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Dermatologic neoplasms (view source)

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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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==Squamous cell carcinoma of the skin==
==Squamous cell carcinoma of the skin==
{{Main|Squamous carcinoma}}
*Abbreviated ''skin SCC'', ''SCC of the skin'', and ''SCC of skin''.
*Abbreviated ''skin SCC'', ''SCC of the skin'', and ''SCC of skin''.
===General===
{{Main|Squamous cell carcinoma of the skin}}
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]]''.
 
High risk features - for SCC of the skin:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SkinSquamousCell_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SkinSquamousCell_11protocol.pdf]. Accessed on: 29 March 2012.</ref>
*Primary site is ear ''or'' lip.†
*Clark level IV/V = reticular dermis or deeper.
*>=2 mm thickness -- measured from ''granular layer'' (stratum granulosum) ''or'' ulcer base to deepest aspect.
*[[Lymphovascular invasion]].
*Perineural invasion.
*Poorly differentiated.
 
Note:
* † The words used are "hair-bearing lip" - but there is considerable confusion about this as the AJCC manual contradicts itself.<ref name=pmid21151529>{{Cite journal  | last1 = Buethe | first1 = D. | last2 = Warner | first2 = C. | last3 = Miedler | first3 = J. | last4 = Cockerell | first4 = CJ. | title = Focus Issue on Squamous Cell Carcinoma: Practical Concerns Regarding the 7th Edition AJCC Staging Guidelines. | journal = J Skin Cancer | volume = 2011 | issue =  | pages = 156391 | month =  | year = 2011 | doi = 10.1155/2011/156391 | PMID = 21151529 | PMC = 2990020 | URL = http://www.hindawi.com/journals/jsc/2011/156391/ }}</ref>
 
DDx:
*[[Inverted follicular keratosis]].
*[[Bowen disease]].
*[[Malignant melanoma]].
*[[Paget disease of the breast]].
*[[Eccrine 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=====
<gallery>
Image:Bowen_disease_%281%29.jpg | Bowen disease - 1. (WC)
Image:Bowen_disease_%282%29.jpg | Bowen disease - 2. (WC)
Image:Bowen_disease_%283%29.jpg | Bowen disease - 3. (WC)
</gallery>
===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>
 
===Sign-out===
====Invasive SCC====
<pre>
SKIN, SITE, BIOPSY:
- MODERATELY-DIFFERENTIATED INVASIVE SQUAMOUS CELL CARCINOMA, SEE COMMENT.
- NEGATIVE FOR LYMPHOVASCULAR INVASION.
- NEGATIVE FOR PERINEURAL INVASION.
 
COMMENT:
The nearest margin (lateral margin) is 1 mm.  The tumour is 9 mm in maximal dimension.
</pre>
 
<pre>
SKIN LESION, SITE, EXCISION:
- INVASIVE SQUAMOUS CELL CARCINOMA, MODERATELY-DIFFERENTIATED.
-- TUMOUR GREATEST DIMENSION: ___ CM.
-- TUMOUR THICKNESS: ___ MM.
-- LATERAL MARGINS: NEGATIVE FOR IN SITU CARCINOMA AND INVASIVE CARCINOMA.
-- DEEP MARGIN: NEGATIVE FOR INVASIVE CARCINOMA.
-- NEAREST MARGIN: 1 MM, LATERAL MARGIN.
-- NEGATIVE FOR LYMPHOVASCULAR INVASION.
-- NEGATIVE FOR PERINEURAL INVASION.
- EXTENSIVE SOLAR ELASTOSIS.
</pre>
 
<pre>
SKIN, SITE, BIOPSY:
- INVASIVE SQUAMOUS CELL CARCINOMA, SEE TUMOUR SUMMARY.
 
