Immunohistochemically detectable duct-like structures in benign and malignant eccrine poromas: CEA and involucrin immunostaining

The duct-like structures present in 7 cases of benign and malignant eccrine poroma were examined by immunohistochemical staining for carcinoembryonic antigen (CEA), involucrin, and S-100 protein. The demonstration of CEA and involucrin was helpful in the recognition of these structures. The overt immunopositivity precedes morphological evidence for duct formation. On the basis of the CEA immunostaining, the duct-like structures were divided into 4 types: 1) mature acrosyringeal structure, 2) cystic luminal structure lined by elongated cells, 3) immature acrosyringeal structure, and 4) vacuole- or dot-like potential lumen in a single cell. Involucrine was observed in the lining cells of 1) and 2). None of the 4 types showed positive reactivity for S-100 protein, suggesting the irrelevance of these structures to the secretory element of sweat gland. The polymorphism of the ductal formation tended to be more remarkably observed in malignant eccrine poromas than in the cases of benign eccrine poroma and poroepithelioma tested.     

Dermoscopic features of actinic keratosis and follow up with dermoscopy: A pilot study

Actinic keratosis (AK) is a common precursor of sun‐related squamous cell carcinoma. AK is difficult to be differentiated from other malignancies with the naked eyes. Dermoscopic features of AK were previously described in some studies, but not extensively investigated. We investigated the dermoscopic features of AK in Asians and assessed dermoscopy as a post‐treatment monitoring tool of AK. We retrospectively examined 34 AK lesions which had been diagnosed by histology. The changes of dermoscopic features and histopathological findings were assessed in all these lesions before and after treatment. Before treatment, 18 lesions were pigmented and 16 lesions were non‐pigmented AK dermoscopically. The frequent dermoscopic features of AK were keratin/scales (79.4%), red pseudonetwork (73.5%), targetoid‐like appearance (55.9%), rosette sign (38.2%) and absent fissures/ridges, crypts and milia‐like cysts. All the lesions had been treated with either photodynamic therapy, cryotherapy or 5% imiquimod cream. After treatment, dermoscopic features of 33 AK lesions were decreased or disappeared, and skin biopsies confirmed that atypical keratinocytes disappeared. One lesion showed accentuated and new dermoscopic features after treatment, and skin biopsy also showed progressing squamous cell carcinoma. In conclusion, scales, red pseudonetwork, targetoid‐like appearance and rosette sign were common dermoscopic findings of AK in Asians. In most cases, the treatment response correlated with the changes in dermoscopic features. These findings suggest that dermoscopy is a useful tool to monitor AK.     

Pigmented eccrine poromas: expression of melanocyte-stimulating cytokines by tumour cells does not always result in melanocyte colonization

Background Although eccrine poroma (EP) occurs preferentially in palmoplantar areas, pigmented variants of EP have not been documented on the palms and soles. Objectives We seek to confirm the notion regarding lack of pigmented EP on palmoplantar areas and determine whether the absence of pigmentation in palmoplantar EPs is due to lack of expression of melanocyte‐stimulating cytokines by tumour cells. Methods We searched the PubMed and Web of Science databases (1966–2006) for reports of pigmented EPs. In addition, a total of 17 EPs were collected from our pathology department. The presence of melanin was examined with haematoxylin‐eosin sections, and melanocyte colonization was shown by immunohistochemical stains for tyrosinase. In addition, immunohistochemical staining with antibodies to melanocyte‐stimulating cytokines, including endothelin‐1, stem cell factor, and nerve growth factor, was done on these tumours. Results A review of the literature revealed 15 pigmented EP reports, none of which were located in palmoplantar areas. Among 17 EPs collected from our pathology department, 7 occurred in palmoplantar areas and 10 in non‐palmoplantar areas. Three of the palmoplantar EPs and three of the non‐palmoplantar EPs showed positive staining with melanocyte‐stimulating cytokines. However, none of the palmoplantar EPs contained melanocytes or melanin pigment, wheras the three non‐palmoplantar EPs that stained positively with melanocyte‐stimulating cytokines were colonized with melanocytes and showed pigmentation clinically. Conclusions The expression of melanocyte‐stimulating factors by tumour cells is associated with melanocyte colonization in non‐palmoplantar EPs but not palmoplantar EPs. Therefore, the presence of melanocyte‐stimulating cytokines per se is not sufficient by itself to induce melanocyte colonization. Certain characteristics of palmoplantar skin, such as the dermal components of these anatomical sites, may play a role in inhibiting melanocyte colonization of EPs.     

