform / pseudoglandular arch.
| myxoid stroma, peripheral palisading
| DDx: [[adenoid cystic carcinoma]]
|-
|}
 
Unique features/differentiation:<ref name=Ref_Derm392-5>{{Ref Derm|392-5}}</ref>
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
! Differentiation / unique cell
! Key histologic feature
! Other histologic features
| Other
|-
| Pigmented cells
| '''any pattern''' can have pigmentation
| pigment may be in malignant cell
| DDx: collision lesion with [[melanocytic lesion]]
|-
| Squamous differentiation (metatypical BCC)
| pink cytoplasm, keratinization
|
| assoc. with ulceration/tumour recurrence
|-
| Eccrine differentiation
| focal duct formation
|
| very rare, DDx: BCC engulfing sweat ducts
|-
| Clear cells (Clear cell BCC)
| clear cytoplasm
|
| due to glycogen
|}
 
===IHC===
*CK5/6 +ve.
**Useful to assess margins... if very close.
*BerEP4 +ve.
**SCC usually negative.<ref name=pmid19187107>{{Cite journal  | last1 = Yu | first1 = L. | last2 = Galan | first2 = A. | last3 = McNiff | first3 = JM. | title = Caveats in BerEP4 staining to differentiate basal and squamous cell carcinoma. | journal = J Cutan Pathol | volume = 36 | issue = 10 | pages = 1074-176 | month = Oct | year = 2009 | doi = 10.1111/j.1600-0560.2008.01223.x | PMID = 19187107 }}</ref>
*CD10 +ve.
*Actin +ve.
 
==Squamous cell carcinoma==
{{Main|Squamous carcinoma}}
===General===
Precursor:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
*[[Actinic keratosis]] (solar keratosis).
**Clinical: yellow-brown scaly, patches, sandpaper sensation.
 
Risk factors:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
*Sun exposure.
*Immune suppression (e.g. organ transplant recipients).
 
Notes:
*[[Keratoacanthoma]].
**Some don't believe this entity exists.
***These people sign this entity as ''low grade squamous cell carcinoma, keratoacanthoma type''.<ref>RS. 17 May 2010.</ref>
 
===Microscopic===
*See ''[[squamous cell carcinoma]]''.
 
====Bowen disease====
'''Bowen disease''' is ''[[squamous cell carcinoma]] in situ'' of the skin. 
*Its histomorphologic appearance may be similar to [[Paget disease of the breast]]/[[Extramammary Paget disease]], Toker cell hyperplasia and [[melanoma]]. 
**[[IHC]] is used to separate the entities definitively.
 
Histologic DDx of Bowen disease:
*Benign Toker cell hyperplasia.
*[[Malignant melanoma]].
*[[Paget disease of the breast]].
*[[Eccrine carcinoma]].
 
Images:
*[http://commons.wikimedia.org/wiki/File:Bowen_disease_%281%29.jpg Bowen disease - 1 (WC)].
*[http://commons.wikimedia.org/wiki/File:Bowen_disease_%283%29.jpg Bowen disease - 3 (WC)].
 
===IHC===
Bowen's disease panel:
*CK5/6 +ve.<ref>RS. May 2010.</ref>
**Usu. -ve in [[Paget disease of the breast]]/[[Extramammary Paget disease]].
*S100 -ve, HMB-45 -ve.
**Both typically +ve in melanoma.
*CEA -ve<ref name=emed_pagets>URL: [http://emedicine.medscape.com/article/1101235-workup#a0721 http://emedicine.medscape.com/article/1101235-workup#a0721]. Accessed on: 2 September 2011.</ref> (+ve in [[Paget disease of the breast]]/[[Extramammary Paget disease]], -ve in Toker cells).
*CK7 -ve.
**Toker cells CK7 +ve.<ref name=pmid19601945>{{Cite journal  | last1 = Nofech-Mozes | first1 = S. | last2 = Hanna | first2 = W. | title = Toker cells revisited. | journal = Breast J | volume = 15 | issue = 4 | pages = 394-8 | month =  | year =  | doi = 10.1111/j.1524-4741.2009.00743.x | PMID = 19601945 }}</ref>


==Melanoma==
==Melanoma==
{{Main|Malignant melanoma}}
{{Main|Malignant melanoma}}
===General===
*Known as the great mimicker in pathology; it may look like many things.
*Known as the great mimicker in pathology; it may look like many things.
===Microscopic===
Features:
*Classic appearance of melanoma:
**Loosely cohesive; mix of small nests of cells, single cells.
**Mixed of spindle and ovoid cell morphology.
**+/-Occasional large binucleated cells.
**Cytoplasm: brown pigment (melanin).
**Prominent (large) red nucleoli (like in ''serous carcinoma'' of the ovary).
**Marked nuclear pleomorphism - variation in cell size, shape & staining (like in ''serous carcinoma'' of the ovary).
**[[Nuclear pseudoinclusions]] (like in ''papillary thyroid carcinoma'').


=Less common malignant=
=Less common malignant=
==Dermatofibrosarcoma protuberans==
==Dermatofibrosarcoma protuberans==
*Abbreviated ''DFSP''.
*Abbreviated ''DFSP''.
===General===
{{Main|Dermatofibrosarcoma protuberans}}
*Dermal location.
*Destroys adnexal structures.
*Occasionally transforms to a (more aggressive) [[adult fibrosarcoma|fibrosarcoma]].<ref name=pmid21128251>{{Cite journal  | last1 = Stacchiotti | first1 = S. | last2 = Pedeutour | first2 = F. | last3 = Negri | first3 = T. | last4 = Conca | first4 = E. | last5 = Marrari | first5 = A. | last6 = Palassini | first6 = E. | last7 = Collini | first7 = P. | last8 = Keslair | first8 = F. | last9 = Morosi | first9 = C. | title = Dermatofibrosarcoma protuberans-derived fibrosarcoma: clinical history, biological profile and sensitivity to imatinib. | journal = Int J Cancer | volume = 129 | issue = 7 | pages = 1761-72 | month = Oct | year = 2011 | doi = 10.1002/ijc.25826 | PMID = 21128251 }}</ref>
 
Treatment:<ref name=Ref_PBoD8_1183>{{Ref PBoD8|1183}}</ref>
*Wide excision.
*May include [[imatinib]] (Gleevec).
 
===Microscopic===
Features:<ref name=Ref_PBoD8_1183>{{Ref PBoD8|1183}}</ref>
*Dermal spindle cell lesion with storiform pattern.
**Spokes of the wheel-pattern.
*Contains adipose tissue within the tumour -- '''key feature'''.
**Described as "honeycomb pattern" and "Swiss cheese pattern".
 
Notes:
*Adnexal structure within tumour are preserved -- this is unusual for a malignant tumour -- '''important'''.
 
 
Main DDx:
*[[Dermatofibroma]] - has entrapment of collagen bundles at the edge of the lesion.
 
DDx of storiform pattern:
*DFSP, dermatofibroma, [[solitary fibrous tumour]], [[undifferentiated pleomorphic sarcoma]].
 
Images:
*[http://commons.wikimedia.org/w/index.php?title=File:Storiform_pattern_-_intermed_mag.jpg DFSP - storiform pattern - intermed. mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Storiform_pattern_-_very_high_mag.jpg DFSP - storiform pattern - very high mag. (WC)].
*[http://webpathology.com/image.asp?case=317&n=1 DFSP (webpathology.com)].
 
