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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.


==Squamous cell carcinoma==
An introduction to dermatopathy is found in the ''[[dermatopathology]]'' article.  Non-malignant disease is covered in the ''[[non-malignant skin disease]]'' article.
{{Main|Squamous carcinoma}}
 
===General===
=The Big Three malignant=
Precursor:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
==Basal cell carcinoma==
*Actinic keratosis (solar keratosis).
{{Main|Basal cell carcinoma}}
**Clinical: yellow-brown scaly, patches, sandpaper sensation.


Risk factors:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
==Squamous cell carcinoma of the skin==
*Sun exposure.
*Abbreviated ''skin SCC'', ''SCC of the skin'', and ''SCC of skin''.
*Immune suppression (e.g. organ transplant recepients).
{{Main|Squamous cell carcinoma of the skin}}


Notes:
==Melanoma==
*Keratocathoma - see ''[[non-malignant skin disease]]''.
{{Main|Malignant melanoma}}
**Some don't believe this entity exists.
*Known as the great mimicker in pathology; it may look like many things.
***These people sign this entity as ''low grade squamous cell carcinoma, keratoacanthoma type''.<ref>RS. 17 May 2010.</ref>
===Microscopic===
*See ''[[squamous cell carcinoma]]''.


==Basal cell carcinoma==
=Less common malignant=
===General===
==Dermatofibrosarcoma protuberans==
*Very common.
*Abbreviated ''DFSP''.
*Sun exposed skin.
{{Main|Dermatofibrosarcoma protuberans}}
*Very rarely metastasizes - so rare... some don't think this is really a malignancy.


===Clinical===
==Cutaneous B-cell lymphoma==
*Telangiectasias.
*Abbreviated CBCL.
*Raised pearly nodule.


====As part of a syndrome====
===General===
*[[Nevoid basal cell carcinoma syndrome]] (NBCCS), AKA ''Gorlin syndrome''.
*CBCL is less common than cutaneous T-cell lymphoma (CTCL).<ref>URL: [http://emedicine.medscape.com/article/1099540-overview http://emedicine.medscape.com/article/1099540-overview]. Accessed on: 24 August 2010.</ref>
*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>


===Microscopic===
===Microscopic===
Features:<ref>NEED REF.</ref>
Features:
*Artefactual separation of basal cell layer from underlying stroma.
*Dermal lymphoid infiltrate.
*Palisading hyperchromatic cells.
*"Grenz zone" - space between the epidermis and the dermal infiltrate - '''key feature'''.


Notes:
===IHC===
*There are various subtypes: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970110-3 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970110-3].
*B cell and T cell markers.  
 
==Cutaneous T-cell lymphoma==
*Abbreviated CTCL.
{{Main|Cutaneous T-cell lymphoma}}


DDx:
==Merkel cell carcinoma==
*Trichoepithelioma.
{{Main|Merkel cell carcinoma}}


==Melanoma==
==Eccrine carcinoma==
===General===
===General===
*[[AKA]] ''Malignant melanoma''.
*Arises from the proximal sweat duct.
*Main DDx: [[melanocytic lesions]] - especially if pigmented.
*Known as the great mimicker in pathology; it may look like many things.
 
====Clinical====
*''ABCD'' = asymmetric, borders (irregular), colour (black), diameter (large).


===Microscopic===
===Microscopic===
Features:
Features:
*Classic appearance of melanoma:
*Pleomorphic nuclei with nucleoli.
**Loosely cohesive; mix of small nests of cells, single cells.
*Duct-like structures - '''key feature'''.
**Mixed of spindle and ovoid cell morphology.
*Extends from dermis into epidermis (follows path of a benign sweat duct).
**+/-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'').


Notes:
Notes:
*Can look almost like anything.
*May resemble [[Extramammary Paget's disease]]/[[Paget's disease of the breast]].
**Like it is said that [[sarcoidosis]] is in every internal medicine DDx... melanoma is every pathologic DDx.
 
*Melanomas with:
==Kaposi sarcoma==
**An epitheloid cell morphology may mimic adenocarcinoma.
:See ''[[Kaposi sarcoma]]''.
**A spindle cell morphology may mimic spindle cell carcinoma (squamous cell carcinoma) or a sarcoma.


===[[Electron microscopy]]===
==Sebaceous carcinoma==
*Melanosomes.
{{Main|Sebaceous carcinoma}}


Image(s):
==Microcystic adnexal carcinoma==
*[http://www.nature.com/nrm/journal/v8/n10/fig_tab/nrm2258_F1.html Melanosomes (nature.com)].
{{Main|Microcystic adnexal carcinoma}}


===Stains===
==Trichilemmal carcinoma==
*''Fontana-Masson stain'', stains melanin.<ref>URL: [http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exfontana.htm http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exfontana.htm]. Accessed on: 5 May 2010.</ref>
{{Main|Trichilemmal carcinoma}}
**May be useful to differentiate melanin from other brown stuff (e.g. lipofuscin, hemosiderin).


