Reticulated acanthoma with apocrine differentiation

Reticulated acanthoma with apocrine differentiation (RAAD) represents a rare variant of adnexal neoplasm first described by Ackerman et al. in 1998. It consists of cords and columns of adnexal keratinocytes that form a reticulated pattern. Variable signs of apocrine, sebaceous and follicular differentiation may be present. Since 1998, no further cases of this condition have been published. We report on a lesion excised from the leg of a 46-year-old man, which displayed histopathological features diagnostic of RAAD. Criteria for diagnosis and differential diagnoses are discussed.     

Trichoblastic neoplasm with apocrine differentiation

Trichoblastoma is a benign neoplasm with primitive hair follicle differentiation. The tumor is characterized by nests and cords of epithelial cells in an organized relation to stroma. The epithelial cells differentiate toward follicular germ and follicular sheath. More divergent differentiation in the form of sebaceous elements in trichoblastoma has infrequently been reported in the literature. We report a trichoblastic neoplasm showing typical features of trichoblastoma as well as areas of apocrine differentiation. The neoplasm, which was present for several months, was removed from the chin of a 31-year-old woman. Histologic examination showed a neoplasm composed of basaloid nests with occasional papillary mesenchymal bodies as well as ducts and glands exhibiting apocrine differentiation. Trichoblastoma with apocrine features is rarely reported in the literature.     

Axillary apocrine carcinoma associated with apocrine adenoma and apocrine gland hyperplasia

Apocrine carcinomas represent a rare group of tumors with a potential for destructive local invasion, regional and distant metastases, and are equally common in both sexes. A case of a 79-year-old woman with axillary apocrine carcinoma associated with apocrine adenoma and apocrine gland hyperplasia is presented. To our knowledge, this is the first case diagnosed in a Caucasian and also the first case diagnosed in a female patient. Grossly, the tumor measured 3.2x1.5x1.2 cm and on cut section appeared granular, white to gray-tanned. Microscopically, the tumor was located in the dermis, poorly demarcated, focally necrotic with ulcerated overlying skin. It was predominantly composed of complex, closely packed tubuloglandular structures but in few areas papillary structures were also observed. The cells contained abundant eosinophilic, finely granular cytoplasm with pleomorphic nuclei and showed apocrine-like decapitation. The cytoplasm contained periodic acid Schiff diastase resistant granules. Mitoses were frequent and some were atypical. In one area, the tumor was lobular and composed of tubular structures lined with one layer of uniform cuboidal or columnar eosinophilic cells, indicating a pre-existing apocrine adenoma. Beneath the tumor, in the deep dermis and subcutaneous tissue, hyperplastic apocrine glands were also found. No additional therapy was used, and one year after the surgery the patient was alive and showed no signs of tumor spread. This and previously reported cases suggest that apocrine hyperplasia and apocrine adenoma may represent successive steps in the development of apocrine carcinoma.     

Trichoblastoma with apocrine and sebaceous differentiation

Trichoblastoma is a rare, benign tumor that differentiates toward the hair germ, the embryonic precursor of a hair follicle. Several cases of trichoblastoma showed multiple differentiation toward more than one type of adnexal structure. We report a case of a trichoblastoma, which had developed on the scalp as a solitary 1-cm nodule 3 years ago. A histologic examination indicated that the specimen had features of multiple differentiation. In particular, there were occasional foci of decapitation secretion, as well as cells with web-like and bubbly cytoplasm suggesting seboblasts, and a sebaceous duct-like structure. In addition, there were occasional germinative cells in the palisade, and scattered hair papilla-like structures showing follicular differentiation. An immunohistochemical study showed that the neoplasm, or areas in it, stained positive for low molecular cytokeratin, high molecular cytokeratin, EMA, S-100, and GCDFP-15. This is an unusual case of a trichoblastoma with apocrine and sebaceous differentiation.     

Axillary apocrine carcinoma with Paget's disease and apocrine naevus

Apocrine carcinoma is a rare malignant sweat-gland neoplasm with apocrine differentiation. There have been some reported cases of apocrine carcinoma with apocrine naevus. We report a case of a 78-year-old man with a painless tumour of the left axilla. Positron emission tomography (PET) showed slight fluorodeoxyglucose (FDG) uptake in both axillae. The patient underwent radical excision of the left axilla with left axillary lymph-node resection. The resected specimen showed apocrine adenocarcinoma with extramammary Paget's disease and apocrine naevus. Two years later, the patient noted enlargement of the right axilla, and PET showed increased FDG uptake. On resection of this enlarging right axilla, an apocrine naevus was found. FDG-PET is a useful method for detecting precancerous lesions, allowing monitoring of abnormal foci that are not suspicious for cancer and have no clinically apparent cause for concern.     

An epithelioma with hair follicle and apocrine differentiation

A tumor on the face showing follicular and apocrine differentiation is described. The coexistence of the two features suggests that the hair follicle has the potential to develop an apocrine gland tumor.     