===IHC===
Panel:<ref>AP. May 2009.</ref>
*CD34 +ve.
**Usually negative in dermatofibroma.<ref name=pmid7694515>{{cite journal |author=Abenoza P, Lillemoe T |title=CD34 and factor XIIIa in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans |journal=Am J Dermatopathol |volume=15 |issue=5 |pages=429–34 |year=1993 |month=October |pmid=7694515 |doi= |url=}}</ref><ref name=pmid9129699>{{cite journal |author=Goldblum JR, Tuthill RJ |title=CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma |journal=Am J Dermatopathol |volume=19 |issue=2 |pages=147–53 |year=1997 |month=April |pmid=9129699 |doi= |url=}}</ref>
*Factor XIIIa -ve.
**Usually positive in dermatofibroma.<ref name=pmid7694515>{{cite journal |author=Abenoza P, Lillemoe T |title=CD34 and factor XIIIa in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans |journal=Am J Dermatopathol |volume=15 |issue=5 |pages=429–34 |year=1993 |month=October |pmid=7694515 |doi= |url=}}</ref><ref name=pmid9129699>{{cite journal |author=Goldblum JR, Tuthill RJ |title=CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma |journal=Am J Dermatopathol |volume=19 |issue=2 |pages=147–53 |year=1997 |month=April |pmid=9129699 |doi= |url=}}</ref>
*S100 -ve (screen for melanoma).
*Caldesmin -ve (screen for muscle differentiation).
*Beta-catenin. (???)
*MIB-1 (proliferation marker).
**Should not be confused with ''MIB1'' a gene that regulates [[apoptosis]].
 
===Molecular===
A characteristic [[translocation]] is seen:<ref>{{Ref PBoD8|1249}}</ref>
t(17;22)(q22;q15) COLA1/PDGFB.


==Cutaneous B-cell lymphoma==
==Cutaneous B-cell lymphoma==
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==Cutaneous T-cell lymphoma==
==Cutaneous T-cell lymphoma==
*Abbreviated CTCL.
*Abbreviated CTCL.
{{Main|Cutaneous T-cell lymphoma}}
==Merkel cell carcinoma==
{{Main|Merkel cell carcinoma}}


==Eccrine carcinoma==
===General===
===General===
*''Mycosis fungoides'' - is a subtype (???).
*Arises from the proximal sweat duct.
*CTCL is more common than cutaneous B-cell lymphoma (CBCL).<ref>URL: [http://emedicine.medscape.com/article/1099540-overview http://emedicine.medscape.com/article/1099540-overview]. Accessed on: 24 August 2010.</ref><ref>URL: [http://emedicine.medscape.com/article/1098342-overview http://emedicine.medscape.com/article/1098342-overview]. Accessed on: 24 August 2010.</ref>
 
Stages - like [[Kaposi sarcoma]]:
*Patch.
*Plaque.
*Nodular.


===Microscopic===
===Microscopic===
*Atypical lymphocytes:
Features:
**Have folded "cerebriform" nuclei; ''Sezary-Lutzner cells''.<ref name=Ref_Klatt385>{{Ref Klatt|385}}</ref>
*Pleomorphic nuclei with nucleoli.
*Grouping:
*Duct-like structures - '''key feature'''.
**Nests in the epidermis - known as "Pautrier microabscesses".
*Extends from dermis into epidermis (follows path of a benign sweat duct).
**Single lymphocytes in epidermis; "lymphocyte exocytosis".<ref>URL: [http://www.mdconsult.com/das/book/body/199872830-2/0/1709/I4-u1.0-B978-0-443-06694-8..50117-2--f2.fig http://www.mdconsult.com/das/book/body/199872830-2/0/1709/I4-u1.0-B978-0-443-06694-8..50117-2--f2.fig]. Accessed on: 6 May 2010.</ref>
**Short linear arrays of lymphocytes along the basal layer of the epidermis; "epidermotropism".<ref name=Ref_Klatt385>{{Ref Klatt|385}}</ref>


DDx:
Notes:
*[[Lymphomatoid papulosis]].
*May resemble [[Extramammary Paget's disease]]/[[Paget's disease of the breast]].


Images:
==Kaposi sarcoma==
*[http://commons.wikimedia.org/wiki/File:Cutaneous_T-cell_lymphoma_-_very_high_mag.jpg CTCL - very high mag. (WC)].
:See ''[[Kaposi sarcoma]]''.
*[http://commons.wikimedia.org/wiki/File:Cutaneous_T-cell_lymphoma_-_intermed_mag.jpg CTCL - intermed. mag. (WC)].
*[http://www.jci.org/articles/view/24826/figure/2 CTCL (jci.org)].
*[http://www.mdconsult.com/das/book/body/199872830-2/0/1709/I4-u1.0-B978-0-443-06694-8..50117-2--f2.fig CTCL (mdconsult.com)].


===IHC===
==Sebaceous carcinoma==
Key stain:
{{Main|Sebaceous carcinoma}}
*CD4 +ve.<ref>{{Ref PBoD8|1185}}</ref>


Other stains:
==Microcystic adnexal carcinoma==
*CD3 +ve.
{{Main|Microcystic adnexal carcinoma}}
*CD8 -ve.
 
*CD20 -ve (to r/o significant B cell population).
==Trichilemmal carcinoma==
*CD30 -ve.
{{Main|Trichilemmal carcinoma}}
*CD5 +ve.
*CD7 -ve (often lost first in T cell lymphomas).
*Ki-67 high.
*CD56 -ve.


==Lymphomatoid papulosis==
==Lymphomatoid papulosis==
Line 325: Line 84:
*CD30 +ve.<ref>URL: [http://path.upmc.edu/cases/case513/dx.html http://path.upmc.edu/cases/case513/dx.html]. Accessed on: 25 January 2012.</ref>
*CD30 +ve.<ref>URL: [http://path.upmc.edu/cases/case513/dx.html http://path.upmc.edu/cases/case513/dx.html]. Accessed on: 25 January 2012.</ref>


==Merkel cell carcinoma==
=Rare malignant=
*Abbreviated ''MCC''.
==Basosquamous carcinoma==
:Should '''not''' be confused with ''basaloid [[squamous cell carcinoma]]'' ([[AKA]] ''squamous cell carcinoma, basaloid variant'').
===General===
===General===
*Aggressive.
*Very rare.
*Rare.
**Largest case series, as of 2000, 35 cases.<ref name=pmid10717618>{{Cite journal  | last1 = Martin | first1 = RC. | last2 = Edwards | first2 = MJ. | last3 = Cawte | first3 = TG. | last4 = Sewell | first4 = CL. | last5 = McMasters | first5 = KM. | title = Basosquamous carcinoma: analysis of prognostic factors influencing recurrence. | journal = Cancer | volume = 88 | issue = 6 | pages = 1365-9 | month = Mar | year = 2000 | doi =  | PMID = 10717618 }}
*Increased risk in the immunodeficient.
*Most caused by ''Merkel cell [[polyomavirus]]''.<ref name=pmid18202256>{{Cite journal  | last1 = Feng | first1 = H. | last2 = Shuda | first2 = M. | last3 = Chang | first3 = Y. | last4 = Moore | first4 = PS. | title = Clonal integration of a polyomavirus in human Merkel cell carcinoma. | journal = Science | volume = 319 | issue = 5866 | pages = 1096-100 | month = Feb | year = 2008 | doi = 10.1126/science.1152586 | PMID = 18202256 }}</ref>
 
===General===
Features:<ref name=pmid20418670>{{Cite journal  | last1 = Calder | first1 = KB. | last2 = Smoller | first2 = BR. | title = New insights into merkel cell carcinoma. | journal = Adv Anat Pathol | volume = 17 | issue = 3 | pages = 155-61 | month = May | year = 2010 | doi = 10.1097/PAP.0b013e3181d97836 | PMID = 20418670 }}</ref>
*Rare.
*Aggressive course/poor prognosis.
*Neuroendocrine-like.<ref name=pmid19395876>{{Cite journal | last1 = Pulitzer | first1 = MP. | last2 = Amin | first2 = BD. | last3 = Busam | first3 = KJ. | title = Merkel cell carcinoma: review. | journal = Adv Anat Pathol | volume = 16 | issue = 3 | pages = 135-44 | month = May | year = 2009 | doi = 10.1097/PAP.0b013e3181a12f5a | PMID = 19395876 }}
</ref>
</ref>
 
*May be considered an aggressive variant of [[basal cell carcinoma]].<ref name=pmid10717618/>
Etiology:
*Aggressive behaviour.<ref name=pmid12859383>{{Cite journal  | last1 = Bowman | first1 = PH. | last2 = Ratz | first2 = JL. | last3 = Knoepp | first3 = TG. | last4 = Barnes | first4 = CJ. | last5 = Finley | first5 = EM. | title = Basosquamous carcinoma. | journal = Dermatol Surg | volume = 29 | issue = 8 | pages = 830-2; discussion 833 | month = Aug | year = 2003 | doi =  | PMID = 12859383 }}.</ref>
*Polyomavirus (?).<ref name=pmid20418670/>
*Immunocompromised/immunosuppressed (e.g. organ transplant recipients).


