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.
*Very rarely metastasizes - so rare... some don't think this is really a malignancy.


====Clinical====
==Squamous cell carcinoma of the skin==
*Telangiectasias.
*Abbreviated ''skin SCC'', ''SCC of the skin'', and ''SCC of skin''.
*Raised pearly nodule.
{{Main|Squamous cell carcinoma of the skin}}


====As part of a syndrome====
==Melanoma==
*[[Nevoid basal cell carcinoma syndrome]] (NBCCS), AKA ''Gorlin syndrome''.
{{Main|Malignant melanoma}}
*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>
*Known as the great mimicker in pathology; it may look like many things.


===Microscopic===
=Less common malignant=
Features:<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref>
==Dermatofibrosarcoma protuberans==
*Nest of hyperchromatic (i.e. blue) cells (similar in appearance to basal cells) with:
*Abbreviated ''DFSP''.
**Palisading of cells at the edge of the cell nests.
{{Main|Dermatofibrosarcoma protuberans}}
**Artefactual separation of cells (forming the nests) from the underlying stroma.


Notes:
==Cutaneous B-cell lymphoma==
*Palisading = the long axes of the cells are alined and the axes are perpendicular to the interface between the (basaloid cell) nests and stroma.
*Abbreviated CBCL.
*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].
 
DDx:
*[[Trichoepithelioma]] - no artefactual cleft.<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref>


==Squamous cell carcinoma==
{{Main|Squamous carcinoma}}
===General===
===General===
Precursor:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
*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>
*[[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===
===Microscopic===
*See ''[[squamous cell carcinoma]]''.
Features:
*Dermal lymphoid infiltrate.
*"Grenz zone" - space between the epidermis and the dermal infiltrate - '''key feature'''.


====Bowen disease====
===IHC===
'''Bowen disease''' is ''squamous cell carcinoma in situ'' of the skin. 
*B cell and T cell markers.  
*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:
==Cutaneous T-cell lymphoma==
*Benign Toker cell hyperplasia.
*Abbreviated CTCL.
*[[Malignant melanoma]].
{{Main|Cutaneous T-cell lymphoma}}
*[[Eccrine carcinoma]].


Images:
==Merkel cell carcinoma==
*[http://commons.wikimedia.org/wiki/File:Bowen_disease_%281%29.jpg Bowen disease - 1 (WC)].
{{Main|Merkel cell carcinoma}}
*[http://commons.wikimedia.org/wiki/File:Bowen_disease_%283%29.jpg Bowen disease - 3 (WC)].


===IHC===
==Eccrine carcinoma==
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==
{{Main|Malignant melanoma}}
===General===
===General===
*Known as the great mimicker in pathology; it may look like many things.
*Arises from the proximal sweat duct.


===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'').


=Less common malignant=
Notes:
==Merkel cell carcinoma==
*May resemble [[Extramammary Paget's disease]]/[[Paget's disease of the breast]].
*Abbreviated ''MCC''.
 
==Kaposi sarcoma==
:See ''[[Kaposi sarcoma]]''.
 
==Sebaceous carcinoma==
{{Main|Sebaceous carcinoma}}
 
==Microcystic adnexal carcinoma==
{{Main|Microcystic adnexal carcinoma}}
 
==Trichilemmal carcinoma==
{{Main|Trichilemmal carcinoma}}
 
==Lymphomatoid papulosis==
===General===
===General===
*Aggressive.
*Rare.
*Rare.
*Increased risk in the immunodeficient.
*Benign behaviour.
*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>


===Microscopic===
===Microscopic===
Features:
Features:
*Neuroendocrine nuclear features - round nucleus, no nucleolus, stippled chromatin - '''key feature'''.
*Dermal lymphocytosis.
*Typically medium size cells ~3x resting lymphocyte.
**No epidermal lymphocytes.
**May be small or large.
*Focal nuclear atypia.
*Arranged in a nested pattern or sheets.
*Scant cytoplasm.
*Abundant mitoses.
*+/-Nuclear moulding.


DDx:
DDx:
*[[Basal cell carcinoma]] - no stippled chromatin, less mitoses active.
*[[CTCL]].
*Cutaneous [[Ewing sarcoma]] - sorted-out with immunostains.
*Cutaneous [[ALCL]].
*[[Lymphoma]].
 
Images:
*[http://www.bccancer.bc.ca/HPI/CE/cytotechnology/cytosleuthquiz/nongyne/ng12hist.htm MCC (bccancer.bc.ca)].
*[http://www.joplink.net/prev/200403/07.html MCC (joplink.net)].


