Apocrine gland carcinoma of the mammary skin concomitant with pagetoid phenomenon

We reported a 52‐year‐old woman with an apocrine gland carcinoma of the mammary skin concomitant with pagetoid phenomenon. She had a 23‐year history of a small nodular lesion on the lower left part of her right breast with a 1‐year history of the pigmented plaque spreading peripherally around the nodule. Our diagnosis revealed that the nodule was an apocrine gland carcinoma and the intraepidermal neoplastic cells with pagetoid spread in the pigmented plaque were derived from the apocrine gland carcinoma. No Paget’s cells were detected in the right nipple, and no tumor cells were observed in the sentinel lymph node and underlying mammary gland tissue. We also investigated the immunohistochemical changes in this case. They showed that both intraepidermal neoplastic cells with pagetoid spread and tumor cells of the apocrine gland carcinoma were positive with cytokeratin‐7 and human epidermal growth factor receptor‐2 (HER‐2)/neu overexpression. The results of the present study conclude that the intraepithelial spread of tumor cells in the mammary skin distant from the nipple occurred as a pagetoid phenomenon, and that HER‐2 may have a key role in pagetoid phenomenon of an underlying apocrine gland carcinoma, as well as in mammary Paget’s disease.     

Apocrine poroma: a distinctive case in a patient with nevoid basal cell carcinoma syndrome

Traditionally, poromas have been classified as eccrine neoplasms, but several recent reports of poroid tumors with sebaceous, follicular, and apocrine differentiation have challenged this idea. In support of alternative differentiation, a case of an "apocrine" poroma is reported in a 19-year-old man with the nevoid basal cell carcinoma syndrome. A papule on the right cheek, thought clinically to be a basal cell carcinoma, was excised. Anastomosing lobules of small uniform basaloid (poroid) cells formed small ductular structures lined by eosinophilic cuticles and extended into the superficial reticular dermis. The neoplasm originated from follicular infundibula and was surrounded by a myxoid stroma. Focally, primitive hair bulb and papillae differentiation was present, and some of the ducts were lined by cells suggesting decapitation secretion. The histologic pattern and the common embryologic origin of the folliculosebaceous-apocrine unit support apocrine differentiation of this tumor. The association with the nevoid basal carcinoma syndrome appears to be unique. This case, in addition, demonstrates overlapping features with the infundibulocystic type of basal cell carcinoma commonly seen in the basal cell nevus syndrome.     

Basal cell carcinoma of the vulva: a report of four cases

Four cases of vulval basal cell carcinoma were identified in multiparous females aged 46-78 years. Symptoms included discomfort and pruritus ranging from 6 weeks to 4 years in duration. Such symptoms occurred in the context of a pink vulval plaque. The non-specific symptoms, in the context of the particular anatomical site, led to late presentation. Subsequent treatment in all cases involved wide local excision following incisional biopsy. No recurrence has been documented after a minimum follow-up period of 12 months.     

胃癌皮肤转移1例

报道１例皮肤转移性肿瘤，患者男性，４８岁，于胃癌切除术后１０月出现于术瘢痕、下腹部及左上臂暗红色斑块，质硬，无自觉症状。组织病理变化为：真皮层及皮下脂肪组织中灶性和散在浸润的癌细胞，体积小，形态及分化七胃癌细胞相关似，为同一类源，用局部放射治疗有效。     

Basal cell carcinoma of the vulva: treatment with Mohs micrographic surgery

Vulval basal cell carcinomas (BCCs) are rare, representing < 5% of vulval malignancies and 1% of all BCCs. They often present with nonspecific symptoms and features that lead to large, poorly circumscribed and late‐presenting lesions. Current and conventional treatments used to treat vulval BCC include cryotherapy, imiquimod and excision. However, recurrence rates as high as 20% have been reported with these treatments. Furthermore, there are no current clinical guidelines for their management. We present the first reported series of patients with vulval BCC treated with Mohs micrographic surgery (MMS). We report seven cases of vulval BCC treated with MMS at a tertiary referral centre over 3 years. Follow‐up was performed at 3 months and up to 3 years. Our series demonstrates that there were no postoperative complications, functional sequelae or recurrences up to the 3‐year follow‐up. We therefore recommend that MMS should be considered in the management of vulval BCCs.     

Penile metastasis from adenocarcinoma of the prostate in a patient with colorectal carcinoma

Skin metastasis secondary to cancer of the prostate is rare and the prognosis is poor. A 65-year-old male patient diagnosed with metastatic colon carcinoma presented with polyuria and subcutaneous nodular mass on dorsal side of the corpus penis. The serum prostate specific antigen (PSA) level was 111.1 ng/mL and therefore the patient underwent transperineal prostate biopsy. Pathology reported adenocarcinoma of the prostate. The subcutaneous nodular lesion on the penis was totally excised and removed. Immunohistochemical examination of the excised mass was carcinoembryonic antigen (CEA) negative and PSA positive. Taking all these findings into consideration, the patient was diagnosed with prostate cancer that had metastasized to the penis. FOLFOX-4 chemotherapy regime in addition to bicalutamide and goserelin acetate was administered to the patient who also had metastatic colon cancer.     