===Microscopic===
===Microscopic===
Features:<ref name=Ref_WMSP491>{{Ref WMSP|491}}</ref>
*Neuroendocrine nuclear features - round nucleus, small nucleoli/no nucleolus, stippled chromatin - '''key feature'''.
*Typically medium size cells ~3x resting lymphocyte.
**May be small or large.
*Architecture: nests, sheets or trabeculae.
*Scant cytoplasm.
*Abundant mitoses. †
*+/-Nuclear moulding.
**Nuclei of adjacent cells conform to one another.
*+/-Tumour infiltrating lymphocytes. ‡ 
Notes:
*† >10 mitoses/HPF = poor prognosis - definition suffers from [[HPFitis]].<ref name=capp_mcc>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols /2011/SkinMerkelCell_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SkinMerkelCell_11protocol.pdf]. Accessed on: 28 March 2012.</ref>
*‡ May be associated with a worse prognosis.<ref name=capp_mcc/>
DDx:
*[[Basal cell carcinoma]] - no stippled chromatin, less mitoses active.
*Cutaneous [[Ewing sarcoma]] - sorted-out with immunostains.
*[[Lymphoma]].
**[[Burkitt lymphoma]].
*Metastatic small cell carcinoma.
*Other [[small round cell tumours]].
Images:
*www:
**[http://www.bccancer.bc.ca/HPI/CE/cytotechnology/cytosleuthquiz/nongyne/ng12hist.htm MCC (bccancer.bc.ca)].
**[http://www.joplink.net/prev/200403/07.html MCC (joplink.net)].
**[http://www.ispub.com/ispub/ijd/volume_5_number_2_8/concurrent_merkel_cell_carcinoma_and_bowen_s_disease_of_the_thigh/bowen-fig3.jpg Merkel cell carcinoma (ispub.com)].
**[http://path.upmc.edu/cases/case398.html Merkel cell carcinoma - several images (upmc.edu)].
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Merkel_cell_carcinoma_-_intermed_mag.jpg MCC - intermed. mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Merkel_cell_carcinoma_-_very_high_mag.jpg MCC - very high mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Merkelcellcarcinoma_Tag.jpg Merkel cell carcinoma - nested pattern (WC)].
===IHC===
Features:
Features:
*CK7 -ve.
*Has features of both [[basal cell carcinoma]] and [[squamous cell carcinoma of the skin|squamous cell carcinoma]].<ref name=pmid12859383/>
*CK20 +ve (perinuclear dot-like).<ref name=pmid11533085>{{Cite journal  | last1 = Leech | first1 = SN. | last2 = Kolar | first2 = AJ. | last3 = Barrett | first3 = PD. | last4 = Sinclair | first4 = SA. | last5 = Leonard | first5 = N. | title = Merkel cell carcinoma can be distinguished from metastatic small cell carcinoma using antibodies to cytokeratin 20 and thyroid transcription factor 1. | journal = J Clin Pathol | volume = 54 | issue = 9 | pages = 727-9 | month = Sep | year = 2001 | doi =  | PMID = 11533085 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1731517/  }}</ref>
**BCC component usually predominant.<ref name=Ref_Derm397>{{Ref Derm|397}}</ref>
*CAM5.2 +ve (dot-like pattern).


Others:
Note:
*TTF-1 -ve.
*''Busam'' notes that there is disagreement about what defines this tumour;<ref name=Ref_Derm372>{{Ref Derm|372}}</ref> however, he goes on the describe it as a ''[[collision tumour]]''.<ref name=Ref_Derm397>{{Ref Derm|397}}</ref>
 
==Eccrine carcinoma==
===General===
*Arises from the proximal sweat duct.
 
===Microscopic===
Features:
*Pleomorphic nuclei with nucleoli.
*Duct-like structures - '''key feature'''.
*Extends from dermis into epidermis (follows path of a benign sweat duct).
 
Notes:
*May resemble [[Extramammary Paget's disease]]/[[Paget's disease of the breast]].
 
==Kaposi sarcoma==
:See ''[[Kaposi sarcoma]]''.
 
==Sebaceous carcinoma==
===General===
*Malignant.
*May arise in a [[salivary gland]].<ref name=Warman/>
 
Notes:
*Sebaceous lesions (from benign to malignant): [[sebaceous hyperplasia]], [[sebaceous adenoma]], sebaceoma, sebaceous carcinoma.
 
===Microscopic===
Features:
*Nuclear atypia.
*Sebaceous differentiation:
**Abundant pale fluffy cytoplasm.
 
Image:
*[http://www.ispub.com/ispub/ijorl/volume_9_number_2_11/sebaceous_adenocarcinoma_of_the_parotid_gland_a_case_report_and_literature_review/gland-fig1a.jpg Sebaceous carcinoma (ispub.com)].<ref name=Warman>URL: [http://www.ispub.com/journal/the_internet_journal_of_otorhinolaryngology/volume_9_number_2_11/article/sebaceous_adenocarcinoma_of_the_parotid_gland_a_case_report_and_literature_review.html http://www.ispub.com/journal/the_internet_journal_of_otorhinolaryngology/volume_9_number_2_11/article/sebaceous_adenocarcinoma_of_the_parotid_gland_a_case_report_and_literature_review.html]. Accessed on: 8 September 2011.</ref>
 
==Microcystic adnexal carcinoma==
*[[AKA]] ''syringomatous carcinoma'', [[AKA]] ''sclerosing sweat duct carcinoma''.<ref name=dermaamin>URL: [http://www.dermaamin.com/site/histopathology-of-the-skin/65-m/1926-microcystic-adnexal-carcinoma-.html http://www.dermaamin.com/site/histopathology-of-the-skin/65-m/1926-microcystic-adnexal-carcinoma-.html]. Accessed on: 16 September 2011.</ref>
===General===
*Low-grade tumour.
*Adults.
 
===Microscopic===
Features:<ref>{{Ref Derm|412}}</ref>
*Small basaloid cells - often forming small cystic spaces - '''key feature'''.
*Fibrotic stroma.


DDx:
DDx:
*Sclerosing [[basal cell carcinoma]].
*Basaloid [[squamous cell carcinoma]].
*Desmoplastic [[trichoepithelioma]].
*[[Basal cell carcinoma]] with squamous differentiation.
*Infiltrative [[squamous cell carcinoma]].
 
Image:
*[http://www.dermaamin.com/site/images/histo-pic/m/microcystic-adnexal-carcinoma/microcystic-adnexal-carcinoma2.jpg Microcystic adnexal carcinoma (dermaamin.com)].<ref name=dermaamin>URL: [http://www.dermaamin.com/site/histopathology-of-the-skin/65-m/1926-microcystic-adnexal-carcinoma-.html http://www.dermaamin.com/site/histopathology-of-the-skin/65-m/1926-microcystic-adnexal-carcinoma-.html]. Accessed on: 16 September 2011.</ref>
 
==Trichilemmal carcinoma==
===General===
*Super rare.
*Not well-described.
 
===Microscopic===
Features:<ref>{{Ref Derm|399-400}}</ref>
*Clear (glycogen-rich) cytoplasm in center of lesion.
*Peripheral palisading at edge of lesion - root sheath differentiation (hair follicle).
*Contiguous with hair follicle ''or'' assoc. with [[trichilemmoma]].
 
DDx:
*[[Squamous cell carcinoma]], clear cell variant.
*[[Basal cell carcinoma]], clear cell variant.
*[[Trichilemmoma]].