===IHC===
===IHC===
Features:
*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>
*CK7 -ve.
*CK20 +ve.
*CAM5.2 +ve (dot-like pattern).


Others:
=Rare malignant=
*TTF-1 -ve.
==Basosquamous carcinoma==
 
:Should '''not''' be confused with ''basaloid [[squamous cell carcinoma]]'' ([[AKA]] ''squamous cell carcinoma, basaloid variant'').
==Dermatofibrosarcoma protuberans==
*Abbreviated ''DFSP''.
===General===
===General===
*Dermal location.
*Very rare.
*Destroys adnexal structures.
**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 }}
 
</ref>
Treatment:<ref name=Ref_PBoD8_1183>{{Ref PBoD8|1183}}</ref>
*May be considered an aggressive variant of [[basal cell carcinoma]].<ref name=pmid10717618/>
*Wide excision.
*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>
*May include [[imatinib]] (Gleevec).


===Microscopic===
===Microscopic===
Features:<ref name=Ref_PBoD8_1183>{{Ref PBoD8|1183}}</ref>
Features:
*Dermal spindle cell lesion with storiform pattern.
*Has features of both [[basal cell carcinoma]] and [[squamous cell carcinoma of the skin|squamous cell carcinoma]].<ref name=pmid12859383/>
**Spokes of the wheel-pattern.
**BCC component usually predominant.<ref name=Ref_Derm397>{{Ref Derm|397}}</ref>
*Contains adipose tissue within the tumour -- '''key feature'''.
**Described as "honeycomb pattern" and "Swiss cheese pattern".


Notes:
Note:
*Adnexal structure within tumour are preserved -- this is unusual for a malignant tumour -- '''important'''.
*''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.


Main DDx:
=Intermediate=
*[[Dermatofibroma]] - has entrapment of collagen bundles at the edge of the lesion.
==Atypical fibroxanthoma==
*Abbreviated ''AFX''.
{{Main|Atypical fibroxanthoma}}


DDx of storiform pattern:
=Benign=
*DFSP, dermatofibroma, [[solitary fibrous tumour]], [[undifferentiated pleomorphic sarcoma]].
==Syringoma==
===General===
*Benign sweat duct tumour.
*Eccrine differentiation.
*Usually close to lower [[eyelid]].<ref>{{Ref PBoD8|1177}}</ref>


Images:
===Microscopic===
*[http://commons.wikimedia.org/w/index.php?title=File:Storiform_pattern_-_intermed_mag.jpg DFSP - storiform pattern - intermed. mag. (WC)].
Features:<ref>URL: [http://emedicine.medscape.com/article/1059871-diagnosis http://emedicine.medscape.com/article/1059871-diagnosis]. Accessed on: 12 May 2010.</ref>
*[http://commons.wikimedia.org/wiki/File:Storiform_pattern_-_very_high_mag.jpg DFSP - storiform pattern - very high mag. (WC)].
*Proliferation of benign ducts with lined by a bilayer (as in normal sweat ducts) with abnormal architecture:
**Tadpole like appearing ducts.


===IHC===
DDx:
Panel:<ref>AP. May 2009.</ref>
*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>
*CD34 +ve.
*[[Chondroid syringoma]]. (???)
**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===
Images:
A characteristic [[translocation]] is seen:<ref>{{Ref PBoD8|1249}}</ref>
*[http://www.flickr.com/photos/euthman/2329061316/ Syringoma (flickr.com)].
t(17;22)(q22;q15) COLA1/PDGFB.
*[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:
====Images====
*[http://commons.wikimedia.org/wiki/File:Cutaneous_T-cell_lymphoma_-_very_high_mag.jpg CTCL - very high mag. (WC)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Cutaneous_T-cell_lymphoma_-_intermed_mag.jpg CTCL - intermed. mag. (WC)].
Image:Sebaceous_adenoma_-_low_mag.jpg | Sebaceous adenoma - low mag. (WC/Nephron)
*[http://www.jci.org/articles/view/24826/figure/2 CTCL (jci.org)].
Image:Sebaceous_adenoma_-_high_mag.jpg | Sebaceous adenoma - high mag. (WC/Nephron)
*[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)].
</gallery>
www:
*[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=587283984 Sebaceous adenoma (jhmi.edu)].


