Papillary eccrine adenoma: immunohistochemical studies of keratin expression

Despite various studies, there are serious disagreements about the cellular differentiation of papillary eccrine adenoma. In the present study, 2 specimens of papillary eccrine adenoma were analyzed by immunohistochemical techniques, using a panel of monoclonal antibodies against keratins, to elucidate its differentiation. Histopathologically, the tumor was composed of multiple tubular structures lined by two or more layers of epithelial cells. The luminal cells of the tubules were flattened or cuboidal. The former were noted in large dilated tubules. The latter were usually observed in small-to-moderate-sized tubules, and formed intra-luminal papillary projections in some tubules. Immunohistochemically, there were two kinds of cuboidal cells in the luminal layers of the tubules. Most of the large dilated tubules and some of the small-to-moderate-sized tubules expressed immunophenotypes similar to those of the eccrine dermal duct. The other tubular structures, including the small tubules resembling those of syringoma, expressed immunophenotypes similar to those of the transitional portions between the dermal ducts and the secretory segments of eccrine glands. From the above comparative studies, papillary eccrine adenoma is considered to differentiate towards the dermal duct and the transitional portions between the dermal ducts and the secretory segments of eccrine glands.     

Papillary eccrine adenoma

A 28-year-old man came to us with a solitary skin colored, mildly tender nodule of 6 months duration on the dorsum of the right hand. On histological examination, multiple dilated ducts without apparent continuity with the surface were found in the dermis. These dilated ducts had branching tubules with eosinophilic amorphous material filling most of the lumina. The peripheral cells of the tubules resembled myoepithelial cells, whereas the luminal border cells were cuboidal or low columnar. Papillary projections arising from the inner cells were seen extending into the lumen. These features were diagnostic of a rare tumor, papillary eccrine adenoma.     

Papillary eccrine adenoma. A tubulopapillary hidradenoma with eccrine differentiation

A slow-growing tumor on the dorsum of the right foot of a 25-year-old female had features that corresponded to papillary eccrine adenoma. The grouping of this entity under the term "tubular apocrine adenoma" in a recent edition of a textbook led to further study of this case in the form of enzyme histochemistry and electron microscopy. The tumor was positive for amylophosphorylase and negative for acid phosphatase, and on electron microscopy showed complex intercellular membrane interdigitation and a possible intercellular canaliculus. No features of apocrine differentiation were found, and we feel that this tumor is distinctly eccrine in its differentiation. The similarity of these two ostensibly separate entities, and the opinion of some authors that intermediate differentiation may be possible in adnexal tumors, would favor them being grouped under the single term of "tubulopapillary hidradenoma," with apocrine or eccrine differentiation as the case may be.     

Papillary eccrine adenoma: an electron microscopic study

A case of papillary eccrine adenoma was studied by electron microscopy. Dilated ducts that contained granular eosinophilic material, often associated with intraluminal papillary projections were observed. The ductlike structures were composed of basal and luminal cells. Within the luminal cells there were intracytoplasmic cavities, but neither secretory granules nor glandular structure were observed. On the basis of our observations, papillary eccrine adenoma appears to differentiate toward ductal structures of the eccrine sweat apparatus.     

Papillary eccrine adenoma. Immunohistochemical and ultrastructural analyses

A case of papillary eccrine adenoma was analysed with immunohistochemical and ultrastructural methods regarding their direction of differentiation. It was found that the majority of the structures show either eccrine ductal or glandular differentiation. There were some segments, particularly in those exhibiting papillary growth, where cells similar to eccrine secretory (clear) cells or cells with characteristics of both ductal basal cells and glandular myoepithelial cells were present.     

Papillary eccrine adenoma: Immunohistochemicai study and literature review

A case of papillary eccrine adenoma on the right forearm of a 78-year-old Japanese woman is reported. The tumor was 1.3 cm in diameter, occupying the whole thickness of the dermis. Histologically, the tumor was composed of dilated tubules of various sizes with intraluminal papillary projections, and was surrounded by a fibrous stroma. An immunohistochemical study revealed that the proliferating tubules were composed of a single outermost layer of α-smooth muscle actin-and keratin 14-positive myoepithelial cells, and keratin 8-positive inner cells. This antigen expression pattern was comparable to that of the normal eccrine secretory coil, which indicates that the tumor differentiated toward the secretory coil of an eccrine sweat gland.     

Papillary eccrine adenoma—a light-microscopic and immunohistochemical study

We report a case of papillary eccrine adenoma. This benign cutaneous tumour had a diagnostic microscopic appearance that consisted of multiple dilated ducts lined by two or more layers of cells. The inner layer often formed intraluminal papillary projections of variable complexity. The lumina were filled by eosinophilic amorphous material. Immunoperoxidase studies showed carcino-embryonic antigen in the luminal border of the ducts, but S-100 protein was absent for tumoral ducts. We discuss the eccrine and apocrine differentiation of this neoplasm on the basis of the immunoperoxidase results. The differential diagnosis includes other cutaneous neoplasms with intraductal papillary proliferation.     

Carcinosarcoma arising in eccrine spiradenoma. A clinicopathologic and immunohistochemical study of two cases

Malignant change in a benign eccrine spiradenoma is rare. Only 13 such cases have been previously reported. Two further cases are described herein, both of which were carcinosarcomas and arose in middle-aged women. In each case continuity was demonstrated between the benign and malignant epithelial components and the sarcomatous element. In case 1 the sarcomatous component showed osteocartilaginous and rhabdomyoblastic differentiation, whereas in case 2 only osteosarcoma was evident. To our knowledge, carcinosarcoma has not been previously described arising in eccrine spiradenoma. The literature regarding malignant eccrine spiradenoma is reviewed.     