=Intermediate=
=Intermediate=
==Atypical fibroxanthoma==
==Atypical fibroxanthoma==
*Abbreviated ''AFX''.
*Abbreviated ''AFX''.
===General===
{{Main|Atypical fibroxanthoma}}
*Typically head & neck region.<ref>URL: [http://emedicine.medscape.com/article/1056204-overview http://emedicine.medscape.com/article/1056204-overview]. Accessed on 2 September 2011.</ref>
*Thought to be related to [[pleomorphic undifferentiated sarcoma]];<ref>{{Cite journal  | last1 = Withers | first1 = AH. | last2 = Brougham | first2 = ND. | last3 = Barber | first3 = RM. | last4 = Tan | first4 = ST. | title = Atypical fibroxanthoma and malignant fibrous histiocytoma. | journal = J Plast Reconstr Aesthet Surg | volume =  | issue =  | pages =  | month = Jun | year = 2011 | doi = 10.1016/j.bjps.2011.05.004 | PMID = 21664889 }}</ref> some say it is the same thing.<ref name=danny>DG. 16 September 2011.</ref>
 
Clinical:
*Rapid growth.
*Elderly.
*Good prognosis.<ref name=pmid20526171>{{Cite journal  | last1 = Beer | first1 = TW. | last2 = Drury | first2 = P. | last3 = Heenan | first3 = PJ. | title = Atypical fibroxanthoma: a histological and immunohistochemical review of 171 cases. | journal = Am J Dermatopathol | volume = 32 | issue = 6 | pages = 533-40 | month = Aug | year = 2010 | doi = 10.1097/DAD.0b013e3181c80b97 | PMID = 20526171 }}</ref>
 
===Microscopic===
Features:<ref name=Ref_Derm521>{{Ref Derm|521}}</ref>
*Dermal lesion - '''key point'''.
*Marked nuclear atypia.
*Mitoses.
*Mulitnucleated cells.
*Foamy cytoplasm - '''key feature'''.
 
DDx:
*[[Melanoma]].
*[[Pleomorphic undifferentiated sarcoma]] (MFH).
*[[Leiomyosarcoma]].
*Sarcomatoid [[squamous carcinoma]].
 
Notes:
*No Grenz zone. (???)
 
Image:
*[http://dermatology.cdlib.org/141/case_reports/afx/1.jpg AFX (cdlib.org)].<ref name=pmid18319023>{{Cite journal  | last1 = Vandergriff | first1 = TW. | last2 = Reed | first2 = JA. | last3 = Orengo | first3 = IF. | title = An unusual presentation of atypical fibroxanthoma. | journal = Dermatol Online J | volume = 14 | issue = 1 | pages = 6 | month =  | year = 2008 | doi =  | PMID = 18319023 }}</ref>
 
===IHC===
Features:<ref name=Ref_Derm521>{{Ref Derm|521}}</ref>
*S100 -ve (done to r/o melanoma).
*34betaE12 -ve, p63 -ve (done to exclude SCC).
*Desmin -ve (done to r/o leiomyosarcoma).


=Benign=
=Benign=
Line 499: Line 116:
*Benign sweat duct tumour.
*Benign sweat duct tumour.
*Eccrine differentiation.
*Eccrine differentiation.
*Usually close to lower eyelid.<ref>{{Ref PBoD8|1177}}</ref>
*Usually close to lower [[eyelid]].<ref>{{Ref PBoD8|1177}}</ref>


===Microscopic===
===Microscopic===
Line 505: Line 122:
*Proliferation of benign ducts with lined by a bilayer (as in normal sweat ducts) with abnormal architecture:
*Proliferation of benign ducts with lined by a bilayer (as in normal sweat ducts) with abnormal architecture:
**Tadpole like appearing ducts.
**Tadpole like appearing ducts.
DDx:
*Syringomatous adenomas of nipple (AKA syringoma of the nipple).<ref name=pmid22355740>{{Cite journal  | last1 = Boecker | first1 = W. | last2 = Junkers | first2 = T. | last3 = Reusch | first3 = M. | last4 = Buerger | first4 = H. | last5 = Korsching | first5 = E. | last6 = Metze | first6 = D. | last7 = Decker | first7 = T. | last8 = Loening | first8 = T. | last9 = Lange | first9 = A. | title = Origin and differentiation of breast nipple syringoma. | journal = Sci Rep | volume = 2 | issue =  | pages = 226 | month =  | year = 2012 | doi = 10.1038/srep00226 | PMID = 22355740 |URL = http://www.nature.com/srep/2012/120117/srep00226/full/srep00226.html }}</ref>
*[[Chondroid syringoma]]. (???)


Images:
Images:
Line 528: Line 149:


Images:
Images:
*[http://www.ispub.com/ispub/ijd/volume_7_number_1_18/cutaneous_mixed_tumor/mixed-fig1.jpg Chondroid syringoma - low mag. (ispub.com)].<ref name=ispub_mts>URL: [http://www.ispub.com/journal/the_internet_journal_of_dermatology/volume_7_number_2_23/article/cutaneous_mixed_tumor.html http://www.ispub.com/journal/the_internet_journal_of_dermatology/volume_7_number_2_23/article/cutaneous_mixed_tumor.html]. Access on: 21 September 2011.</ref>
*[https://www.dermnetnz.org/topics/apocrine-mixed-tumour-pathology Chondroid syringoma (DermnetNZ)].
*[http://www.ispub.com/ispub/ijd/volume_7_number_1_18/cutaneous_mixed_tumor/mixed-fig2.jpg Chondroid syringoma - high mag. (ispub.com)].<ref name=ispub_mts>URL: [http://www.ispub.com/journal/the_internet_journal_of_dermatology/volume_7_number_2_23/article/cutaneous_mixed_tumor.html http://www.ispub.com/journal/the_internet_journal_of_dermatology/volume_7_number_2_23/article/cutaneous_mixed_tumor.html]. Access on: 21 September 2011.</ref>


==Dermal cylindroma==
==Dermal cylindroma==
===General===
{{Main|Dermal cylindroma}}
*Benign skin lesion.
*Should not be confused with ''cylindroma'' ([[adenoid cystic carcinoma]]).
*May be related to ''[[ecrrine spiradenoma]]''.<ref name=pmid6302142>{{Cite journal  | last1 = Gerber | first1 = JE. | last2 = Descalzi | first2 = ME. | title = Eccrine spiradenoma and dermal cylindroma. | journal = J Cutan Pathol | volume = 10 | issue = 1 | pages = 73-8 | month = Feb | year = 1983 | doi =  | PMID = 6302142 }}</ref><ref name=pmid8936072>{{Cite journal  | last1 = Lee | first1 = MW. | last2 = Kelly | first2 = JW. | title = Dermal cylindroma and eccrine spiradenoma. | journal = Australas J Dermatol | volume = 37 | issue = 1 | pages = 48-9 | month = Feb | year = 1996 | doi =  | PMID = 8936072 }}</ref>
 
===Microscopic===
Features:
*Nests that fit together like a jigsaw puzzle.
**The borders of the nests are opposed and undulate.
*Cells nests surrounded by hyaline (i.e. glassy, eosinophilic, acellular) material.
DDx:
*[[Eccrine spiradenoma]].
*[[Basal cell carcinoma]] - has [[myxoid stroma]].
 
Images:
*[http://commons.wikimedia.org/wiki/File:Dermal_cylindroma_intermed_mag.jpg Dermal cylindroma (WC)].
*[http://commons.wikimedia.org/wiki/File:Dermal_cylindroma_intermed_mag_deep.jpg Dermal cylindroma - high mag. (WC)].


==Keratoacanthoma==
==Keratoacanthoma==
*Abbreviated ''KA''.
{{Main|Keratoacanthoma}}
===General===
*Generally considered to be benign.
**Rare reports of [[metastases]] suggesting it may be a form of [[squamous cell carcinoma]].<ref>{{cite journal |author=Mandrell JC, Santa Cruz D |title=Keratoacanthoma: hyperplasia, benign neoplasm, or a type of squamous cell carcinoma? |journal=Semin Diagn Pathol |volume=26 |issue=3 |pages=150–63 |year=2009 |month=August |pmid=20043514 |doi= |url=}}</ref>
 
====Clinical====
*May grow rapidly (weeks or months) then involute.
*Main DDx is [[squamous cell carcinoma]].
*Exophytic lesion, well-circumscribed.
 