A case of sebaceoma with extensive apocrine differentiation

Apocrine differentiation is a rare event in sebaceoma, and only 3 cases have been reported. We report a case of sebaceoma with extensive apocrine differentiation on the scalp in a 73-year-old Japanese woman. The resected tumor was located entirely within the dermis and subcutis as a well-circumscribed, lobulated, solid, and partially cystic mass, measuring 35 mm at the largest diameter. Histopathologically, it was composed of uniform basaloid cells with clusters of sebocytes, squamous islands of ductal structures, and apocrine cells with apparent decapitation secretion. Nuclear atypia of all types of cells was inconspicuous, and mitotic figures were infrequent. We considered the lesion to be a sebaceoma with apocrine differentiation.     

皮脂腺痣并发鳞状细胞癌

报告1例皮脂腺痣并发鳞状细胞癌.患者男,28岁.右颊部疣状增生性斑块28年,原有皮损上缘新发结节并发溃疡2周.皮肤科检查:右颊部一纵向淡黄色隆起性斑块,表面呈疣状,无毛发,质地坚实.皮损上缘见一淡红色半球形结节.结节质地坚实,触之稍有浸润感,结节顶端呈火山口样浅溃疡.组织病理学检查:结节周边表皮疣状增生,真皮浅层大量成熟皮脂腺小叶.肿瘤完全由不典型的梭形细胞构成,束状及弥散状排列,浸润性生长.肿瘤细胞梭形,泡状核,核分裂象多见.免疫组化染色:AE1/AE3(+),角蛋白(CK)5/6(+),CK7(+),CAM5.2(+),波形蛋白(vimentin)(+),CD31(-),CD34(-),S-100蛋白(-),HMB45(-),A103(-),上皮膜抗原(EMA)(-),结蛋白(desmin)(-),平滑肌肌动蛋白(SMA)(-),钙桥(caldesmon)(-),KP-1(-),Fas(+/-),Ki67(+,30%).     

Sebaceous carcinoma in children

Sebaceous carcinoma is a rare malignant tumor derived from the epithelium of sebaceous glands. It potentially may develop from any sebaceous gland, but most commonly occurs in the periorbital area. We report a case of sebaceous carcinoma in a 14-year-old girl who was first seen with an asymptomatic 2.5 x 2.3-cm firm, multilobulated cutaneous nodule on the anterior thorax, which had been present for 1 year. She was adopted, and no family history is available. A skin biopsy specimen revealed a poorly differentiated infiltrative carcinoma involving the dermis and subcutaneous fat and focally involving the epidermis. Tumor cells had sebaceous and squamous differentiation. A diagnosis of sebaceous carcinoma was made. She was treated by surgical excision with a 2-cm margin. Further work-up showed no evidence of Muir-Torre syndrome.     

Cutaneous spindle cell adenolipoma with eccrine and apocrine differentiation

Cutaneous spindle cell adenolipoma (SCAL) is a recently described rare variant of lipoma with 11 cases reported to date. Here we report a consultation case of a 77-year-old male who presented with a nodule on the right nasolabial fold, diagnosed as apocrine fibroadenoma or sebaceous hyperplasia by an outside pathologist. The specimen revealed an ill-defined dermal tumor composed of mature adipocytes, bland spindle cells, ropey collagen, and dilated eccrine and apocrine glands and ducts in a fibromyxoid stroma. The spindle cells were positive for CD34 and negative for S100 protein and SOX10. These findings are consistent with those of cutaneous SCAL. The pathogenesis of this entity is controversial and includes a hamartomatous process, derivation from adipose tissue surrounding eccrine glands, or preexisting glands entrapment within a growing lipoma. In the present case, the glandular component is extensive and includes both eccrine and apocrine differentiation, which has not been previously described and further supports the hamartomatous nature. Awareness of this rare entity is helpful to prevent confusion with other look-alike primary and metastatic cutaneous lesions.     

Vulval basal cell carcinoma associated with apocrine hidrocystoma

报告1例女性外阴基底细胞癌并发大汗腺汗囊瘤.患者女,56岁.外阴肿块1年,呈蓝褐色球状,无自觉症状.肿块切除后组织病理检查证实为结节型基底细胞癌并发大汗腺汗囊瘤.     

Sebaceous carcinoma and the T-antigen

Carcinomas of sebaceous glands are uncommon. They are traditionally classified into ocular and extraocular sebaceous carcinomas (SC). Ocular SC tend to be more common and more aggressive than extraocular SC. However, the latter can occasionally follow a fatal course. Histologically, SC should be classified into 1) SC in situ; 2) SC, infiltrating, low-grade with or without pagetoid spread; 3) SC, infiltrating, high-grade, with or without pagetoid spread; and 4) SC with extraocular and extracutaneous involvement, including metastases. Immunohistochemistry plays a minor role in the diagnosis of SC. Thomsen-Friedenreich (T) antigen can be a helpful tool in differentiating SC (strong T-antigen reactivity in basaloid cells) from other mimicking neoplasms (basaloid cells are T-antigen negative). The histologic differential diagnosis, pathogenesis, and management of SC are reviewed.     

Sebaceous carcinoma of the nipple

Sebaceous carcinoma (SC) is an uncommon neoplasm that usually presents as an ocular or extraocular cutaneous lesion of the head and neck. We report a case of an 83-year-old woman with SC of the nipple. To our knowledge, this is the first report of SC arising in the nipple.