===[[IHC]]===
==Lymphomatoid papulosis==
Standard panel:
===General===
*S-100 +ve.
*Rare.
*HMB-45 +ve.
*Benign behaviour.
*Melan A (MART-1) +ve.


Others:
===Microscopic===
*SOX10 +ve -- useful for diff. from excision scar.<ref name=pmid20653825>{{cite journal |author=Ramos-Herberth FI, Karamchandani J, Kim J, Dadras SS |title=SOX10 immunostaining distinguishes desmoplastic melanoma from excision scar |journal=J. Cutan. Pathol. |volume=37 |issue=9 |pages=944–52 |year=2010 |month=September |pmid=20653825 |doi=10.1111/j.1600-0560.2010.01568.x |url=}}</ref>
Features:
**SOX-10 = pan-schwannian and melanocytic marker.
*Dermal lymphocytosis.
**No epidermal lymphocytes.
*Focal nuclear atypia.


Notes:
DDx:
*The standard panel above (S-100, HMB-45, MART-1) is also positive in other lesions, e.g. ''cellular blue nevus''.
*[[CTCL]].
*Cutaneous [[ALCL]].
 
===IHC===
*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>


==Dermatofibrosarcoma protuberans==
=Rare malignant=
==Basosquamous carcinoma==
:Should '''not''' be confused with ''basaloid [[squamous cell carcinoma]]'' ([[AKA]] ''squamous cell carcinoma, basaloid variant'').
===General===
===General===
*Abbreviated ''DFSP''.
*Very rare.
*Dermal location.
**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 }}
*Destroys adnexal structures.
</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>
 
===Microscopic===
Features:
*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>
 
Note:
*''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>
 
DDx:
*Basaloid [[squamous cell carcinoma]].
*[[Basal cell carcinoma]] with squamous differentiation.


Treatment
=Intermediate=
*Wide excision.
==Atypical fibroxanthoma==
*Abbreviated ''AFX''.
{{Main|Atypical fibroxanthoma}}


===Histology===
=Benign=
*Spindle cell morphology.
==Syringoma==
*Contains adipose tissue within the tumour -- ''key feature''.
===General===
*Benign sweat duct tumour.
*Eccrine differentiation.
*Usually close to lower [[eyelid]].<ref>{{Ref PBoD8|1177}}</ref>


===IHC===
===Microscopic===
Panel:<ref>AP. May 2009.</ref>
Features:<ref>URL: [http://emedicine.medscape.com/article/1059871-diagnosis http://emedicine.medscape.com/article/1059871-diagnosis]. Accessed on: 12 May 2010.</ref>
*CD34 +ve.
*Proliferation of benign ducts with lined by a bilayer (as in normal sweat ducts) with abnormal architecture:
**Usually negative in dermatofibroma.<ref name=pmid7694515>PMID 7694515.</ref><ref name=pmid9129699>PMID 9129699.</ref>
**Tadpole like appearing ducts.
*Factor XIIIa -ve.
**Usually positive in dermatofibroma.<ref name=pmid7694515>PMID 7694515.</ref><ref name=pmid9129699>PMID 9129699.</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]].


===DDx - histologic===
DDx:
*Dermatofibroma - has entrapment of collagen bundles at the edge of the lesion.
*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:
*[http://www.flickr.com/photos/euthman/2329061316/ Syringoma (flickr.com)].
*[http://dermatology.cdlib.org/144/tumors/axillary_syringoma/2.jpg Syringoma (dermatology.cdlib.org)].<ref>{{Cite journal  | last1 = Nosrati | first1 = N. | last2 = Coleman | first2 = NM. | last3 = Hsu | first3 = S. | title = Axillary syringomas. | journal = Dermatol Online J | volume = 14 | issue = 4 | pages = 13 | month =  | year = 2008 | doi =  | PMID = 18627735 |URL = http://dermatology.cdlib.org/144/tumors/axillary_syringoma/hsu.html}}</ref>


==Cutaneous B-cell lymphoma==
==Chondroid syringoma==
*Abbreviated CBCL.
*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>


===General===
===General===
*CBCL is less common than cutaneous T-cell lymphoma (CTCL).<ref>URL: [http://emedicine.medscape.com/article/1099540-overview http://emedicine.medscape.com/article/1099540-overview]. Accessed on: 24 August 2010.</ref>
*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:
*Dermal lymphoid infiltrate.
*Mix tumour with:<ref name=pmid19693940/>
*"Grenz zone" - space between the epidermis and the dermal infiltrate - '''key feature'''.
*#Epithelial component:
*#*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)].


