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 - '''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:
*[[WC]]:
**[http://en.wikipedia.org/wiki/File:Basal_cell_carcinoma_pathology.jpg BCC - crappy (WC)].
*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>
 
====Subtypes/unique features====
*Many patterns exist.
*The prognosis is similar for all of the BCC subtypes -- except for ''sclerosing'' variant and ''infiltrating nested'' variant.<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.
 
==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]], Toker cell hyperplasia and [[melanoma]].  **[[IHC]] is used to separate the entities definitively.


Histologic DDx of Bowen disease:
==Squamous cell carcinoma of the skin==
*Benign Toker cell hyperplasia.
*Abbreviated ''skin SCC'', ''SCC of the skin'', and ''SCC of skin''.
*[[Malignant melanoma]].
{{Main|Squamous cell carcinoma of the skin}}
*[[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.
 
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)].
 
===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==
Line 255: Line 36:
==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>


===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>
 
==Microcystic adnexal carcinoma==
{{Main|Microcystic adnexal carcinoma}}


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


==Lymphomatoid papulosis.==
==Lymphomatoid papulosis==
===General===
===General===
*Rare.
*Rare.
Line 304: Line 79:
DDx:
DDx:
*[[CTCL]].
*[[CTCL]].
*Cutaneous [[ALCL]].


==Merkel cell carcinoma==
===IHC===
*Abbreviated ''MCC''.
*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>
===General===
*Aggressive.
*Rare.
*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>


=Rare malignant=
==Basosquamous carcinoma==
:Should '''not''' be confused with ''basaloid [[squamous cell carcinoma]]'' ([[AKA]] ''squamous cell carcinoma, basaloid variant'').
===General===
===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>
*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 }}
*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/>
*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>


Etiology:
===Microscopic===
*Polyomavirus (?).<ref name=pmid20418670/>
Features:
*Immunocompromised/immunosuppressed (e.g. organ transplant recipients).
*Has features of both [[basal cell carcinoma]] and [[squamous cell carcinoma of the skin|squamous cell carcinoma]].<ref name=pmid12859383/>
**BCC component usually predominant.<ref name=Ref_Derm397>{{Ref Derm|397}}</ref>


===Microscopic===
Note:
Features:<ref name=Ref_WMSP491>{{Ref WMSP|491}}</ref>
*''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>
*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.


DDx:
DDx:
*[[Basal cell carcinoma]] - no stippled chromatin, less mitoses active.
*Basaloid [[squamous cell carcinoma]].
*Cutaneous [[Ewing sarcoma]] - sorted-out with immunostains.
*[[Basal cell carcinoma]] with squamous differentiation.
*[[Lymphoma]].
*Metastatic small cell carcinoma.
*Other [[small round cell tumours]].


Images:
=Intermediate=
*[http://www.bccancer.bc.ca/HPI/CE/cytotechnology/cytosleuthquiz/nongyne/ng12hist.htm MCC (bccancer.bc.ca)].
==Atypical fibroxanthoma==
*[http://www.joplink.net/prev/200403/07.html MCC (joplink.net)].
*Abbreviated ''AFX''.
*[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)].
{{Main|Atypical fibroxanthoma}}
*[http://commons.wikimedia.org/wiki/File:Merkelcellcarcinoma_Tag.jpg Merkel cell carcinoma - nested pattern (WC)].


===IHC===
=Benign=
Features:
==Syringoma==
*CK7 -ve.
{{Main|Syringoma}}
*CK20 +ve (perinuclear ???).
*CAM5.2 +ve (dot-like pattern).


Others:
==Chondroid syringoma==
*TTF-1 -ve.
*Used to be called ''mixed tumour of skin''.<ref name=pmid19693940>{{Cite journal  | last1 = Kumar | first1 = B. | title = Chondroid syringoma diagnosed by fine needle aspiration cytology. | journal = Diagn Cytopathol | volume = 38 | issue = 1 | pages = 38-40 | month = Jan | year = 2010 | doi = 10.1002/dc.21159 | PMID = 19693940 }}</ref>


==Eccrine carcinoma==
===General===
===General===
*Arises from the proximal sweat duct.
*Mixed apocrine & eccrine tumour of skin, usually in the head & neck<ref name=pmid19693940/>, especially nose and cheek.<ref name=pmid19633639/>
*May be in major and minor salivary glands.<ref name=pmid19633639>{{Cite journal  | last1 = Rauso | first1 = R. | last2 = Santagata | first2 = M. | last3 = Tartaro | first3 = G. | last4 = Filipi | first4 = M. | last5 = Colella | first5 = G. | title = Chondroid syringoma: a rare tumor of orofacial region. | journal = Minerva Stomatol | volume = 58 | issue = 7-8 | pages = 383-8 | month =  | year =  | doi =  | PMID = 19633639 }}</ref>