===IHC===
==Trichilemmoma==
Features:
*May be spelled ''tricholemmoma''.
*CD4 +ve.<ref>{{Ref PBoD8|1185}}</ref>
{{Main|Trichilemmoma}}


==Merkel cell carcinoma==
==Poroma==
===General===
{{Main|Poroma}}
Features:<ref name=pmid20418670>{{Cite journal  | last1 = Calder | first1 = KB. | last2 = Smoller | first2 = BR. | title = New insights into merkel cell carcinoma. | journal = Adv Anat Pathol | volume = 17 | issue = 3 | pages = 155-61 | month = May | year = 2010 | doi = 10.1097/PAP.0b013e3181d97836 | PMID = 20418670 }}</ref>
*Rare.
*Aggressive course/poor prognosis.
*Neuroendocrine-like.<ref name=pmid19395876>{{Cite journal  | last1 = Pulitzer | first1 = MP. | last2 = Amin | first2 = BD. | last3 = Busam | first3 = KJ. | title = Merkel cell carcinoma: review. | journal = Adv Anat Pathol | volume = 16 | issue = 3 | pages = 135-44 | month = May | year = 2009 | doi = 10.1097/PAP.0b013e3181a12f5a | PMID = 19395876 }}
</ref>


Etiology:
==Nodular hidradenoma==
*Polyomavirus (?).<ref name=pmid20418670/>
*[[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>
*Immunocompromised/immunosuppressed (e.g. organ transplant recipients).
{{Main|Nodular hidradenoma}}


===Microscopic===
==Trichoblastoma==
Features:<ref name=Ref_WMSP491>{{Ref WMSP|491}}</ref>
{{Main|Trichoblastoma}}
*Nests or sheets or trabeculae.
*Scant cytoplasm.
*Nuclear moulding.
*Multiple small nucleoli.
*Usually mitotically active.


Image:
==Trichofolliculoma==
*[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|Trichofolliculoma}}
*[http://commons.wikimedia.org/wiki/File:Merkelcellcarcinoma_Tag.jpg Merkel cell carcinoma - nested pattern (WC)].


===IHC===
==Apocrine carcinoma of the skin==
*CK7 -ve, CK20 +ve
 
==Eccrine carcinoma==
===General===
===General===
*Arises from the proximal sweat duct.
*Rare.<ref name=pmid7678545>{{Cite journal  | last1 = Paties | first1 = C. | last2 = Taccagni | first2 = GL. | last3 = Papotti | first3 = M. | last4 = Valente | first4 = G. | last5 = Zangrandi | first5 = A. | last6 = Aloi | first6 = F. | title = Apocrine carcinoma of the skin. A clinicopathologic, immunocytochemical, and ultrastructural study. | journal = Cancer | volume = 71 | issue = 2 | pages = 375-81 | month = Jan | year = 1993 | doi =  | PMID = 7678545 }}</ref>
*Usually very good prognosis.<ref name=pmid7678545/>


===Microscopic===
===Microscopic===
Features:
Features:<ref name=pmid7678545/>
*Pleomorphic nuclei with nucleoli.
*Nests.
*Duct-like structures - '''key feature'''.
*Apocrine snouts - "decapitation secretion"
*Extends from dermis into epidermis (follows path of a benign sweat duct).
 
DDx:
*[[Paget disease of the breast]]/[[Extramammary Paget disease]].


Notes:
====Images====
*May resemble [[Extramammary Paget's disease]]/[[Paget's disease of the breast]].
<gallery>
Image:Apocrine_carcinoma_-_intermed_mag.jpg | Apocrine carcinoma - intermed. mag. (WC/Nephron)
Images:  
Image:Apocrine_carcinoma_-_high_mag.jpg | Apocrine carcinoma - high mag. (WC/Nephron)
*[http://commons.wikimedia.org/wiki/File:Eccrine_carcinoma_intermed_mag.jpg Eccrine carcinoma - intermed. mag. (WC)].
</gallery>
*[http://commons.wikimedia.org/wiki/File:Eccrine_carcinoma_high_mag.jpg Eccrine carcinoma - high mag. (WC)].
===Stains===
Features:<ref name=pmid7678545/>
*PAS +ve.
*PASD +ve.


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


=Intermediate=
==Dermatomyofibroma==
==Atypical fibroxanthoma==
:Should ''not'' be confused with [[dermatofibroma]].
*Abbreviated ''AFX''.
*Abbreviated ''DMF''.
===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>
*Uncommon.
*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>
 
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=Ref_Derm504>{{Ref Derm|504}}</ref>
*Dermal lesion - '''key point'''.
*Poorly formed fasicles parallel to the skin surface, usu. restricted to the superficial dermis.
*Marked nuclear atypia.
*Moderate cellular density - less cellular than [[DFSP]].
*Mitoses.
*Eosinophilic cytoplasm.
*Mulitnucleated cells.
*Foamy cytoplasm - '''key feature'''.