===IHC===
==Dermal cylindroma==
*B cell and T cell markers.
{{Main|Dermal cylindroma}}


==Cutaneous T-cell lymphoma==
==Keratoacanthoma==
*Abbreviated CTCL.
{{Main|Keratoacanthoma}}


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


===Microscopic===
===Microscopic===
*Atypical lymphocytes:
Features:
**Have folded "cerebriform" nuclei; ''Sezary-Lutzner cells''.<ref name=Ref_Klatt385>{{Ref Klatt|385}}</ref>
*Abnormal sebaceous glands (pale fluffy cytoplasm):
*Grouping:
**Increased basal epithelium.
**Nests in the epidermis - known as "Pautrier microabscesses".
**Multiple dilated glands - opening to the surface.
**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>
====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)].
 
==Trichilemmoma==
*May be spelled ''tricholemmoma''.
{{Main|Trichilemmoma}}


Images:
==Poroma==
*[http://www.jci.org/articles/view/24826/figure/2 CTCL (jci.org)].
{{Main|Poroma}}
*[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)].


==Merkel cell carcinoma==
==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>
{{Main|Nodular hidradenoma}}
 
==Trichoblastoma==
{{Main|Trichoblastoma}}
 
==Trichofolliculoma==
{{Main|Trichofolliculoma}}
 
==Apocrine carcinoma of the skin==
===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>
*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>
*Rare.
*Usually very good prognosis.<ref name=pmid7678545/>
*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>


Etiology:
===Microscopic===
*Polyomavirus (?).<ref name=pmid20418670/>
Features:<ref name=pmid7678545/>
*Immunocompromised/immunosuppressed (e.g. organ transplant recipients).
*Nests.
*Apocrine snouts - "decapitation secretion"


===Microscopic===
DDx:
Features:<ref name=Ref_WMSP491>{{Ref WMSP|491}}</ref>
*[[Paget disease of the breast]]/[[Extramammary Paget disease]].
*Nests or sheets or trabeculae.
*Scant cytoplasm.
*Nuclear moulding.
*Multiple small nucleoli.
*Usually mitotically active.


Image:
====Images====
*[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)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Merkelcellcarcinoma_Tag.jpg Merkel cell carcinoma - nested pattern (WC)].
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.


===IHC===
===IHC===
*CK7 -ve, CK20 +ve
*[[GCDFP-15]] (gross cystic disease fluid protein-15) +ve.<ref name=pmid7678545/>


==Eccrine carcinoma==
==Dermatomyofibroma==
:Should ''not'' be confused with [[dermatofibroma]].
*Abbreviated ''DMF''.
===General===
===General===
*Arises from the proximal sweat duct.
*Uncommon.


===Microscopic===
===Microscopic===
Features:
Features:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*Pleomorphic nuclei with nucleoli.
*Poorly formed fasicles parallel to the skin surface, usu. restricted to the superficial dermis.
*Duct-like structures - '''key feature'''.
*Moderate cellular density - less cellular than [[DFSP]].
*Extends from dermis into epidermis (follows path of a benign sweat duct).
*Eosinophilic cytoplasm.
 
Image: [http://commons.wikimedia.org/wiki/File:Eccrine_carcinoma_intermed_mag.jpg Eccrine carcinoma - intermed. mag. (WC)].
DDx:
*[[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===
Features:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*CD10 +ve.
*Vimentin +ve.
 
Others:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*CD34 -ve.
*Factor XIIIa -ve.
*S-100 -ve.


==Eccrine poroma==
==Papillary eccrine adenoma==
*Abbreviated ''[[PEA]]''.
===General===
===General===
*Benign tumour arising from the distal sweat duct.
*Uncommon.
*Erythematous - gross.
*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>
 
Treatment:
*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://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.
Note:
*May appear to have more than two cell layers.
 
DDx:
*[[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>
 
Image:
*[http://www.ijdvl.com/viewimage.asp?img=ijdvl_2004_70_6_370_13482_2.jpg PEA - crappy image (ijdvl.com)].<ref name=pmid17642667/>
 
===IHC===
Outer layer of epithelium:<ref name=pmid9508346/>
*SMA-alpha +ve.  
*Keratin 14 +ve.
Inner layer of epithelium:<ref name=pmid9508346/>
*Keratin 8 +ve.
 
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>
*Vimentin +ve.
*CEA +ve.
*[[EMA]] +ve.
*S-100 +ve.


Notes:
===Sign out===
*Area above gland appears crusted.
<pre>
SKIN LESION, LEFT PARIETAL SCALP, BIOPSY:
- PAPILLARY ECCRINE ADENOMA.
</pre>
 
====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.


==Kaposi sarcoma==
There is no significant nuclear atypia and no mitotic activity is appreciated. The overlying epidermis matures appropriately. A granular layer is present.
:See ''[[Kaposi sarcoma]]''.


==See also==
=See also=
*[[Dermatopathology]].
*[[Dermatopathology]].
*[[Cytopathology]].
*[[Cytopathology]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Dermatopathology]]
[[Category:Dermatopathology]]
Michael
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