===Microscopic===
Features:<ref name=Ref_Klatt378>{{Ref Klatt|378}}</ref>
*Expansion of stratum spinosum - pushing [[tongue]]-like downward growth of epidermis into the dermis.
*Keratin collection ("keratin plug") at the center of lesion-superficial aspect.
*Cells have glassy pink cytoplasm.
*Minimal/no nuclear atypia.
 
Note:
*Classically described as a "volcano lesion" with pale pink cells.
*May have features of regression - [[PMN]]s, fibrosis (???).
 
Image:
*[http://commons.wikimedia.org/wiki/File:Skin_keratoacanthoma_whole_slide.jpg Keratocanthoma (WC).]


==Sebaceous adenoma==
==Sebaceous adenoma==
===General===
===General===
*Seen in [[Muir-Torre syndrome]] - a variant of [[Lynch syndrome]] (hereditary non-polyposis colon cancer).
*Seen in [[Muir-Torre syndrome]] - a variant of [[Lynch syndrome]] (hereditary non-polyposis colon cancer).
Notes:
*Sebaceous lesions (from benign to malignant): [[sebaceous hyperplasia]], sebaceous adenoma, sebaceoma, [[sebaceous carcinoma]].


===Microscopic===
===Microscopic===
Line 586: Line 170:
**Multiple dilated glands - opening to the surface.
**Multiple dilated glands - opening to the surface.


Images:
====Images====
*www:
<gallery>
**[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=587283984 Sebaceous adenoma (jhmi.edu)].
Image:Sebaceous_adenoma_-_low_mag.jpg | Sebaceous adenoma - low mag. (WC/Nephron)
*[[WC]]:
Image:Sebaceous_adenoma_-_high_mag.jpg | Sebaceous adenoma - high mag. (WC/Nephron)
**[http://commons.wikimedia.org/wiki/File:Sebaceous_adenoma_-_low_mag.jpg Sebaceous adenoma - low mag. (WC)].
</gallery>
**[http://commons.wikimedia.org/wiki/File:Sebaceous_adenoma_-_high_mag.jpg Sebaceous adenoma - high mag. (WC)].
www:
*[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=587283984 Sebaceous adenoma (jhmi.edu)].


==Trichilemmoma==
==Trichilemmoma==
*May be spelled ''tricholemmoma''.
*May be spelled ''tricholemmoma''.
===General===
{{Main|Trichilemmoma}}
*Benign neoplasm with features of the pilosebaceous follicular epithelium.<ref>URL: [http://emedicine.medscape.com/article/1059940-overview http://emedicine.medscape.com/article/1059940-overview]. Accessed on: 2 September 2011.</ref>
 
*Associated with ''nevus sebaceous''.<ref name=pmid16503928>{{Cite journal  | last1 = Baykal | first1 = C. | last2 = Buyukbabani | first2 = N. | last3 = Yazganoglu | first3 = KD. | last4 = Saglik | first4 = E. | title = [Tumors associated with nevus sebaceous]. | journal = J Dtsch Dermatol Ges | volume = 4 | issue = 1 | pages = 28-31 | month = Jan | year = 2006 | doi = 10.1111/j.1610-0387.2006.05855.x | PMID = 16503928 }}</ref>
==Poroma==
*Muliple trichilemmomas associated with [[Cowden syndrome]].<ref name=Ref_Derm386>{{Ref Derm|386}}</ref>
{{Main|Poroma}}


===Microscopic===
==Nodular hidradenoma==
Features:<ref name=Ref_Derm386>{{Ref Derm|386}}</ref>
*[[AKA]] ''eccrine acrospiroma''.<ref name=pmid18319032>{{Cite journal  | last1 = Punia | first1 = RP. | last2 = Garg | first2 = S. | last3 = Bal | first3 = A. | last4 = Mohan | first4 = H. | title = Pigmented nodular hidradenoma masquerading as nodular malignant melanoma. | journal = Dermatol Online J | volume = 14 | issue = 1 | pages = 15 | month =  | year = 2008 | doi =  | PMID = 18319032 |URL = http://dermatology.cdlib.org/141/case_presentations/hidradenoma/punia.html }}</ref>
*Superficial dermal lesion contiguous with the epidermis:
{{Main|Nodular hidradenoma}}
**Core of lesion:
***Cuboidal cells with round nuclei, eosinophilic-clear cytoplasm.
**Periphery of lesion:
***Surrounded by hyaline band.
***Peripheral palisading.


DDx:
==Trichoblastoma==
*[[Trichilemmal carcinoma]].
{{Main|Trichoblastoma}}
*[[Basal cell carcinoma]].
*[[Inverted follicular keratosis]].


Images:
==Trichofolliculoma==
*[http://ccr.cancer.gov/staff/images/9033_12822_Lee_1520.jpg Trichilemmoma - low mag. (cancer.gov)].<ref name=lee>URL: [http://ccr.cancer.gov/staff/gallery.asp?profileid=12822 http://ccr.cancer.gov/staff/gallery.asp?profileid=12822]. Accessed on: 2 September 2011.</ref>
{{Main|Trichofolliculoma}}
*[http://ccr.cancer.gov/staff/images/9033_12822_Lee_1521.jpg Trichilemmoma - high mag. (cancer.gov)].<ref name=lee/>
*[http://dermimages.med.jhmi.edu/images/trichilemmoma_1_060109.jpg Trichilemmoma (jhmi.edu)].<ref>URL: [http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=667496720 http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=667496720]. Accessed on: 2 September 2011.</ref>
*[http://www.flickr.com/photos/40981620@N04/3812019838/in/pool-1185084@N23/ Trichilemmoma - low mag. (flickr.com/Irlam)].
*[http://www.flickr.com/photos/40981620@N04/3812019930/in/pool-1185084@N23/ Trichilemmoma - intermed. mag. (flickr.com/Irlam)].
*[http://www.flickr.com/photos/40981620@N04/3811204517/in/pool-1185084@N23/ Trichilemmoma - high mag. (flickr.com/Irlam)].


==Eccrine poroma==
==Apocrine carcinoma of the skin==
===General===
===General===
*Benign tumour arising from the distal sweat duct.
*Rare.<ref name=pmid7678545>{{Cite journal  | last1 = Paties | first1 = C. | last2 = Taccagni | first2 = GL. | last3 = Papotti | first3 = M. | last4 = Valente | first4 = G. | last5 = Zangrandi | first5 = A. | last6 = Aloi | first6 = F. | title = Apocrine carcinoma of the skin. A clinicopathologic, immunocytochemical, and ultrastructural study. | journal = Cancer | volume = 71 | issue = 2 | pages = 375-81 | month = Jan | year = 1993 | doi =  | PMID = 7678545 }}</ref>
*Erythematous - gross.
*Usually very good prognosis.<ref name=pmid7678545/>


===Microscopic===
===Microscopic===
Features:<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70190-5 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70190-5]. Accessed on: 2 July 2010.</ref>
Features:<ref name=pmid7678545/>
*Broad sheets of basaloid cells - attached to the epidermis - containing ductal structures - '''key feature'''.
*Nests.
*Biphasic stroma:
*Apocrine snouts - "decapitation secretion"
*#Edematous stroma.
*#Sclerotic stroma.
*Moderate nuclear pleomorphism.
*+/-Occasional mitoses.


Notes:
DDx:
*Area above gland appears crusted.
*[[Paget disease of the breast]]/[[Extramammary Paget disease]].


DDx:
====Images====
*[[Trichilemmoma]].
<gallery>
*[[Nodular hidradenoma]].
Image:Apocrine_carcinoma_-_intermed_mag.jpg | Apocrine carcinoma - intermed. mag. (WC/Nephron)
Image:Apocrine_carcinoma_-_high_mag.jpg | Apocrine carcinoma - high mag. (WC/Nephron)
</gallery>
===Stains===
Features:<ref name=pmid7678545/>
*PAS +ve.
*PASD +ve.