===Microscopic===
===Microscopic===
Features:
Features:
*Pleomorphic nuclei with nucleoli.
*Mix tumour with:<ref name=pmid19693940/>
*Duct-like structures - '''key feature'''.
*#Epithelial component:
*Extends from dermis into epidermis (follows path of a benign sweat duct).
*#*Nests of cells with:
*#**Moderate dull eosinophilic cytoplasm.
*#**Round/ovoid nuclei with nucleoli.
*#Mesenchymal component - '''key feature''':
*#*[[Chondromyxoid stroma]].
 
Images:
*[https://www.dermnetnz.org/topics/apocrine-mixed-tumour-pathology Chondroid syringoma  (DermnetNZ)].


Notes:
==Dermal cylindroma==
*May resemble [[Extramammary Paget's disease]]/[[Paget's disease of the breast]].
{{Main|Dermal cylindroma}}
Images:
*[http://commons.wikimedia.org/wiki/File:Eccrine_carcinoma_intermed_mag.jpg Eccrine carcinoma - intermed. mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Eccrine_carcinoma_high_mag.jpg Eccrine carcinoma - high mag. (WC)].


==Kaposi sarcoma==
==Keratoacanthoma==
:See ''[[Kaposi sarcoma]]''.
{{Main|Keratoacanthoma}}


==Sebaceous carcinoma==
==Sebaceous adenoma==
===General===
===General===
*Malignant.
*Seen in [[Muir-Torre syndrome]] - a variant of [[Lynch syndrome]] (hereditary non-polyposis colon cancer).
*May arise in a [[salivary gland]].<ref name=Warman/>


Notes:
Notes:
*Sebaceous lesions (from benign to malignant): [[sebaceous hyperplasia]], [[sebaceous adenoma]], sebaceoma, sebaceous carcinoma.
*Sebaceous lesions (from benign to malignant): [[sebaceous hyperplasia]], sebaceous adenoma, sebaceoma, [[sebaceous carcinoma]].


===Microscopic===
===Microscopic===
Features:
Features:
*Nuclear atypia.
*Abnormal sebaceous glands (pale fluffy cytoplasm):
*Sebaceous differentiation:
**Increased basal epithelium.
**Abundant pale fluffy cytoplasm.
**Multiple dilated glands - opening to the surface.
 
====Images====
<gallery>
Image:Sebaceous_adenoma_-_low_mag.jpg | Sebaceous adenoma - low mag. (WC/Nephron)
Image:Sebaceous_adenoma_-_high_mag.jpg | Sebaceous adenoma - high mag. (WC/Nephron)
</gallery>
www:
*[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=587283984 Sebaceous adenoma (jhmi.edu)].


Image:
==Trichilemmoma==
*[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>
*May be spelled ''tricholemmoma''.
{{Main|Trichilemmoma}}


==Microcystic adnexal carcinoma==
==Poroma==
*[[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>
{{Main|Poroma}}
===General===
*Low-grade tumour.
*Adults.


===Microscopic===
==Nodular hidradenoma==
Features:<ref>{{Ref Derm|412}}</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>
*Small basaloid cells - often forming small cystic spaces - '''key feature'''.
{{Main|Nodular hidradenoma}}
*Fibrotic stroma.


DDx:
==Trichoblastoma==
*Sclerosing [[basal cell carcinoma]].
{{Main|Trichoblastoma}}
*Desmoplastic [[trichoepithelioma]].
*Infiltrative [[squamous cell carcinoma]].


Image:
==Trichofolliculoma==
*[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>
{{Main|Trichofolliculoma}}


=Intermediate=
==Apocrine carcinoma of the skin==
==Atypical fibroxanthoma==
*Abbreviated ''AFX''.
===General===
===General===
*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>
*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>
*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>
*Usually very good prognosis.<ref name=pmid7678545/>
 
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===
===Microscopic===
Features:<ref name=Ref_Derm521>{{Ref Derm|521}}</ref>
Features:<ref name=pmid7678545/>
*Dermal lesion - '''key point'''.
*Nests.
*Marked nuclear atypia.
*Apocrine snouts - "decapitation secretion"
*Mitoses.
*Mulitnucleated cells.
*Foamy cytoplasm - '''key feature'''.


