Difference between revisions of "Dermatologic neoplasms"

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Dermatologic neoplasms (view source)

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→‎Sebaceous carcinoma: split-out
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==Sebaceous carcinoma==
==Sebaceous carcinoma==
*[[AKA]] ''sebaceous cell carcinoma''.
{{Main|Sebaceous carcinoma}}
===General===
*Malignant.
*May arise in a [[salivary gland]].<ref name=Warman/>
*Can be part of [[Muir-Torre syndrome]].
 
Notes:
*Sebaceous lesions (from benign to malignant): [[sebaceous hyperplasia]], [[sebaceous adenoma]], sebaceoma, sebaceous carcinoma.
 
===Gross===
Features:<ref name=Ref_Derm431>{{Ref Derm|431}}</ref>
*Classically [[head and neck pathology|head and neck]] tumour.
*Yellow or red (ulcerated) nodule.
 
===Microscopic===
Features:<ref name=Ref_Derm431-2>{{Ref Derm|431-2}}</ref>
*Sebaceous differentiation - may be a minor component - '''key feature'''.
**Sebocytes = abundant pale fluffy cytoplasm with vacuolization.
*Basaloid cells - often dominant.
**May lead to confusion with basaloid tumours.
*Nodular or diffuse growth pattern surrounded by a dense fibrous stroma.
*Infiltrative border - '''important'''.
**The key difference with [[sebaceous adenoma]] in cases where there isn't significant nuclear atypia.
*+/-Nuclear atypia.
*+/-Squamous differentiation.
*+/-Foreign body-type [[giant cells]].
 
DDx:
*[[Sebaceous adenoma]] - non-infiltrative border.
*[[Squamous cell carcinoma]], clear cell variant.
*[[Malignant melanoma]].
*[[Extramammary Paget disease]].
*[[Trichoblastoma]].
*[[Basal cell carcinoma]].
*[[Sweat gland carcinoma]].
 
====Images====
<gallery>
Image:Sebaceous_carcinoma_-_intermed_mag.jpg | Sebaceous carcinoma - intermed. mag. (WC/Nephron)
Image:Sebaceous_carcinoma_-_high_mag.jpg | Sebaceous carcinoma - high mag. (WC/Nephron)
Image:Sebaceous_carcinoma_-_very_high_mag.jpg | Sebaceous carcinoma - very high mag. (WC/Nephron)
</gallery>
www:
*[http://www.ispub.com/journal/the-internet-journal-of-otorhinolaryngology/volume-9-number-2/sebaceous-adenocarcinoma-of-the-parotid-gland-a-case-report-and-literature-review.article-g01.fs.jpg Sebaceous carcinoma (ispub.com)].<ref name=Warman>URL: [http://www.ispub.com/journal/the_internet_journal_of_otorhinolaryngology/volume_9_number_2_11/article/sebaceous_adenocarcinoma_of_the_parotid_gland_a_case_report_and_literature_review.html http://www.ispub.com/journal/the_internet_journal_of_otorhinolaryngology/volume_9_number_2_11/article/sebaceous_adenocarcinoma_of_the_parotid_gland_a_case_report_and_literature_review.html]. Accessed on: 8 September 2011.</ref>
 
====Grading====
Three tier system:<ref name=Ref_Derm431-2>{{Ref Derm|431-2}}</ref>
*Well-differentiated - sebocytes predominant.
*Moderately differentiated - sebocytes are easily recognized but a minor component.
*Poorly differentiated - sebocytes are rare.
 
===IHC===
Features:<ref name=Ref_Derm431-2>{{Ref Derm|431-2}}</ref>
*CK7 +ve<ref name=pmid21592202>{{Cite journal  | last1 = Ansai | first1 = S. | last2 = Arase | first2 = S. | last3 = Kawana | first3 = S. | last4 = Kimura | first4 = T. | title = Immunohistochemical findings of sebaceous carcinoma and sebaceoma: retrieval of cytokeratin expression by a panel of anti-cytokeratin monoclonal antibodies. | journal = J Dermatol | volume = 38 | issue = 10 | pages = 951-8 | month = Oct | year = 2011 | doi = 10.1111/j.1346-8138.2011.01274.x | PMID = 21592202 }}</ref> - often weak.
*EMA +ve -- only sebaceous component.<ref name=pmid10369589/>
*CEA -ve.
**Positive in [[extramammary Paget disease]], sweat duct tumours.
 
Images:
*[http://archopht.jamanetwork.com/data/journals/ophth/9858/m_ecs8482f1.png Sebaceous carcinoma - EMA, AE1/AE3, CAM5.2 (jamanetwork.com)].<ref name=pmid10369589>{{Cite journal  | last1 = Sinard | first1 = JH. | title = Immunohistochemical distinction of ocular sebaceous carcinoma from basal cell and squamous cell carcinoma. | journal = Arch Ophthalmol | volume = 117 | issue = 6 | pages = 776-83 | month = Jun | year = 1999 | doi =  | PMID = 10369589 }}</ref>
 
===Sign out===
<pre>
SKIN LESION, NOSE, BIOPSY:
- SEBACEOUS CARCINOMA, WELL-DIFFERENTIATED, COMPLETELY EXCISED IN THE PLANE OF SECTION.
 
COMMENT:
EMA staining marks the sebocytes.  The lesion is negative for Ber-EP4.
 
Sebaceous carcinoma may be seen in the context of Muir-Torre syndrome.
</pre>
 
====Micro====
=====Well differentiated=====
The sections show well-circumscribed dermal nests of basaloid cells with peripheral palisading,
surrounded by a dense fibrous stroma. The basaloid cells have distinct nucleoli. Focally, the
basaloid nests contain small clusters of cells with abundant pale, vacuolated, fluffy-appearing
cytoplasm (sebocytes). Mitotic activity is minimal.
 
There is no artefactual clefting between the stroma and basaloid cell nests. The epidermis
matures to the surface and does not have basal atypia.
 
The lesion is completely excised in the plane of section.
 
=====Poor differentiated=====
The sections show well-circumscribed dermal nests of basaloid cells with peripheral
palisading, surrounded by a dense fibrous stroma, that extend from the skin surface almost
to the adipose tissue. The basaloid cells have moderate nuclear atypia with occasional monstrous cells.  Mitotic activity is abundant and atypical mitoses are present. The nests contain rare cells with pale, fluffy-appearing cytoplasm, suggestive of sebocytes.


==Microcystic adnexal carcinoma==
==Microcystic adnexal carcinoma==
Michael
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