Images:
===IHC===
*[http://www.flickr.com/photos/40981620@N04/3808316834/in/photostream/ Eccrine poroma - low mag. (flickr.com)]
*[[GCDFP-15]] (gross cystic disease fluid protein-15) +ve.<ref name=pmid7678545/>
*[http://www.flickr.com/photos/40981620@N04/3807502071/in/photostream Eccrine poroma - intermed. mag. (flickr.com)].


==Nodular hidradenoma==
==Dermatomyofibroma==
*[[AKA]] ''eccrine acrospiroma''.<ref name=pmid18319032>{{Cite journal  | last1 = Punia | first1 = RP. | last2 = Garg | first2 = S. | last3 = Bal | first3 = A. | last4 = Mohan | first4 = H. | title = Pigmented nodular hidradenoma masquerading as nodular malignant melanoma. | journal = Dermatol Online J | volume = 14 | issue = 1 | pages = 15 | month =  | year = 2008 | doi =  | PMID = 18319032 |URL = http://dermatology.cdlib.org/141/case_presentations/hidradenoma/punia.html }}</ref>
:Should ''not'' be confused with [[dermatofibroma]].
*Abbreviated ''DMF''.
===General===
===General===
*Benign adnexal tumour.<ref name=pmid9537017>{{Cite journal  | last1 = Stratigos | first1 = AJ. | last2 = Olbricht | first2 = S. | last3 = Kwan | first3 = TH. | last4 = Bowers | first4 = KE. | title = Nodular hidradenoma. A report of three cases and review of the literature. | journal = Dermatol Surg | volume = 24 | issue = 3 | pages = 387-91 | month = Mar | year = 1998 | doi =  | PMID = 9537017 }}</ref>
*Uncommon.
 
Typical locations:<ref name=pmid18319032/>
*Scalp.
*Face.
*Trunk, anterior.


===Microscopic===
===Microscopic===
Features:<ref name=pmid9537017/>
Features:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*Well-circumscribed dermal lesions with:
*Poorly formed fasicles parallel to the skin surface, usu. restricted to the superficial dermis.
**Back-to-back nests with a whorled appearance.
*Moderate cellular density - less cellular than [[DFSP]].
**Spaces between cells.
*Eosinophilic cytoplasm.
**Nuclei ovoid and centrally placed in the cell.
***No nucleolus.
**Cystic spaces with degenerated cells.


DDx:
DDx:
*[[Eccrine poroma]].
*[[DFSP]].
*[[Dermatofibroma]].
 
Images:
*[http://www.dermpedia.org/node/8822 DMF - low mag. (dermpedia.org)].
*[http://www.dermpedia.org/node/8824 DMF - high mag. (dermpedia.org)].


===IHC===
===IHC===
Features:<ref name=pmid9537017/>
Features:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*CAM5.2 +ve.
*CD10 +ve.
*AE1/AE3 +ve.
*Vimentin +ve.
*EMA +ve.
*S100 -ve.
*Desmin -ve.


==Trichoblastoma==
Others:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*[[AKA]] ''trichoepithelioma''.
*CD34 -ve.
**''Trichoepithelioma'' is considered a superficial version of trichoblastoma; WHO lumps the two entities together.<ref name=Ref_Derm383>{{Ref Derm|383}}</ref>
*Factor XIIIa -ve.
*S-100 -ve.
 
==Papillary eccrine adenoma==
*Abbreviated ''[[PEA]]''.
===General===
===General===
*Benign.
*Uncommon.
**Maligant counterpart of trichoepithelioma: [[trichilemmal carcinoma]].
*Benign.<ref name=pmid857729>{{Cite journal  | last1 = Rulon | first1 = DB. | last2 = Helwig | first2 = EB. | title = Papillary eccrine adenoma. | journal = Arch Dermatol | volume = 113 | issue = 5 | pages = 596-8 | month = May | year = 1977 | doi = | PMID = 857729 }}</ref>
*May be familial:
 
**Multiple familial trichoepithelioma.<ref name=pmid15289313>{{Cite journal  | last1 = Salhi | first1 = A. | last2 = Bornholdt | first2 = D. | last3 = Oeffner | first3 = F. | last4 = Malik | first4 = S. | last5 = Heid | first5 = E. | last6 = Happle | first6 = R. | last7 = Grzeschik | first7 = KH. | title = Multiple familial trichoepithelioma caused by mutations in the cylindromatosis tumor suppressor gene. | journal = Cancer Res | volume = 64 | issue = 15 | pages = 5113-7 | month = Aug | year = 2004 | doi = 10.1158/0008-5472.CAN-04-0307 | PMID = 15289313 }}</ref>
Treatment:
**Brooke-Spiegler syndrome.
*Excision.<ref>URL: [http://archderm.jamanetwork.com/article.aspx?articleid=541159 http://archderm.jamanetwork.com/article.aspx?articleid=541159]. Accessed on: 10 December 2012.</ref>
===Gross===
*Central location.
 
Note:
*The ''digital papillary adenoma'' is considered malignant; the AFIP says these are best classified as ''adenocarcinomas'', i.e. ''[[digital papillary adenocarcinoma]]''.<ref name=pmid10843279>{{Cite journal  | last1 = Duke | first1 = WH. | last2 = Sherrod | first2 = TT. | last3 = Lupton | first3 = GP. | title = Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited). | journal = Am J Surg Pathol | volume = 24 | issue = 6 | pages = 775-84 | month = Jun | year = 2000 | doi = | PMID = 10843279 }}</ref>


===Microscopic===
===Microscopic===
Features:<ref>URL: [http://emedicine.medscape.com/article/1060049-workup#a0723 http://emedicine.medscape.com/article/1060049-workup#a0723]. Accessed on: 31 August 2011.</ref>
Features:<ref name=pmid17642667>{{Cite journal  | last1 = Laxmisha | first1 = C. | last2 = Thappa | first2 = DM. | last3 = Jayanthi | first3 = S. | title = Papillary eccrine adenoma. | journal = Indian J Dermatol Venereol Leprol | volume = 70 | issue = 6 | pages = 370-2 | month =  | year =  | doi =  | PMID = 17642667 | URL = http://www.ijdvl.com/article.asp?issn=0378-6323;year=2004;volume=70;issue=6;spage=370;epage=372;aulast=Laxmisha }}</ref><ref name=pmid9793207/>
*Well-circumscribed cell nest in the superficial dermis.  
*Well-circumscribed lesions consisting of multiple cystic spaces lined by a bilayered epithelium with:
*Surrounding by a fibrous stroma.  
**Papillary projections into the lumen.
*Basaloid cells with [[peripheral palisading]].
**Amorphous eosinophilic material in the cystic spaces.
*+/-Surround keratin-filled cysts.
**Surrounded by a fibrous stroma.<ref name=pmid9508346>{{Cite journal  | last1 = Mizuoka | first1 = H. | last2 = Senzaki | first2 = H. | last3 = Shikata | first3 = N. | last4 = Uemura | first4 = Y. | last5 = Tsubura | first5 = A. | title = Papillary eccrine adenoma: immunohistochemical study and literature review. | journal = J Cutan Pathol | volume = 25 | issue = 1 | pages = 59-64 | month = Jan | year = 1998 | doi =  | PMID = 9508346 }}</ref>
*Fibroblasts-like cell aggregate, similar to a follicular papillae (papillary-mesenchymal body).


Notes:
Note:
*Very rarely an artefactual cleft - as in [[basal cell carcinoma]].
*May appear to have more than two cell layers.
 
Variants:
*Desmoplastic trichoblastoma.


