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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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=The Big Three malignant=
=The Big Three malignant=
==Basal cell carcinoma==
==Basal cell carcinoma==
*Abbreviated ''BCC''.
{{Main|Basal cell carcinoma}}
===General===
*Very common.
*Sun exposed skin.
*Hair bearing area; tumour derived from hair follicle - a more appropriate name might be ''trichoblastic carcinoma''.<ref name=Ref_Derm389>{{Ref Derm|389}}</ref>
*Very rarely metastasizes:
**Dermatopathologists might see a couple in their career.
**There are only ~ 300 literature reports of metastatic BCC.<ref name=pmid16208438>{{Cite journal  | last1 = Ting | first1 = PT. | last2 = Kasper | first2 = R. | last3 = Arlette | first3 = JP. | title = Metastatic basal cell carcinoma: report of two cases and literature review. | journal = J Cutan Med Surg | volume = 9 | issue = 1 | pages = 10-5 | month = Jan | year = 2005 | doi = 10.1007/s10227-005-0027-1 | PMID = 16208438 }}</ref>


====Clinical====
==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.
*[[Xeroderma pigmentosum]].


===Microscopic===
=Less common malignant=
Features:<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref><ref name=Ref_Derm390>{{Ref Derm|390}}</ref>
==Dermatofibrosarcoma protuberans==
*Basaloid cells - similar in appearance to basal cells:
*Abbreviated ''DFSP''.
**Moderate blue/grey cytoplasm.
{{Main|Dermatofibrosarcoma protuberans}}
**Dark ovoid/ellipsoid nucleus with uniform chromatin.
 
*Palisading of cells at the edge of the cell nests.
==Cutaneous B-cell lymphoma==
*Artefactual separation of cells (forming the nests) from the underlying stroma - '''key feature'''.
*Abbreviated CBCL.
*Surrounded by blue (myxoid) stroma - '''key feature'''.


Notes:
===General===
*Palisading = the long axes of the cells are alined and the axes are perpendicular to the interface between the (basaloid cell) nests and stroma.
*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>
*Key elements in a list: Artefactual clefting (of nests), Basaloid cells, Peripheral palisading, Myxoid stroma.


DDx:
===Microscopic===
*[[Trichoepithelioma]] - no artefactual cleft.<ref name=Ref_PBoD8_1180-1>{{Ref PBoD8|1180-1}}</ref>
Features:
*[[Adenoid cystic carcinoma]] - no myxoid stroma, no peripheral palisading.
*Dermal lymphoid infiltrate.
*[[Eccrine poroma]] - on palms & soles, BCC rarely found there.<ref>{{Ref DCHH|284}}</ref>
*"Grenz zone" - space between the epidermis and the dermal infiltrate - '''key feature'''.


Images:
===IHC===
*[[WC]]:
*B cell and T cell markers.  
**[http://en.wikipedia.org/wiki/File:Basal_cell_carcinoma_pathology.jpg BCC - crappy (WC)].
*www:
**[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/basal_cell_carcinoma_high_power.jpg BCC (ucsf.edu)].<ref>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/basal_cell_carcinoma.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/basal_cell_carcinoma.html]. Accessed on: 4 September 2011.</ref>


====Subtypes====
==Cutaneous T-cell lymphoma==
Many patterns exist:<ref name=Ref_Derm392-5>{{Ref Derm|392-5}}</ref>
*Abbreviated CTCL.
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
{{Main|Cutaneous T-cell lymphoma}}
! Pattern
! Key histologic feature
! Other histologic features
| Other
|-
| Superficial pattern
| connected to epidermis
|
|
|-
| Nodular pattern
| nodules
| partial detachment from epidermis
| subgroup ''micronodular'' = nests equal size ~ 0.2 mm dia., >=25% of lesion
|-
| Morpheaform (sclerosing) pattern
| stroma sclerosis
|
| often seen with ''infiltrative pattern''
|-
| Infiltrative pattern
| small irregular cell aggregates
|
| often also sclerosing or morpheaform
|-
| Fibroepitheliomatous pattern
| cords and columns of basaloid cells
| fibrous stroma
| name of pattern comes from ''fibroepithelioma of Pinkus''
|-
| Infundibulocystic pattern
| small keratocysts (keratin cysts)
| usu. small, often in cords
| usu. indolent
|-
| Adenoidal pattern
| cribriform / pseudoglandular arch.
| myxoid stroma, peripheral palisading
| DDx: [[adenoid cystic carcinoma]]
|-
|}


Unique features/differentiation:<ref name=Ref_Derm392-5>{{Ref Derm|392-5}}</ref>
==Merkel cell carcinoma==
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
{{Main|Merkel cell carcinoma}}
! Differentiation / unique cell
! Key histologic feature
! Other histologic features
| Other
|-
| Pigmented cells
| '''any pattern''' can have pigmentation
| pigment may be in malignant cell
| DDx: collision lesion with [[melanocytic lesion]]
|-
| Squamous differentiation (metatypical BCC)
| pink cytoplasm, keratinization
|
| assoc. with ulceration/tumour recurrence
|-
| Eccrine differentiation
| focal duct formation
|
| very rare, DDx: BCC engulfing sweat ducts
|-
| Clear cells (Clear cell BCC)
| clear cytoplasm
|
| due to glycogen
|}


==Squamous cell carcinoma==
==Eccrine carcinoma==
{{Main|Squamous carcinoma}}
===General===
===General===
Precursor:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
*Arises from the proximal sweat duct.
*[[Actinic keratosis]] (solar keratosis).
**Clinical: yellow-brown scaly, patches, sandpaper sensation.


Risk factors:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref>
===Microscopic===
*Sun exposure.
Features:
*Immune suppression (e.g. organ transplant recipients).
*Pleomorphic nuclei with nucleoli.
*Duct-like structures - '''key feature'''.
*Extends from dermis into epidermis (follows path of a benign sweat duct).


Notes:
Notes:
*[[Keratoacanthoma]].
*May resemble [[Extramammary Paget's disease]]/[[Paget's disease of the breast]].
**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===
==Kaposi sarcoma==
*See ''[[squamous cell carcinoma]]''.
:See ''[[Kaposi sarcoma]]''.


====Bowen disease====
==Sebaceous carcinoma==
'''Bowen disease''' is ''squamous cell carcinoma in situ'' of the skin. 
{{Main|Sebaceous carcinoma}}
*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:
==Microcystic adnexal carcinoma==
*Benign Toker cell hyperplasia.
{{Main|Microcystic adnexal carcinoma}}
*[[Malignant melanoma]].
*[[Eccrine carcinoma]].


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


===IHC===
==Lymphomatoid papulosis==
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.
===Microscopic===
Features:
*Classic appearance of melanoma:
**Loosely cohesive; mix of small nests of cells, single cells.
**Mixed of spindle and ovoid cell morphology.
**+/-Occasional large binucleated cells.
**Cytoplasm: brown pigment (melanin).
**Prominent (large) red nucleoli (like in ''serous carcinoma'' of the ovary).
**Marked nuclear pleomorphism - variation in cell size, shape & staining (like in ''serous carcinoma'' of the ovary).
**[[Nuclear pseudoinclusions]] (like in ''papillary thyroid carcinoma'').
=Less common malignant=
==Merkel cell carcinoma==
*Abbreviated ''MCC''.
===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===
*CK7 -ve, CK20 +ve


==Eccrine carcinoma==
==Apocrine carcinoma of the skin==
===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=
Michael
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