DDx:
DDx:
*[[Melanoma]].
*[[Paget disease of the breast]]/[[Extramammary Paget disease]].
*[[Pleomorphic undifferentiated sarcoma]] (MFH).
*[[Leiomyosarcoma]].
*Sarcomatoid [[squamous carcinoma]].


Notes:
====Images====
*No Grenz zone. (???)
<gallery>
 
Image:Apocrine_carcinoma_-_intermed_mag.jpg | Apocrine carcinoma - intermed. mag. (WC/Nephron)
Image:
Image:Apocrine_carcinoma_-_high_mag.jpg | Apocrine carcinoma - high mag. (WC/Nephron)
*[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>  
</gallery>
===Stains===
Features:<ref name=pmid7678545/>
*PAS +ve.
*PASD +ve.


===IHC===
===IHC===
Features:<ref name=Ref_Derm521>{{Ref Derm|521}}</ref>
*[[GCDFP-15]] (gross cystic disease fluid protein-15) +ve.<ref name=pmid7678545/>
*S100 -ve (done to r/o melanoma).
*34betaE12 -ve, p63 -ve (done to exclude SCC).
*Desmin -ve (done to r/o leiomyosarcoma).


=Benign=
==Dermatomyofibroma==
:Should ''not'' be confused with [[dermatofibroma]].
*Abbreviated ''DMF''.
===General===
*Uncommon.


==Sebaceous adenoma==
===General===
*Seen in [[Muir-Torre syndrome]] - a variant of [[Lynch syndrome]] (hereditary non-polyposis colon cancer).
===Microscopic===
===Microscopic===
Features:
Features:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*Abnormal sebaceous glands (pale fluffy cytoplasm):
*Poorly formed fasicles parallel to the skin surface, usu. restricted to the superficial dermis.
**Increased basal epithelium.
*Moderate cellular density - less cellular than [[DFSP]].
**Multiple dilated glands - opening to the surface.
*Eosinophilic cytoplasm.
 
DDx:
*[[DFSP]].
*[[Dermatofibroma]].


Image:
Images:
*[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=587283984 Sebaceous adenoma (jhmi.edu)].
*[http://www.dermpedia.org/node/8822 DMF - low mag. (dermpedia.org)].
*[http://www.dermpedia.org/node/8824 DMF - high mag. (dermpedia.org)].


==Trichilemmoma==
===IHC===
*May be spelled ''tricholemmoma''.
Features:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
===General===
*CD10 +ve.
*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>
*Vimentin +ve.
*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>
*Muliple trichilemmomas associated with [[Cowden syndrome]].<ref name=Ref_Derm386>{{Ref Derm|386}}</ref>


===Microscopic===
Others:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
Features:<ref name=Ref_Derm386>{{Ref Derm|386}}</ref>
*CD34 -ve.
*Superficial dermal lesion contiguous with the epidermis:
*Factor XIIIa -ve.
**Core of lesion:
*S-100 -ve.
***Cuboidal cells with round nuclei, eosinophilic-clear cytoplasm.
**Periphery of lesion:
***Surrounded by hyaline band.
***Peripheral palisading.


Images:
==Papillary eccrine adenoma==
*[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>
*Abbreviated ''[[PEA]]''.
*[http://ccr.cancer.gov/staff/images/9033_12822_Lee_1521.jpg Trichilemmoma - high mag. (cancer.gov)].<ref name=lee/>
===General===
*[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>
*Uncommon.
DDx:
*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>
*[[Trichilemmal carcinoma]].
*[[Basal cell carcinoma]].
*[[Inverted follicular keratosis]].


==Eccrine poroma==
Treatment:
*[[AKA]] ''nodular hidradenoma''. (???)
*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.


===General===
Note:
*Benign tumour arising from the distal sweat duct.
*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>
*Erythematous - gross.


===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=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/>
*Broad sheets of basaloid cells containing ductal structures - '''key feature'''.
*Well-circumscribed lesions consisting of multiple cystic spaces lined by a bilayered epithelium with:
*Biphasic stroma:
**Papillary projections into the lumen.
*#Edematous stroma.
**Amorphous eosinophilic material in the cystic spaces.
*#Sclerotic stroma.
**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>
*Moderate nuclear pleomorphism.
*+/-Occasional mitoses.


Notes:
Note:
*Area above gland appears crusted.
*May appear to have more than two cell layers.