67例小汗腺汗孔瘤临床及病理分析

对我院明确诊断的67例小汗腺汗孔瘤患者进行回顾性分析, 其中男36例,女31例,平均年龄（51.19±19.17）岁。患者皮疹好发于掌跖（34例,50.7%）,主要表现为肤色、暗褐色或紫红色,圆形或类圆形斑块、结节、息肉状糜烂或出血性溃疡病灶,大多数无明显自觉症状。首诊诊断误诊率约95.5%,易误诊为疣（18例,26.87%）、肉芽肿（10例,14.93%）、脂溢性角化病（9例,13.43%）。组织学特点是皮损由形态一致的小基底细胞样立方形细胞组成,伴导管分化,细胞核呈圆形或卵圆形,与周围界限清楚。67例患者行手术切除术后,随诊观察1个月～3年,其中18例失访,49例随访患者均未复发。     

细胞周期蛋白D1和磷酸化Rb蛋白在小汗腺汗孔癌和小汗腺汗孔瘤中的表达

小汗腺汗孔癌(eccrine porocarcinoma,EPC),以往被称为恶性小汗腺汗孔瘤,是最常见的恶性汗腺肿瘤.好发于老年患者的下肢、躯干、头皮和上肢,男女发病率为1.3:1.小汗腺汗孔瘤(eccrine poroma,EP)是一种好发于足底、足侧缘等部位的呈孤立结节的良性汗腺肿瘤.组织学上,认为它们起源于末端汗管的外层细胞和真皮上部的小汗腺导管.国内外有关EPC和EP的发病机制的研究报道较少,有报道p53和p16/Rb与这两种小汗腺来源的良恶性有关[1-2].     

Pedunculated pigmented eccrine poroma of the scalp with increased urinary excretion of 5-S-cysteinyldopa

We describe a 52-year-old man with a pedunculated pigmented eccrine poroma mimicking a nodular malignant melanoma in the occipital region. The tumor was once resected but soon recurred. Histologically, the tumor mass extended from the epidermis downwards into the dermis and contained melanin granules in some areas. The tumor cells were uniformly cuboidal in appearance and had round, deeply basophilic nuclei. Initially, the urinary excretion level of 5-S-cysteinyldopa (5-S-CD) was high, but, after resection of the tumor, the level of 5-S-CD returned to normal.     

The role of line-field confocal optical coherence tomography (LC-OCT) in the diagnosis of eccrine poroma: A case report

Poroma is skin cancer that arises from the sweat gland cells. Its diagnosis could be difficult. Line-field optical coherence tomography (LC-OCT) is a novel imaging technique that has shown promise in the diagnosis and monitoring of various skin conditions. We report a case of poroma diagnosed by LC-OCT.     