Tubular apocrine adenoma and papillary eccrine adenoma. Entities or unity?

A case of a tubulopapillary hidradenoma was studied by light and electron microscopy and by immunohistochemistry. The tumor, the first reported from the axilla, demonstrated both eccrine and apocrine differentiation and may have arisen from the recently described apoeccrine gland located at this site.     

Malignant eccrine spiradenoma. A clinicopathologic study.

Malignant eccrine spiradenomas (MES) are exceedingly rare and their immunohistochemical and ultrastructural features have not been fully characterized. We studied two cases, one of them immunohistochemically and electron microscopically. Patient 1 had a 25-year history of multiple exophytic tumors involving the scalp, the skin of the face, and the torso. Of the lesions removed, ten were spiradenomas, two with malignant changes, and three were cylindromas. The malignant areas showed loss of tubular and nesting patterns, lack of two cell populations, and contained anaplastic cells with high mitotic rate. The immunohistochemical findings were consistent with eccrine differentiation. Patient 2 had a cystlike mass of long duration in the right groin. Histologically, the mass consisted of nodules of benign eccrine spiradenomas adjacent to a ductal-cystic mass lined by anaplastic cells, but areas of squamous and glandular differentiation were also present. Conclusions: (a) Case 1 is probably the first reported MES associated with multiple spiradenomas and cylindromas. (b) Cytodifferentiation in MES is variable, sometimes with almost complete loss of eccrine differentiation. (c) Identification of adjacent spiradenomas may be required for definite diagnosis of MES. (d) Clinical history of longstanding lesions with recent fast growth warrants tissue diagnosis.     

Chondroid syringoma associated with hidrocystoma-like changes. Possible differentiation into eccrine gland. A histologic, immunohistochemical and electron microscopic study

A case of chondroid syringoma associated with hidrocystoma-like changes was investigated by histology, immunohistochemistry and electron microscopy. Chondroid syringoma was histologically compatible with apocrine mixed tumor, and hidrocystoma-like changes did not fulfill diagnostic criteria of either eccrine hidrocystoma or apocrine hidrocystoma. However, epithelial cellular elements composing both chondroid syringoma and hidrocystoma-like changes suggested, immunohistochemically and electron microscopically, differentiation into eccrine gland. The lesions of both had an apparent transition of ductal structures of chondroid syringoma into hidrocystoma-like changes. Therefore, chondroid syringoma and hidrocystoma-like changes in this case may be organized as a peculiar type of cutaneous appendage tumor differentiating toward eccrine gland.     

Acne aestivalis. A histopathological study.

Twelve histological sections with the diagnosis acne aestivalis (Mallorca acne) were revised and compared with the clinical diagnosis. Two histological diagnosis were wrong, one being folliculitis necroticans the other an uncharacteristic follicular disease. Non the less this patient had clinical acne aestivalis. In five patients accordance was found between histopathology and the clinical picture. Among the last five patients with histological acne aestivalis one had clinical rosacea, one yersinosis and dermatitis herpetiformis, one acne vulgaris, one miliaria or transcient acantholytic dermatosis, and the last one folliculitis perforans. The two last mentioned patients had the same histological picture which could be consistent with folliculitis perforans. The similarity in histopathology in this disease and acne aestivalis is emphasized. The histopathology in acne aestivalis could indicate, that the disease starts as a damage in corium and that the changes in the pilosebaceous apparatus are secondary.     

Vitiligo vs. hypopigmented mycosis fungoides (histopathological and immunohistochemical study, univariate analysis)

Vitiligo is a common skin disease characterized by the presence of well circumscribed, depigmented milky white macules devoid of identifiable melanocytes. On the other hand, hypopigmented mycosis fungoides (MF) is a rare variant of MF which presents clinically as persistent hypopigmented macules and patches. Both disorders show a predominance of CD8+ T cells in tissue samples and hence the differentiation between the two diseases on clinical, histopathological and even immunohistochemical grounds may offer great difficulty. The aim of this work is to identity certain histopathological clues which might help to differentiate between the two diseases. The study included 54 patients (26 vitiligo patients and 28 patients with Hypopigmented MF). Skin biopsies were taken and examined by hematoxylin and eosin and CD3, CD4 and CD8 markers were performed for ten vitiligo and nine MF patients. We have found that epidermotropism, hydropic degeneration of basal cells, partial loss of pigment, preservation of some melanocytes, presence of lymphocytes within the papillary dermis, increased density of the dermal infiltrate and wiry fibrosis of the papillary dermal collagen were detected with a significantly higher incidence in hypopigmented MF rather than vitiligo (P-values < 0.0001, < 0.00011, < 0.00011, = 0.001, = 0.008 and = 0.001 respectively). On the other hand, focal thickening of the basement membrane, complete loss of pigmentation, total absence of melanocytes, as well as absence or sparsness of lymphocytes in the dermal papillae were seen much more frequently in vitiligo. Statistical analysis of these differences was significant with P-values < 0.00011, < 0.00011, < 0.00011, = 0.008 respectively, regarding these pathological criteria. We conclude that differentiation of hypopigmented MF from vitiligo is possible by relying on the histopathological clues described in this study. This is particularly useful in areas of the world where cost benefit is crucial.