DDx:
DDx:
*[[Melanoma]].
*[[DFSP]].
*[[Pleomorphic undifferentiated sarcoma]] (MFH).
*[[Dermatofibroma]].
*[[Leiomyosarcoma]].
*Sarcomatoid [[squamous carcinoma]].


Notes:
Images:
*No Grenz zone. (???)
*[http://www.dermpedia.org/node/8822 DMF - low mag. (dermpedia.org)].
 
*[http://www.dermpedia.org/node/8824 DMF - high mag. (dermpedia.org)].
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===
===IHC===
Features:<ref name=Ref_Derm521>{{Ref Derm|521}}</ref>
Features:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*S100 -ve (done to r/o melanoma).
*CD10 +ve.
*34betaE12 -ve, p63 -ve (done to exclude SCC).
*Vimentin +ve.
*Desmin -ve (done to r/o leiomyosarcoma).


=Benign=
Others:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*CD34 -ve.
*Factor XIIIa -ve.
*S-100 -ve.


==Trichilemmoma==
==Papillary eccrine adenoma==
*May be spelled ''tricholemmoma''.
*Abbreviated ''[[PEA]]''.
===General===
===General===
*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>
*Uncommon.
*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>
*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>
*Muliple trichilemmomas associated with [[Cowden syndrome]].<ref name=Ref_Derm386>{{Ref Derm|386}}</ref>


===Microscopic===
Treatment:
Features:<ref name=Ref_Derm386>{{Ref Derm|386}}</ref>
*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>
*Superficial dermal lesion contiguous with the epidermis:
===Gross===
**Core of lesion:
*Central location.
***Cuboidal cells with round nuclei, eosinophilic-clear cytoplasm.
**Periphery of lesion:
***Surrounded by hyaline band.
***Peripheral palisading.


Images:
Note:
*[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>
*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>
*[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>
DDx:
*[[Trichilemmal carcinoma]].
*[[Basal cell carcinoma]].


==Eccrine poroma==
===Microscopic===
*[[AKA]] ''nodular hidradenoma''. (???)
Features:<ref name=pmid17642667>{{Cite journal  | last1 = Laxmisha | first1 = C. | last2 = Thappa | first2 = DM. | last3 = Jayanthi | first3 = S. | title = Papillary eccrine adenoma. | journal = Indian J Dermatol Venereol Leprol | volume = 70 | issue = 6 | pages = 370-2 | month =  | year =  | doi =  | PMID = 17642667 | URL = http://www.ijdvl.com/article.asp?issn=0378-6323;year=2004;volume=70;issue=6;spage=370;epage=372;aulast=Laxmisha }}</ref><ref name=pmid9793207/>
*Well-circumscribed 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.<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>


===General===
Note:
*Benign tumour arising from the distal sweat duct.
*May appear to have more than two cell layers.
*Erythematous - gross.


===Microscopic===
DDx:
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>
*[[Digital papillary adenocarcinoma]] - location important.
*Broad sheets of basaloid cells containing ductal structures - '''key feature'''.
*[[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>
*Biphasic stroma:
*#Edematous stroma.
*#Sclerotic stroma.
*Moderate nuclear pleomorphism.
*+/-Occasional mitoses.


Notes:
Image:
*Area above gland appears crusted.
*[http://www.ijdvl.com/viewimage.asp?img=ijdvl_2004_70_6_370_13482_2.jpg PEA - crappy image (ijdvl.com)].<ref name=pmid17642667/>


==Trichoepithelioma==
===IHC===
===General===
Outer layer of epithelium:<ref name=pmid9508346/>
*Benign.
*SMA-alpha +ve.  
**Maligant counterpart of trichoepithelioma: [[trichilemmal carcinoma]].  
*Keratin 14 +ve.  
*May be familial:  
Inner layer of epithelium:<ref name=pmid9508346/>
**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>
*Keratin 8 +ve.
**Brooke-Spiegler syndrome.