Immunohistochemical study of angiotensin receptors in normal human sweat glands and eccrine poroma

BACKGROUND: Angiotensin II exerts its actions through its specific receptors. However, expression of these receptors has not been determined in sweat glands. OBJECTIVES: To clarify the expression and localization of the angiotensin receptors in normal human sweat glands and eccrine poroma. METHODS: Expression of angiotensin type 1 (AT1) and type 2 (AT2) receptors in normal human eccrine and apocrine sweat glands and 12 cases of eccrine poroma was studied using immunohistochemistry. RESULTS: In eccrine sweat glands, the acrosyringium and the inner surfaces and luminal cells of the intradermal duct showed positive staining with AT1. In apocrine sweat glands, the intraepithelial duct and luminal cells of the intradermal duct showed positive staining with AT1. In 12 cases of eccrine poroma, some of the tumour cells in the tumour strands and cells surrounding the luminal structures stained positively. There were no positive findings with AT2. CONCLUSIONS: Studying AT1 distribution may be useful in understanding the pathophysiology of sweat glands and sweat gland tumours.     

Treatment of advanced malignant eccrine poroma with locoregional chemotherapy

Malignant eccrine poroma is a rare disease with approximately 200 cases reported in the literature. Regional cutaneous and systemic metastases are rarely observed and their management has been generally unsuccessful. We report on a case in which topical 5-fluorouracil application and intra-arterial chemotherapy with docetaxel resulted in a histologically confirmed complete response of multiple regional skin metastases for more than 2 years. Despite intravenous administration of docetaxel, slow progression of systemic disease was observed.     

Dermoscopic features of Bowen’s disease in Asians

Background Previously, dermoscopic features of Bowen’s disease (BD) were extensively investigated in two studies, but there were some discrepancies. The dispute necessitated a further study concerning the dermoscopic features of BD. Objective To describe the dermoscopic features of BD in Asians and to assess dermoscopy as a post‐treatment monitoring tool of BD. Materials and methods Dermoscopic examinations of histopathologically diagnosed 26 BD lesions were performed to evaluate for the presence of various dermoscopic features. In addition, the correlating changes of dermoscopic features and histopathological results before and after treatments were assessed in five patients with BD. Results Dermoscopically, 10 lesions were pigmented and 16 lesions were non‐pigmented. The most frequent dermoscopic findings of BD were vascular structures (96%) and a scaly surface (96%). Among vascular structure, glomerular vessels were most frequently observed (77%). The other vascular structures in our study were linear irregular vessels, dotted vessels, polymorphous/atypical vessels and arborizing vessels. Among five patients who had been treated with either photodynamic therapy or 5% imiquimod cream, four patients revealed disappearance of dermoscopic vascular structures, but one patient showed remaining vascular structures after treatment. Skin biopsy from treated lesions disclosed clearance of BD in four patients who had no vascular structures but remaining BD in the patient whose dermoscopic finding displayed no disappearance of vascular structures. Conclusions Vascular structures, especially glomerular vessels plus a scaly surface, were common dermoscopic findings of BD in Asians. In addition, existence of dermoscopic vascular structures after treatment appears to be associated with residual disease.     

14例小汗腺螺旋腺瘤临床及病理特征分析

回顾性分析2015-2019年我院皮肤科确诊为小汗腺螺旋腺瘤的14例患者的临床及病理资料,并复习相关文献.结果示14例小汗腺螺旋腺瘤患者中,男5例,女9例,中位发病年龄为40.5岁.10例患者皮疹发生于躯干.皮损形态为皮色、红色、蓝色、浅褐色的皮下包块或结节,且多伴疼痛.14例患者临床首诊均误诊,误诊为表皮囊肿6例、色...     