Apocrine mixed tumor of the skin with a prominent pilomatricomal component

Pilomatrical differentiation within an apocrine mixed tumor (AMT) when present is only focal and has not been reported to be extensive. We herein report an AMT with prominent pilomatrical differentiation. A 47-year-old male presented with a 0.7 cm lesion on the right eyebrow. Histologic sections revealed, underneath a neurofibroma, a well-circumscribed tumor composed of nodules of branching epithelial elements and occasional keratinous cysts within a myxoid and lipomatous stroma. The ductal structures appeared to be composed of two layers of basophilic cuboidal cells and exhibited decapitation secretion. In approximately 50% of the tumor, eosinophilic ghost/shadow cells associated with a foreign body giant cell reaction formed a nodule resembling a pilomatricoma. Focally, columns of matrical cells were seen giving rise to shadow cells. Cytokeratin (CK) 5/6 and CK14 labeled the epithelial component. CK7, CK19 and Ber-EP4 labeled the ductal structures. Carcinoembryonic antigen and epithelial membrane antigen highlighted the luminal surface. S100 stained the stromal cells within the myxoid matrix, adipocytes and spindle cells within the overlying neurofibroma. CK10 highlighted the corneocytes within the keratinous cysts. CK17 labeled the epithelial lining of the keratinous cyst. The presence of follicular and apocrine differentiation within our tumor reinforces the common embryologic derivation of these elements.     

Clinicopathological correlation of cutaneous metastatic breast carcinoma using lymphatic and vascular markers: lymphatics are mainly involved in cutaneous metastasis

Precise clinicopathological correlations of the clinical features of metastatic breast carcinoma with lymphatic-specific markers are rare. We classified 28 patients with metastatic breast carcinoma according to their clinical features. Immunohistochemical staining was performed using D2-40, CD31 and CD34. Of the 28 patients, 8 (28.6%) had inflammatory metastatic carcinoma, 6 (21.4%) had the telangiectatic type, 5 had the nodular type, 3 had the en cuirasse type, 3 had alopecia neoplastica, and 3 had a combination of features. D2-40 staining revealed dilated lymphatic channels (lymphangiectasia) in the upper dermis of all patients; in addition, 13 patients (46.4%) had intralymphatic tumour-cell emboli, which were common in those with the inflammatory and telangiectatic types. Intratumoral lymphatic invasion in the main tumour nodule was seen in 12 patients (42.9%). Our results suggest that cutaneous metastatic breast carcinomas have various clinical presentations, and that lymphatic vessels play an important role in all types of cutaneous metastasis.     

Spindle and pseudoglandular squamous cell carcinoma arising in lichen sclerosus of the vulva

An 83-year-old woman presented with a vulval mass. Radical vulvectomy was performed and histology showed a unique mixed picture of spindle, pseudoglandular and classical squamous cell carcinoma arising in vulval lichen sclerosus.     

Paget''s disease of the vulva associated with local adenocarcinoma and previous breast adenocarcinoma: report of two cases

We report two women in whom vulval Paget's disease occurred in association with local adenocarcinoma and previous breast adenocarcinoma. The first patient presented at the age of 83 years with moist erythematous changes over the perineum and an indurated area near the anus. Biopsy of the indurated area showed Paget's cells throughout the epidermis and, below, adenocarcinoma infiltrating the dermis. Ten years previously, she had undergone a left mastectomy for infiltrating ductal carcinoma of the breast. The second patient was diagnosed as having Paget's disease at the age of 74 years. A vulval biopsy showed Paget's cells in the epidermis but, in addition, there were changes suggestive of adenocarcinoma of the sweat glands. Her symptoms of vulval itching had started at the age of 45 years and had led to a simple vulvectomy at the age of 57 years. Retrospective review of this vulvectomy specimen showed Paget's disease. She had also previously been treated for infiltrating ductal adenocarcinoma of the breast and adenocarcinoma of the rectum. The management of Paget's disease is difficult because of its high recurrence rate and, as illustrated by our two cases, treatment is difficult if the patients are elderly and in poor general health.     