===Microscopic===
Other stains:<ref name=pmid9793207>{{Cite journal  | last1 = Guccion | first1 = JG. | last2 = Patterson | first2 = RH. | last3 = Nayar | first3 = R. | last4 = Saini | first4 = NB. | title = Papillary eccrine adenoma: an ultrastructural and immunohistochemical study. | journal = Ultrastruct Pathol | volume = 22 | issue = 3 | pages = 263-9 | month =  | year =  | doi =  | PMID = 9793207 }}</ref>
Features:<ref>URL: [http://emedicine.medscape.com/article/1060049-workup#a0723 http://emedicine.medscape.com/article/1060049-workup#a0723]. Accessed on: 31 August 2011.</ref>
*Vimentin +ve.
*Well-circumscribed cell nest in the superficial dermis.  
*CEA +ve.
*Surrounding by a fibrous stroma.  
*[[EMA]] +ve.
*Basaloid cells with [[peripheral pallisading]].
*S-100 +ve.
*+/-Surround keratin-filled cysts.
*Fibroblasts-like cell aggregate, similar to a follicular papillae (papillary-mesenchymal body).  


Notes:
===Sign out===
*Very rarely an artifical cleft - as in [[basal cell carcinoma]].
<pre>
SKIN LESION, LEFT PARIETAL SCALP, BIOPSY:
- PAPILLARY ECCRINE ADENOMA.
</pre>


Variants:
====Micro====
*Desmoplastic.
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.


DDx:
There is no significant nuclear atypia and no mitotic activity is appreciated. The overlying epidermis matures appropriately. A granular layer is present.
*[[Basal cell carcinoma]].


=See also=
=See also=

Latest revision as of 04:04, 6 June 2018

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

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

The Big Three malignant

Basal cell carcinoma

Main article: Basal cell carcinoma

Squamous cell carcinoma of the skin

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

Melanoma

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

Less common malignant

Dermatofibrosarcoma protuberans

  • Abbreviated DFSP.
Main article: Dermatofibrosarcoma protuberans

Cutaneous B-cell lymphoma

  • Abbreviated CBCL.

General

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

Microscopic

Features:

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

IHC

  • B cell and T cell markers.

Cutaneous T-cell lymphoma

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

Merkel cell carcinoma

Main article: Merkel cell carcinoma

Eccrine carcinoma

General

  • Arises from the proximal sweat duct.

Microscopic

Features:

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

Notes:

Kaposi sarcoma

See Kaposi sarcoma.

Sebaceous carcinoma

Main article: Sebaceous carcinoma

Microcystic adnexal carcinoma

Main article: Microcystic adnexal carcinoma

Trichilemmal carcinoma

Main article: Trichilemmal carcinoma

Lymphomatoid papulosis

General

  • Rare.
  • Benign behaviour.

Microscopic

Features:

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

DDx:

IHC

Rare malignant

Basosquamous carcinoma

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

General

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

Microscopic

Features:

Note:

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

DDx:

Intermediate

Atypical fibroxanthoma

  • Abbreviated AFX.
Main article: Atypical fibroxanthoma

Benign

Syringoma

General

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

Microscopic

Features:[8]

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

DDx:

Images:

Chondroid syringoma

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

General

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

Microscopic

Features:

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

Images:

Dermal cylindroma

Main article: Dermal cylindroma

Keratoacanthoma

Main article: Keratoacanthoma

Sebaceous adenoma

General

Notes:

Microscopic

Features:

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

Images

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

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

www:

Trichilemmoma

  • May be spelled tricholemmoma.
Main article: Trichilemmoma

Poroma

Main article: Poroma

Nodular hidradenoma

Main article: Nodular hidradenoma

Trichoblastoma

Main article: Trichoblastoma

Trichofolliculoma

Main article: Trichofolliculoma

Apocrine carcinoma of the skin

General

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

Microscopic

Features:[14]

  • Nests.
  • Apocrine snouts - "decapitation secretion"

DDx:

Images

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

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

Stains

Features:[14]

  • PAS +ve.
  • PASD +ve.

IHC

Dermatomyofibroma

Should not be confused with dermatofibroma.
  • Abbreviated DMF.

General

  • Uncommon.

Microscopic

Features:[15]

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

DDx:

Images:

IHC

Features:[15]

  • CD10 +ve.
  • Vimentin +ve.

Others:[15]

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

Papillary eccrine adenoma

  • Abbreviated PEA.

General

  • Uncommon.
  • Benign.[16]

Treatment:

Gross

  • Central location.

Note:

Microscopic

Features:[19][20]

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

Note:

  • May appear to have more than two cell layers.

DDx:

Image:

IHC

Outer layer of epithelium:[21]

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

Inner layer of epithelium:[21]

  • Keratin 8 +ve.

Other stains:[20]

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

Sign out

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

Micro

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

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

See also

References

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