成人型黄色肉芽肿44例临床皮肤镜和组织病理分析

目的:总结成人型黄色肉芽肿的临床、皮肤镜及组织病理学特点。方法:对重庆市第一人民医院皮肤科门诊2010年1月—2018年6月间44例经组织病理诊断为黄色肉芽肿的成人患者临床、皮肤镜与组织病理资料进行回顾性分析。结果:44例患者中,男25例(57%),女19例(43%),平均发病年龄35岁,42例(95%)为单发皮损,2例(5%)为多发皮损。皮损多见于头颈部(29例,66%),未发现皮肤以外器官受累。临床诊断正确率仅为36%,最易误诊为黄瘤。皮肤镜表现主要为"落日征"。组织病理表现为隆起性皮损,表皮萎缩,真皮内见境界清楚的细胞团块,主要由组织细胞及少量炎性细胞组成,绝大多数病例可见Touton巨细胞(39例,89%);免疫组化检查显示全部病例浸润细胞CD68阳性,少数患者(4例,9%)见散在S-100蛋白阳性,CD1a均阴性。结论:成人型黄色肉芽肿多为单发皮疹,临床最易误诊为黄瘤,皮肤镜主要表现为"落日征",组织病理学主要表现为真皮内组织细胞团块,绝大部分以Touton巨细胞为特征,早期组织细胞泡沫化常不明显,而成熟期见典型泡沫化组织细胞,晚期常表现为梭形细胞浸润。     

Dermoscopic features of melanomas associated with MC1R variants in Spanish CDKN2A mutation carriers

BACKGROUND: The presence of at least one MC1R gene variant is associated with a reduction in age at melanoma diagnosis in families with CDKN2A mutations. OBJECTIVES: To describe dermoscopic features of early melanoma in CDKN2A gene mutation-positive Spanish individuals and to evaluate the possibility of a correlation between particular dermatoscopic pattern and MC1R gene variants. METHODS: Patients in whom a melanoma was diagnosed during specific follow up of high-risk individuals carrying CDKN2A mutations (with familial or personal history of previous melanoma) were included in this study. The decision to remove such melanomas was taken on the basis of history, clinical and dermoscopic evaluations including total body photography and digital dermoscopy. RESULTS: Of the nine patients included in this study, three were noncarriers of the red hair MC1R polymorphism, three patients had one red hair MC1R polymorphism and three patients had two red hair MC1R polymorphisms. On dermoscopic analysis of suspect melanocytic lesions we found that the mean +/- SD ABCD total dermoscopy score (TDS) was significantly higher in noncarriers of red hair MC1R polymorphisms than in carriers of two MC1R gene red hair variants (6.8 +/- 0.4 vs. 4.4 +/- 0.9; P = 0.014). CONCLUSIONS: Early melanomas in patients with two MC1R red hair variants may be difficult to diagnose definitively by dermoscopy because, in our limited experience, they show fewer colours and structures and have a lower TDS. In such melanomas, subtle atypical vessels and other changes detected by digital image follow up may be useful to confirm the diagnosis of melanoma. An integrated approach including clinical history and dermoscopic data (also considering additional information, such as the presence of atypical vessels) should be utilized in evaluating these high-risk patients. Further studies are necessary to confirm our suggestion.     

Eccrine Porocarcinoma: A Multicenter Retrospective Study with Review of the Literatures Reported in Korea

BackgroundEccrine porocarcinoma (EPC) is a rare malignant cutaneous adnexal tumor. Other than several scattered case reports, no comprehensive review on EPC has been conducted in Korea.ObjectiveTo clinicopathologically review all EPC cases from our institutions as well as those reported in Korea.MethodsMedical records and histopathological slides of EPC cases in the skin biopsy registries of our institutions were retrospectively reviewed. Additionally, EPC cases reported in Korea before June 2019 were retrieved by searching the PubMed, KoMCI, KoreaMed, and KMbase databases.ResultsNine EPC cases from our institutions were included in the study. In addition, 27 reports of 28 patients with EPC were reported in Korea. A total of 37 patients with EPC were identified, consisting of 19 males (male:female ratio, 1.06:1; mean age at diagnosis, 65.6 years). The most common site of primary tumor was the head and neck (29.7%). Wide excision was the most common (78.4%) treatment method. Initial metastasis work-up imaging studies were performed in 18 patients (48.6%), and metastasis was confirmed in eight patients (21.6%).ConclusionEPC is a rare cutaneous carcinoma in Korea. EPC usually affects elderly patients, with no sexual predilection. Due to possible metastasis, careful diagnosis and appropriate metastasis work-ups are warranted in EPC.