TUMOUR SUMMARY:
Histologic type: squamous cell carcinoma, type not otherwise specified.
Histologic grade: moderately differentiated.
Greatest dimension: ___ cm.
Tumour thickness: ___ mm.
Peripheral margin: negative for invasive carcinoma and in situ carcinoma.
Deep margin (invasive component): negative for invasive carcinoma.
Closest margin: deep margin, ___ mm.
Lymphovascular invasion: not identified.
Perineural invasion: not identified.
</pre>
 
====Bowen's disease====
<pre>
SKIN LESION, RIGHT EAR, BIOPSY:
- SQUAMOUS CELL CARCINOMA IN SITU (BOWEN'S DISEASE), INCOMPLETELY EXCISED.
 
COMMENT:
Complete excision of the lesion is recommended.
</pre>
 
<pre>
SKIN LESION, CHEST/STERNUM, EXCISIONAL BIOPSY:
- SQUAMOUS CELL CARCINOMA IN SITU (BOWEN'S DISEASE), COMPLETELY EXCISED.
- SOLAR ELASTOSIS, MODERATE.
</pre>


==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.
**Usu. 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).
**Often 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=
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==Cutaneous T-cell lymphoma==
==Cutaneous T-cell lymphoma==
*Abbreviated CTCL.
*Abbreviated CTCL.
 
{{Main|Cutaneous T-cell lymphoma}}
===General===
*''Mycosis fungoides'' - is a subtype (???).
*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===
*Atypical lymphocytes:
**Have folded "cerebriform" nuclei; ''Sezary-Lutzner cells''.<ref name=Ref_Klatt385>{{Ref Klatt|385}}</ref>
*Grouping:
**Nests in the epidermis - known as "Pautrier microabscesses".
**Single lymphocytes in epidermis - without accompanying edema.
**Short linear arrays of lymphocytes along the basal layer of the epidermis; "epidermotropism".<ref name=Ref_Klatt385>{{Ref Klatt|385}}</ref>
 
DDx:
*[[Lymphomatoid papulosis]].
 
====Images====
<gallery>
Image:Cutaneous_T-cell_lymphoma_-_very_high_mag.jpg | CTCL - very high mag. (WC/Nephron)
Image:Cutaneous_T-cell_lymphoma_-_intermed_mag.jpg | CTCL - intermed. mag. (WC/Nephron)
</gallery>
www:
*[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===
Key stain:
*CD4 +ve.<ref>{{Ref PBoD8|1185}}</ref>
 
Other stains:
*CD3 +ve.
*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.


==Merkel cell carcinoma==
==Merkel cell carcinoma==
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==Trichilemmal carcinoma==
==Trichilemmal carcinoma==
===General===
{{Main|Trichilemmal carcinoma}}
*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]].


==Lymphomatoid papulosis==
==Lymphomatoid papulosis==
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==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 name=pmid21664889>{{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><ref name=pmid23319144>{{Cite journal  | last1 = Tchernev | first1 = G. | last2 = Tronnier | first2 = M. | last3 = Ananiev | first3 = J. | last4 = Taneva | first4 = T. | last5 = Patterson | first5 = JW. | last6 = Gulubova | first6 = M. | last7 = Trafeli | first7 = JP. | last8 = Gegova | first8 = A. | last9 = Harrell | first9 = M. | title = Atypical fibroxanthoma-a diagnosis of exclusion! | journal = Wien Med Wochenschr | volume = 163 | issue = 15-16 | pages = 380-386 | month = Aug | year = 2013 | doi = 10.1007/s10354-012-0173-1 | PMID = 23319144 }}</ref> some say it is the same thing.<ref name=danny>Ghazarian, Danny; 16 September 2011.</ref>
*Usually benign.
**May metastasize - case report-type of occurrence.<ref>{{Cite journal  | last1 = New | first1 = D. | last2 = Bahrami | first2 = S. | last3 = Malone | first3 = J. | last4 = Callen | first4 = JP. | title = Atypical fibroxanthoma with regional lymph node metastasis: report of a case and review of the literature. | journal = Arch Dermatol | volume = 146 | issue = 12 | pages = 1399-404 | month = Dec | year = 2010 | doi = 10.1001/archdermatol.2010.206 | PMID = 20713774 | URL = http://archderm.jamanetwork.com/article.aspx?articleid=422416 }}</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) - deeper than the dermis.
*[[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)
**Scant staining not considered +ve.
*Desmin -ve (done to r/o leiomyosarcoma).
 