DDx:
DDx:
*[[Basal cell carcinoma]] - usu. mitoses, mucinous stroma and '''no''' papillary-mesenchymal bodies.
*[[Digital papillary adenocarcinoma]] - location important.
*[[Dermal cylindroma]] - has hyaline stroma.
*[[Tubular apocrine adenoma]] (tubulopapillary hidradenoma<ref name=pmid1566975>{{Cite journal  | last1 = Fox | first1 = SB. | last2 = Cotton | first2 = DW. | title = Tubular apocrine adenoma and papillary eccrine adenoma. Entities or unity? | journal = Am J Dermatopathol | volume = 14 | issue = 2 | pages = 149-54 | month = Apr | year = 1992 | doi =  | PMID = 1566975 }}</ref>) - a related tumour.<ref name=pmid8238787>{{Cite journal  | last1 = Ishiko | first1 = A. | last2 = Shimizu | first2 = H. | last3 = Inamoto | first3 = N. | last4 = Nakmura | first4 = K. | title = Is tubular apocrine adenoma a distinct clinical entity? | journal = Am J Dermatopathol | volume = 15 | issue = 5 | pages = 482-7 | month = Oct | year = 1993 | doi =  | PMID = 8238787 }}</ref>


Images:
Image:
*[[WC]]:
*[http://www.ijdvl.com/viewimage.asp?img=ijdvl_2004_70_6_370_13482_2.jpg PEA - crappy image (ijdvl.com)].<ref name=pmid17642667/>
**[http://commons.wikimedia.org/wiki/File:Trichoepithelioma_-_low_mag.jpg Trichoepithelioma - low mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Trichoepithelioma_-_high_mag.jpg Trichoepithelioma - high mag. (WC)].


==Apocrine carcinoma of the skin==
===IHC===
===General===
Outer layer of epithelium:<ref name=pmid9508346/>
*Rare.<ref name=pmid7678545>{{Cite journal  | last1 = Paties | first1 = C. | last2 = Taccagni | first2 = GL. | last3 = Papotti | first3 = M. | last4 = Valente | first4 = G. | last5 = Zangrandi | first5 = A. | last6 = Aloi | first6 = F. | title = Apocrine carcinoma of the skin. A clinicopathologic, immunocytochemical, and ultrastructural study. | journal = Cancer | volume = 71 | issue = 2 | pages = 375-81 | month = Jan | year = 1993 | doi =  | PMID = 7678545 }}</ref>
*SMA-alpha +ve.  
*Usu. very good prognosis.<ref name=pmid7678545/>
*Keratin 14 +ve.  
Inner layer of epithelium:<ref name=pmid9508346/>
*Keratin 8 +ve.


===Microscopic===
Other stains:<ref name=pmid9793207>{{Cite journal  | last1 = Guccion | first1 = JG. | last2 = Patterson | first2 = RH. | last3 = Nayar | first3 = R. | last4 = Saini | first4 = NB. | title = Papillary eccrine adenoma: an ultrastructural and immunohistochemical study. | journal = Ultrastruct Pathol | volume = 22 | issue = 3 | pages = 263-9 | month =  | year =  | doi =  | PMID = 9793207 }}</ref>
Features:<ref name=pmid7678545/>
*Vimentin +ve.
*Nests.
*CEA +ve.
*Apocrine snouts - "decapitation secretion"
*[[EMA]] +ve.
*S-100 +ve.


DDx:
===Sign out===
*[[Paget disease of the breast]]/[[Extramammary Paget disease]].
<pre>
SKIN LESION, LEFT PARIETAL SCALP, BIOPSY:
- PAPILLARY ECCRINE ADENOMA.
</pre>


Images:
====Micro====
*[http://commons.wikimedia.org/wiki/File:Apocrine_carcinoma_-_intermed_mag.jpg Apocrine carcinoma - intermed. mag. (WC)].
The sections show a well-circumscribed multi-locular superficial dermal lesion with a bilayered epithelium and intracystic papillary projections. The cystic spaces contain amorphous eosinophilic material. The cystic component is surrounded by a dense fibrous stroma with a mixed inflammatory infiltrate, consisting primary of plasma cells and lymphocytes.
*[http://commons.wikimedia.org/wiki/File:Apocrine_carcinoma_-_high_mag.jpg Apocrine carcinoma - high mag. (WC)].


===Stains===
There is no significant nuclear atypia and no mitotic activity is appreciated. The overlying epidermis matures appropriately. A granular layer is present.
Features:<ref name=pmid7678545/>
*PAS +ve.
*PASD +ve.
 
===IHC===
*GCDFP-15 (gross cystic disease fluid protein-15) +ve.<ref name=pmid7678545/>


=See also=
=See also=

Revision as of 04:04, 6 June 2018

This article deals with dermatologic neoplasms, also known as skin tumours. It includes dermatologic cancer, which can be deadly. Collectively, dermatologic cancers are the most common form of cancer.

An introduction to dermatopathy is found in the dermatopathology article. Non-malignant disease is covered in the non-malignant skin disease article.

The Big Three malignant

Basal cell carcinoma

Main article: Basal cell carcinoma

Squamous cell carcinoma of the skin

  • Abbreviated skin SCC, SCC of the skin, and SCC of skin.
Main article: Squamous cell carcinoma of the skin

Melanoma

Main article: Malignant melanoma
  • Known as the great mimicker in pathology; it may look like many things.

Less common malignant

Dermatofibrosarcoma protuberans

  • Abbreviated DFSP.
Main article: Dermatofibrosarcoma protuberans

Cutaneous B-cell lymphoma

  • Abbreviated CBCL.

General

  • CBCL is less common than cutaneous T-cell lymphoma (CTCL).[1]

Microscopic

Features:

  • Dermal lymphoid infiltrate.
  • "Grenz zone" - space between the epidermis and the dermal infiltrate - key feature.

IHC

  • B cell and T cell markers.

Cutaneous T-cell lymphoma

  • Abbreviated CTCL.
Main article: Cutaneous T-cell lymphoma

Merkel cell carcinoma

Main article: Merkel cell carcinoma

Eccrine carcinoma

General

  • Arises from the proximal sweat duct.

Microscopic

Features:

  • Pleomorphic nuclei with nucleoli.
  • Duct-like structures - key feature.
  • Extends from dermis into epidermis (follows path of a benign sweat duct).

Notes:

Kaposi sarcoma

See Kaposi sarcoma.

Sebaceous carcinoma

Main article: Sebaceous carcinoma

Microcystic adnexal carcinoma

Main article: Microcystic adnexal carcinoma

Trichilemmal carcinoma

Main article: Trichilemmal carcinoma

Lymphomatoid papulosis

General

  • Rare.
  • Benign behaviour.

Microscopic

Features:

  • Dermal lymphocytosis.
    • No epidermal lymphocytes.
  • Focal nuclear atypia.

DDx:

IHC

Rare malignant

Basosquamous carcinoma

Should not be confused with basaloid squamous cell carcinoma (AKA squamous cell carcinoma, basaloid variant).

General

  • Very rare.
    • Largest case series, as of 2000, 35 cases.[3]
  • May be considered an aggressive variant of basal cell carcinoma.[3]
  • Aggressive behaviour.[4]

Microscopic

Features:

Note:

  • Busam notes that there is disagreement about what defines this tumour;[6] however, he goes on the describe it as a collision tumour.[5]

DDx:

Intermediate

Atypical fibroxanthoma

  • Abbreviated AFX.
Main article: Atypical fibroxanthoma

Benign

Syringoma

General

  • Benign sweat duct tumour.
  • Eccrine differentiation.
  • Usually close to lower eyelid.[7]

Microscopic

Features:[8]

  • Proliferation of benign ducts with lined by a bilayer (as in normal sweat ducts) with abnormal architecture:
    • Tadpole like appearing ducts.

DDx:

Images:

Chondroid syringoma

  • Used to be called mixed tumour of skin.[11]

General

  • Mixed apocrine & eccrine tumour of skin, usually in the head & neck[11], especially nose and cheek.[12]
  • May be in major and minor salivary glands.[12]

Microscopic

Features:

  • Mix tumour with:[11]
    1. Epithelial component:
      • Nests of cells with:
        • Moderate dull eosinophilic cytoplasm.
        • Round/ovoid nuclei with nucleoli.
    2. Mesenchymal component - key feature:

Images:

Dermal cylindroma

Main article: Dermal cylindroma

Keratoacanthoma

Main article: Keratoacanthoma

Sebaceous adenoma

General

Notes:

Microscopic

Features:

  • Abnormal sebaceous glands (pale fluffy cytoplasm):
    • Increased basal epithelium.
    • Multiple dilated glands - opening to the surface.