Images:
DDx:
*[http://www.flickr.com/photos/40981620@N04/3808316834/in/photostream/ Eccrine poroma - low mag. (flickr.com)]
*[[Digital papillary adenocarcinoma]] - location important.
*[http://www.flickr.com/photos/40981620@N04/3807502071/in/photostream Eccrine poroma - intermed. mag. (flickr.com)].
*[[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>


==Trichoblastoma==
Image:
*[[AKA]] ''trichoepithelioma''.
*[http://www.ijdvl.com/viewimage.asp?img=ijdvl_2004_70_6_370_13482_2.jpg PEA - crappy image (ijdvl.com)].<ref name=pmid17642667/>
**''Trichoepithelioma'' is considered a superficial version of trichoblastoma; WHO lumps the two entities together.<ref name=Ref_Derm383>{{Ref Derm|383}}</ref>
===General===
*Benign.
**Maligant counterpart of trichoepithelioma: [[trichilemmal carcinoma]].
*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>
**Brooke-Spiegler syndrome.


===Microscopic===
===IHC===
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>
Outer layer of epithelium:<ref name=pmid9508346/>
*Well-circumscribed cell nest in the superficial dermis.  
*SMA-alpha +ve.  
*Surrounding by a fibrous stroma.  
*Keratin 14 +ve.  
*Basaloid cells with [[peripheral pallisading]].
Inner layer of epithelium:<ref name=pmid9508346/>
*+/-Surround keratin-filled cysts.
*Keratin 8 +ve.
*Fibroblasts-like cell aggregate, similar to a follicular papillae (papillary-mesenchymal body).  


Notes:
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>
*Very rarely an artefactual cleft - as in [[basal cell carcinoma]].
*Vimentin +ve.
*CEA +ve.
*[[EMA]] +ve.
*S-100 +ve.


Variants:
===Sign out===
*Desmoplastic trichoblastoma.
<pre>
SKIN LESION, LEFT PARIETAL SCALP, BIOPSY:
- PAPILLARY ECCRINE ADENOMA.
</pre>


DDx:
====Micro====
*[[Basal cell carcinoma]] - usu. mitoses, mucinous stroma and '''no''' papillary-mesenchymal bodies.
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.


Images:
There is no significant nuclear atypia and no mitotic activity is appreciated. The overlying epidermis matures appropriately. A granular layer is present.
*[[WC]]:
**[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)].


=See also=
=See also=

Latest revision as of 14:10, 8 October 2024

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

Squamous cell carcinoma of the skin

  • Abbreviated skin SCC, SCC of the skin, and SCC of skin.

Melanoma

  • Known as the great mimicker in pathology; it may look like many things.

Less common malignant

Dermatofibrosarcoma protuberans

  • Abbreviated DFSP.

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.

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

Microcystic adnexal carcinoma

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.

Benign

Syringoma

Chondroid syringoma

  • Used to be called mixed tumour of skin.[7]

General

  • Mixed apocrine & eccrine tumour of skin, usually in the head & neck[7], especially nose and cheek.[8]
  • May be in major and minor salivary glands.[8]

Microscopic

Features:

  • Mix tumour with:[7]
    1. Epithelial component:
      • Nests of cells with:
        • Moderate dull eosinophilic cytoplasm.
        • Round/ovoid nuclei with nucleoli.
    2. Mesenchymal component - key feature:

Images:

Dermal cylindroma

Keratoacanthoma

Sebaceous adenoma

General

Notes:

Microscopic

Features:

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

Images

www:

Trichilemmoma

  • May be spelled tricholemmoma.

Poroma

Nodular hidradenoma

Trichoblastoma

Trichofolliculoma

Apocrine carcinoma of the skin

General

  • Rare.[10]
  • Usually very good prognosis.[10]

Microscopic

Features:[10]

  • Nests.
  • Apocrine snouts - "decapitation secretion"

DDx:

Images

Stains

Features:[10]

  • PAS +ve.
  • PASD +ve.

IHC

Dermatomyofibroma

Should not be confused with dermatofibroma.
  • Abbreviated DMF.

General

  • Uncommon.

Microscopic

Features:[11]

  • 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:[11]

  • CD10 +ve.
  • Vimentin +ve.

Others:[11]

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

Papillary eccrine adenoma

  • Abbreviated PEA.

General

  • Uncommon.
  • Benign.[12]

Treatment:

Gross

  • Central location.

Note:

Microscopic

Features:[15][16]

  • 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.[17]

Note:

  • May appear to have more than two cell layers.

DDx:

Image:

IHC

Outer layer of epithelium:[17]

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

Inner layer of epithelium:[17]

  • Keratin 8 +ve.

Other stains:[16]

  • 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. 7.0 7.1 7.2 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.
  8. 8.0 8.1 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.
  9. 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.
  10. 10.0 10.1 10.2 10.3 10.4 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.
  11. 11.0 11.1 11.2 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 504. ISBN 978-0443066542.
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