===Sign out===
====Incompletely excised====
<pre>
SKIN LESION, MID BACK, SHAVE BIOPSY:
- ATYPICAL SPINDLE CELL NEOPLASM, SEE MICRO AND COMMENT.
 
COMMENT:
The diagnosis of atypical fibroxanthoma (AFX) is favoured.  The main differential
diagnosis is pleomorphic undifferentiated sarcoma.
 
The extent of the lesion cannot be determined, as it is present at the deep margin.
 
This lesion should be re-excised, as it could represent an aggressive malignancy.
</pre>


=Benign=
=Benign=
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*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===
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Images:
Images:
*[http://archive.ispub.com/journal/the-internet-journal-of-dermatology/volume-7-number-1/cutaneous-mixed-tumor.article-g01.fs.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://archive.ispub.com/journal/the-internet-journal-of-dermatology/volume-7-number-1/cutaneous-mixed-tumor.article-g02.fs.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.
**Occasionally malignant.<ref name=pmid16882695/>
*Should not be confused with ''cylindroma'' ([[adenoid cystic carcinoma]]).
*May be related to ''[[eccrine 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>
 
May be familial:<ref name=pmid16882695/>
*Familial cylindromatosis (autosomal dominant).
*Brook–Spiegler syndrome.
 
===Gross===
*Classically scalp - usually head and neck or face.
 
===Microscopic===
Features:<ref name=pmid16882695/>
*Nests of cells that fit together like a jigsaw puzzle - the borders of the nests are opposed and undulate.
*#Basaloid cells with scant cytoplasm and dark nuclei palisade around the edge of the nests.
*#Larger cells with moderate eosinophilic cytoplasm and lighter staining nuclei are at the centre of the nests.
*Cells nests surrounded by a band of hyaline (i.e. glassy, eosinophilic, acellular) material ~ 2X thickness of a basilar cell - '''key feature'''.
**This is basement membrane.
DDx:
*[[Eccrine spiradenoma]].
*[[Basal cell carcinoma]] - has [[myxoid stroma]].
 
====Images====
<gallery>
Image:Dermal_cylindroma_intermed_mag.jpg | Dermal cylindroma. (WC/Nephron)
Image:Dermal_cylindroma_intermed_mag_deep.jpg | Dermal cylindroma - high mag. (WC/Nephron)
</gallery>
www:
*[http://jcp.bmj.com/content/60/2/145/F7.large.jpg Dermal cylindroma (bmj.com)].<ref name=pmid16882695>{{Cite journal  | last1 = Obaidat | first1 = NA. | last2 = Alsaad | first2 = KO. | last3 = Ghazarian | first3 = D. | title = Skin adnexal neoplasms--part 2: an approach to tumours of cutaneous sweat glands. | journal = J Clin Pathol | volume = 60 | issue = 2 | pages = 145-59 | month = Feb | year = 2007 | doi = 10.1136/jcp.2006.041608 | PMID = 16882695 | PMC = 1860616 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860616/?tool=pubmed }}</ref>
 
===Stains===
*PAS +ve (basement membrane).<ref name=pmid16882695/>


==Keratoacanthoma==
==Keratoacanthoma==
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==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>
*Muliple trichilemmomas associated with [[Cowden syndrome]].<ref name=Ref_Derm386>{{Ref Derm|386}}</ref>
 
===Microscopic===
Features:<ref name=Ref_Derm386>{{Ref Derm|386}}</ref>
*Superficial dermal lesion contiguous with the epidermis:
**Core of lesion:
***Cuboidal cells with round nuclei, eosinophilic-clear cytoplasm.
**Periphery of lesion:
***Surrounded by hyaline band.
***Peripheral palisading.
 
DDx:
*[[Trichilemmal carcinoma]].
*[[Basal cell carcinoma]].
*[[Inverted follicular keratosis]].
 
Images:
*[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>
*[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==
===General===
*Benign tumour arising from the distal sweat duct.
*Erythematous - gross.
 