Images

  • Sebaceous adenoma - low mag. (WC/Nephron)

  • Sebaceous adenoma - high mag. (WC/Nephron)

www:

Trichilemmoma

  • May be spelled tricholemmoma.
Main article: Trichilemmoma

Poroma

Main article: Poroma

Nodular hidradenoma

Main article: Nodular hidradenoma

Trichoblastoma

Main article: Trichoblastoma

Trichofolliculoma

Main article: Trichofolliculoma

Apocrine carcinoma of the skin

General

  • Rare.[14]
  • Usually very good prognosis.[14]

Microscopic

Features:[14]

  • Nests.
  • Apocrine snouts - "decapitation secretion"

DDx:

Images

  • Apocrine carcinoma - intermed. mag. (WC/Nephron)

  • Apocrine carcinoma - high mag. (WC/Nephron)

Stains

Features:[14]

  • PAS +ve.
  • PASD +ve.

IHC

Dermatomyofibroma

Should not be confused with dermatofibroma.
  • Abbreviated DMF.

General

  • Uncommon.

Microscopic

Features:[15]

  • Poorly formed fasicles parallel to the skin surface, usu. restricted to the superficial dermis.
  • Moderate cellular density - less cellular than DFSP.
  • Eosinophilic cytoplasm.

DDx:

Images:

IHC

Features:[15]

  • CD10 +ve.
  • Vimentin +ve.

Others:[15]

  • CD34 -ve.
  • Factor XIIIa -ve.
  • S-100 -ve.

Papillary eccrine adenoma

  • Abbreviated PEA.

General

  • Uncommon.
  • Benign.[16]

Treatment:

Gross

  • Central location.

Note:

Microscopic

Features:[19][20]

  • Well-circumscribed lesions consisting of multiple cystic spaces lined by a bilayered epithelium with:
    • Papillary projections into the lumen.
    • Amorphous eosinophilic material in the cystic spaces.
    • Surrounded by a fibrous stroma.[21]

Note:

  • May appear to have more than two cell layers.

DDx:

Image:

IHC

Outer layer of epithelium:[21]

  • SMA-alpha +ve.
  • Keratin 14 +ve.

Inner layer of epithelium:[21]

  • Keratin 8 +ve.

Other stains:[20]

  • Vimentin +ve.
  • CEA +ve.
  • EMA +ve.
  • S-100 +ve.

Sign out

SKIN LESION, LEFT PARIETAL SCALP, BIOPSY:
- PAPILLARY ECCRINE ADENOMA.

Micro

The sections show a well-circumscribed multi-locular superficial dermal lesion with a bilayered epithelium and intracystic papillary projections. The cystic spaces contain amorphous eosinophilic material. The cystic component is surrounded by a dense fibrous stroma with a mixed inflammatory infiltrate, consisting primary of plasma cells and lymphocytes.

There is no significant nuclear atypia and no mitotic activity is appreciated. The overlying epidermis matures appropriately. A granular layer is present.

See also

References

  1. ↑ URL: http://emedicine.medscape.com/article/1099540-overview. Accessed on: 24 August 2010.
  2. ↑ URL: http://path.upmc.edu/cases/case513/dx.html. Accessed on: 25 January 2012.
  3. ↑ 3.0 3.1 Martin, RC.; Edwards, MJ.; Cawte, TG.; Sewell, CL.; McMasters, KM. (Mar 2000). "Basosquamous carcinoma: analysis of prognostic factors influencing recurrence.". Cancer 88 (6): 1365-9. PMID 10717618.
  4. ↑ 4.0 4.1 Bowman, PH.; Ratz, JL.; Knoepp, TG.; Barnes, CJ.; Finley, EM. (Aug 2003). "Basosquamous carcinoma.". Dermatol Surg 29 (8): 830-2; discussion 833. PMID 12859383..
  5. ↑ 5.0 5.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 397. ISBN 978-0443066542.
  6. ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 372. ISBN 978-0443066542.
  7. ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1177. ISBN 978-1416031215.
  8. ↑ URL: http://emedicine.medscape.com/article/1059871-diagnosis. Accessed on: 12 May 2010.
  9. ↑ Boecker, W.; Junkers, T.; Reusch, M.; Buerger, H.; Korsching, E.; Metze, D.; Decker, T.; Loening, T. et al. (2012). "Origin and differentiation of breast nipple syringoma.". Sci Rep 2: 226. doi:10.1038/srep00226. PMID 22355740.
  10. ↑ Nosrati, N.; Coleman, NM.; Hsu, S. (2008). "Axillary syringomas.". Dermatol Online J 14 (4): 13. PMID 18627735.
  11. ↑ 11.0 11.1 11.2 Kumar, B. (Jan 2010). "Chondroid syringoma diagnosed by fine needle aspiration cytology.". Diagn Cytopathol 38 (1): 38-40. doi:10.1002/dc.21159. PMID 19693940.
  12. ↑ 12.0 12.1 Rauso, R.; Santagata, M.; Tartaro, G.; Filipi, M.; Colella, G.. "Chondroid syringoma: a rare tumor of orofacial region.". Minerva Stomatol 58 (7-8): 383-8. PMID 19633639.
  13. ↑ Punia, RP.; Garg, S.; Bal, A.; Mohan, H. (2008). "Pigmented nodular hidradenoma masquerading as nodular malignant melanoma.". Dermatol Online J 14 (1): 15. PMID 18319032.
  14. ↑ 14.0 14.1 14.2 14.3 14.4 Paties, C.; Taccagni, GL.; Papotti, M.; Valente, G.; Zangrandi, A.; Aloi, F. (Jan 1993). "Apocrine carcinoma of the skin. A clinicopathologic, immunocytochemical, and ultrastructural study.". Cancer 71 (2): 375-81. PMID 7678545.
  15. ↑ 15.0 15.1 15.2 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 504. ISBN 978-0443066542.
  16. ↑ Rulon, DB.; Helwig, EB. (May 1977). "Papillary eccrine adenoma.". Arch Dermatol 113 (5): 596-8. PMID 857729.
  17. ↑ URL: http://archderm.jamanetwork.com/article.aspx?articleid=541159. Accessed on: 10 December 2012.
  18. ↑ Duke, WH.; Sherrod, TT.; Lupton, GP. (Jun 2000). "Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited).". Am J Surg Pathol 24 (6): 775-84. PMID 10843279.
  19. ↑ 19.0 19.1 Laxmisha, C.; Thappa, DM.; Jayanthi, S.. "Papillary eccrine adenoma.". Indian J Dermatol Venereol Leprol 70 (6): 370-2. PMID 17642667.
  20. ↑ 20.0 20.1 Guccion, JG.; Patterson, RH.; Nayar, R.; Saini, NB.. "Papillary eccrine adenoma: an ultrastructural and immunohistochemical study.". Ultrastruct Pathol 22 (3): 263-9. PMID 9793207.
  21. ↑ 21.0 21.1 21.2 Mizuoka, H.; Senzaki, H.; Shikata, N.; Uemura, Y.; Tsubura, A. (Jan 1998). "Papillary eccrine adenoma: immunohistochemical study and literature review.". J Cutan Pathol 25 (1): 59-64. PMID 9508346.
  22. ↑ Fox, SB.; Cotton, DW. (Apr 1992). "Tubular apocrine adenoma and papillary eccrine adenoma. Entities or unity?". Am J Dermatopathol 14 (2): 149-54. PMID 1566975.
  23. ↑ Ishiko, A.; Shimizu, H.; Inamoto, N.; Nakmura, K. (Oct 1993). "Is tubular apocrine adenoma a distinct clinical entity?". Am J Dermatopathol 15 (5): 482-7. PMID 8238787.
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