Sarcomatoid carcinoma of the lung presenting as a cutaneous metastasis

The author reports a very rare case of cutaneous metastasis of sarcomatoid carcinoma of the lung. The skin metastasis was an initial presentation. A 67‐year‐old man consulted our hospital because of left chest skin mass. An excisional biopsy was performed, and it showed proliferation of malignant sarcomatoid spindle and polygonal cells in the deep dermis and subcutis remote from the epidermis and appendages. Immunohistochemically, the tumor cells were positive for pancytokeratins, cytokeratin (CK) 7, CK 18, vimentin, p53, Ki‐67 (95%) and PDGFRA. They were negative for high molecular weight CK, CK 5/6, CK 14, CK 19, CK 20, epithelial membrane antigen, TTF‐1, CEA, desmin, S100 protein, α‐smooth muscle actin, p63, CD34, surfactant apoprotein A, chromogranin, synaptophysin, neuron‐specific enolase, CD68, CD56, D2‐40, calretinin and KIT. A pathological diagnosis of metastatic sarcomatoid carcinoma probably originating from the lung was made. Then, the patient was admitted to our hospital, and imaging modalities including compured tomography (CT) and magnetic resonance imaging (MRI) revealed a tumor in the left lung. No other tumors were detected in the imaging techniques. Lung biopsy was planned, but the patient suddenly died; the cause of death was unclear. Autopsy was not performed. The present report suggests that sarcomatoid carcinoma of the lung should be considered in cutaneous metastatic lesions. Terada T. Sarcomatoid carcinoma of the lung presenting as a cutaneous metastasis.     

头皮带状硬皮病伴雄激素性秃发和斑秃一例

患者女,25岁.因顶部脱发4年,双颞部及枕部斑片状脱发1年,额部及头皮红斑、发硬3个月来我科就诊.4年前患者顶部头发逐渐稀少并进行性加重,1年前突然出现双颞侧和枕部头皮的斑片状脱发,3月前额中部偏左侧出现条带状、凹陷性的红斑;无雷诺现象.患者既往体健,其父有雄激素性秃发,余家族成员无类似疾病史.系统体检无异常发现.     

Basaloid carcinoma of the lung presenting concurrently with cutaneous metastasis

Basaloid carcinoma of the lung is a rarely occurring form of lung cancer morphologically resembling the basal cell carcinoma of the skin. Although various histologic types of lung cancers have metastasized to the skin, basaloid carcinoma of the lung that shows cutaneous metastasis has yet to be reported. A 48-year-old man was admitted to our pulmonology department with mild dyspnea and a solitary cutaneous mass on the left portion of his chin. Chest radiography and computed tomography of the thorax revealed an irregular infiltrative mass confined to the central portion of the left lower lobe bronchus, which is a compatible finding of primary lung cancer. Microscopically, both a cutaneous mass and fine-needle aspirate material in the lung revealed the identical findings of basaloid morphologic patterns.     

High-resolution real-time sonography in the evaluation of local lymphatic metastases in malignant melanomas

120 patients suffering from malignant melanoma were examined by means of 10-Mcs sonographic scanner for the detection of regional lymphatic metastases. Metastases appeared as circumscribed regions of very low echodensity and could readily be separated from benign alterations. Sonography of the regional lymph nodes, therefore, proved to be a useful technique for the follow-up of melanoma patients.     

Post-implantation erythema in 3 patients and a review of reticular telangiectatic erythema

Background. The appearance of erythematous, blanchable patches or plaques overlying an implant suggests possible reticular telangiectatic erythema (RTE). RTE is a benign reactive cutaneous manifestation that can present following the implantation of a cardiac pacemaker, defibrillator or intrathecal infusion pump in an otherwise asymptomatic, non‐infectious patient. Objective. To demonstrate the variety in clinical presentation of patients presenting with RTE or similar patch test‐negative post‐implantation erythema. Patients/Materials/Methods. After institutional board approval had been obtained, patient information was obtained from electronic medical record files, which included surgical reports, pathology reports, and notes from outpatient encounters. Results. We report post‐implantation erythema following insertion of an elbow prosthesis, a knee prosthesis, and a spinal cord stimulator, which have not previously been cited as aetiologies of RTE. Conclusion. Owing to the delayed onset and variable recovery, RTE remains a diagnostic challenge. RTE should be included in the differential diagnosis of any patient presenting with erythema over the site of a previously implanted device.     

Aggressive angiomyxoma of the vulva in a patient with systemic lupus erythematosus

Aggressive angiomyxoma is a rare, slow-growing mesenchymal neoplasm with a tendency to recur. It mainly involves the pelvis, vulva, perineum, vagina, and urinary bladder in adult women of reproductive age group. We describe a 26-year-old female with large swellings of both labia majora which was histologically diagnosed as aggressive angiomyxoma. She also had systemic lupus erythematosus. The swelling was surgically removed and she had no recurrence at 1-year follow-up. Although it is a rare tumor, it must be considered as a differential diagnosis for any mass in the perineum or soft tissue of the pelvis. Long-term follow-up is necessary for early diagnosis of local recurrence.