===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>
*Broad sheets of basaloid cells - attached to the epidermis - containing ductal structures - '''key feature'''.
*Biphasic stroma:
*#Edematous stroma.
*#Sclerotic stroma.
*Moderate nuclear pleomorphism.
*+/-Occasional mitoses.
 
Notes:
*Area above gland appears crusted.
 
DDx:
*[[Trichilemmoma]].
*[[Nodular hidradenoma]].


Images:
==Poroma==
*[http://www.flickr.com/photos/40981620@N04/3808316834/in/photostream/ Eccrine poroma - low mag. (flickr.com)]
{{Main|Poroma}}
*[http://www.flickr.com/photos/40981620@N04/3807502071/in/photostream Eccrine poroma - intermed. mag. (flickr.com)].


==Nodular hidradenoma==
==Nodular hidradenoma==
*[[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>
*[[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>
===General===
{{Main|Nodular hidradenoma}}
*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>
 
Typical locations:<ref name=pmid18319032/>
*Scalp.
*Face.
*Trunk, anterior.
 
===Microscopic===
Features:<ref name=pmid9537017/>
*Well-circumscribed dermal lesions with:
**Back-to-back nests with a whorled appearance.
**Spaces between cells.
**Nuclei ovoid and centrally placed in the cell.
***No nucleolus.
**Cystic spaces with degenerated cells.
 
DDx:
*[[Eccrine poroma]].
 
====Images====
<gallery>
Image:Nodular_hidradenoma_-_low_mag.jpg | Nodular hidradenoma - low mag. (WC/Nephron)
Image:Nodular_hidradenoma_-_intermed_mag.jpg | Nodular hidradenoma - intermed. mag. (WC/Nephron)
Image:Nodular_hidradenoma_-_very_high_mag.jpg | Nodular hidradenoma - very high mag. (WC/Nephron)
</gallery>
===IHC===
Features:<ref name=pmid9537017/>
*CAM5.2 +ve.
*AE1/AE3 +ve.
*EMA +ve.
*S100 -ve.
*Desmin -ve.


==Trichoblastoma==
==Trichoblastoma==
Line 543: Line 193:


==Trichofolliculoma==
==Trichofolliculoma==
===General===
{{Main|Trichofolliculoma}}
*Benign.
 
===Microscopic===
Features:<ref name=Ref_Derm382>{{Ref Derm|382}}</ref>
*Irregular hair follicle (basilar nest of cells with an acellular hair shaft) with:
**Smaller satellites (follicles) consisting of well-circumscribed basilar cells.
 
Note:
*Lack artificial clefting between the (basilar) nests and stroma (seen in [[BCC]]).
*Surrounding stroma does not have a basophilic tingle (seen in [[BCC]]).
 
DDx:
*[[Trichoblastoma]].
*[[Basal cell carcinoma]].
*[[Pilar sheath acanthoma]].
 
====Images====
www:
*[http://www.dermatopathonline.com/trichofolliculoma2.html Trichofolliculoma - several images (dermatopathonline.com)].
<gallery>
Image:SkinTumors-P6190340.JPG | Trichofolliculoma. (WC)
</gallery>


==Apocrine carcinoma of the skin==
==Apocrine carcinoma of the skin==
Line 591: Line 219:


===IHC===
===IHC===
*GCDFP-15 (gross cystic disease fluid protein-15) +ve.<ref name=pmid7678545/>
*[[GCDFP-15]] (gross cystic disease fluid protein-15) +ve.<ref name=pmid7678545/>


==Dermatomyofibroma==
==Dermatomyofibroma==
Line 635: Line 263:


Note:
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>
*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===
Line 648: Line 276:


DDx:
DDx:
*Digital papillary adenocarcinoma - location important.
*[[Digital papillary adenocarcinoma]] - location important.
*[[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>
*[[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>


Line 664: Line 292:
*Vimentin +ve.
*Vimentin +ve.
*CEA +ve.
*CEA +ve.
*EMA +ve.
*[[EMA]] +ve.
*S-100 +ve.
*S-100 +ve.


Michael
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