汗管样小汗腺癌1例

患者男,52岁,右面颊结节2年余。患者2年前右面颊无明显诱因出现一坚实肤色结节,表面光滑,无明显自觉症状,皮疹缓慢增大。既往有痛风史10余年,长期口服秋水仙碱,否认肿瘤史,家族中无类似病例及其他遗传病史……     

Clear cell syringoid carcinoma: an ultrastructural and immunohistochemical study

Syringoid carcinoma (syringoid "eccrine" carcinoma or eccrine epithelioma) is a rare cutaneous tumor with some controversy regarding its correct definition. It may also be difficult to differentiate from its benign counterpart (syringoma), other adnexal carcinomas, and cutaneous metastasis from adenocarcinomas. We present a case of a syringoid carcinoma of the clear cell variant complemented with an immunohistochemical and ultrastructural study, the latter revealing cytoplasmic accumulation of glycogen and presence of intercellular and intracellular lumina in clear tumor cells, as well as diverse hallmarks of malignancy (i.e., perineural invasion, tumor necrosis, and deep invasion). Clear tumor cells showed cytoplasmic and membranous immunoreactivity to epithelial membrane antigen, carcinoembryonic antigen, keratins, and S-100. Our ultrastructural and immunohistochemical results support the ductal differentiation of the glycogen-filled clear cell tumor population.     

Desmoplastic syringoid eccrine cancer with basalioma

We report on a 59-year-old woman suffering from desmoplastic syringoid eccrine carcinoma with basal cell epithelioma at her right temple. 40 years ago, lupus vulgaris had been X-rayed in this area.     

Low-grade clear cell eccrine carcinoma

Two patients had facial tumors that had a distinctive microscopic appearance. Each consisted of multiple nests of glycogen-filled clear cells dispersed in the dermis and associated with a hyalinized, collagenous stroma. There were also ductular features suggestive of eccrine differentiation. The lesions had a locally infiltrative microscopic appearance, and one involved the subcutaneous fat and skeletal muscle. Although neither tumor has recurred following excision, we believe that they are low-grade eccrine carcinomas and that they may represent a distinctive, albeit rare, subtype of adnexal neoplasm.     

An unusual melanocytic lesion associated with eccrine duct fibroadenomatosis and syringoid features

The intimate association of nevomelanocytic nevi with eccrine ducts commonly seen in congenital nevi was emphasized by Mishima, who described as eccrine-centered nevi those lesions characterized by nevomelanocytic cells predominantly proliferating around and within the eccrine sweat duct walls. However, there were no changes in the overlying epidermis, dermis, or eccrine acrosyringeal or dermal duct proliferation in these lesions. We present the case of a 16-year-old boy with a 1-year-history of a 0.6-cm diameter single tan papule on the right heel, clinically thought to be a Spitz nevus. Histopathologic examination revealed a compound nevomelanocytic nevus associated with epidermal hyperplasia, thin anastomosing cords of acrosyringeal epithelium extending within the dermis, and eccrine ductal proliferation in a syringoma-like pattern associated with a dense fibrous stroma. Features that distinguish our case from eccrine-centered nevus are that the latter lacks epidermal and eccrine duct hyperplasia and a dense fibrous stroma. The location of the lesion on the heel in our case suggests the possibility that the pathologic changes observed could result from repetitive trauma.     

Clear cell eccrine porocarcinoma with extensive cutaneous metastasis and peripheral lymphocyte dysfunction

An 81-year-old woman came to our clinic (Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan) with multiple erythematous, indurated papules over the left side of her face. Two years earlier, the patient had a skin biopsy done at a similar anatomical area with the histopathological diagnosis of Bowen's disease. After reviewing surgical specimens and confirming no systemic involvement, clear cell eccrine porocarcinoma with extensive cutaneous metastasis has been diagnosed. In addition, the peripheral blood lymphocyte function of the patient was evaluated. The expression of interleukin-2 receptors on lymphocytes after stimulation is abnormal compared with the age-matched normal control and a patient with cutaneous squamous cell carcinoma. This clinical manifestation of eccrine porocarcinoma is exceptional, and lymphocyte dysfunction in this patient has probably contributed to extensive cutaneous metastasis.     

Penile basal cell carcinoma with eccrine differentiation

Basal cell carcinoma (BCC) is rare on the penis. There have been only 17 cases of penile BCC reported in the literature. Eccrine differentiation may not be uncommon in BCC but has not been reported in penile BCC. We report here a 75-year-old man with multiple penile BCC with histological features of eccrine differentiation. A brief review of the literature is included.     

Syringoid eccrine carcinoma

A rare case of a syringoid eccrine carcinoma in a 52-year-old male patient is described. During the first hospitalization, syringoma was diagnosed, both clinically and histologically, keeping in mind the possibility of its malignant alteration. Difficulties in making a diagnosis with histological and immunohistochemical examinations are reported. The possibility of differential diagnosis of primary breast carcinoma and methods of its exclusion are also described. Treatment of the patient was surgical with good results.     

Clear cell basal cell carcinoma: An unusual degenerative variant

Clear cell basal cell carcinoma (BCC) is an unusual variant of BCC which is characterized by a variable component of large clear cells. Twenty cases are presented which are further subdivided into pure, mixed, or metatypical categories. Although initially thought to represent sebaceous or tricholemmal differentiation, electron microscopic studies demonstrated that the clear cell changes are a degenerative phenomenon, probably involving lysosomes.     

鳞样小汗腺导管癌

患者男,48岁。 主诉：左额部出现肿块2年。 现病史：患者于2年前发现左额部出现花生米大肿块,逐渐增大,无任何不适。曾在当地医院就诊,并行手术切除,当时未做组织病理学检查。术后半年皮损复发,生长较快,于2004年11月23日来我院就诊。     

Clear cell carcinoma of the skin: a tricholemmal carcinoma?

We report the light and electron microscopic findings of an unusual, locally aggressive cutaneous clear cell carcinoma involving extensively the left cheek and upper lip of a 61-year-old woman. The patient remained free of recurrence 5 years after wide local excision. Microscopically, the tumor was a poorly circumscribed and deeply invasive clear cell neoplasm characterized by large lobules and convoluted trabeculae of polygonal and columnar cells with palisading of the peripheral cells rimmed by thick basement membranes, and horn microcysts with tricholemmal keratinization. The tumor infiltrated the muscle and the salivary glands. Only slight cytologic atypia and a few mitotic figures were present. No definite ductal differentiation was found. Immunoperoxidase staining for carcinoembryonic and epithelial membrane antigens was negative. Ultrastructurally, the tumor cells were joined by desmosomes, and surrounded by thick basal lamina. The cytoplasm contained large pools of glycogen. Peculiar whorls of tonofilaments and aggregates of needle-shaped and club-shaped structures were observed in a small keratinizing focus. The tumor showed features resembling the outer root sheath of the hair follicle microscopically. Furthermore, the lack of duct-like structures and immunoreactivity of carcinoembryonic antigen tend to favor tricholemmal over sweat gland differentiation in this tumor which possibly represents a rare example of tricholemmal carcinoma.     

The enigmatic eccrine epithelioma (eccrine syringomatous carcinoma)

Eccrine epithelioma is an exceedingly rare cutaneous tumor thought to represent the malignant counterpart of the eccrine dermal syringoma. To data, only 10 accepted cases appear to have been reported. Two additional cases are described here and the literature is reviewed. The first case showed the typical histologic features of eccrine epithelioma. The second case showed extensive clear cell change (due to glycogen accumulation), reminiscent of the clear cell syringoma; conspicuous pseudo-apocrine metaplasia was also noted. The latter appearance has not been previously described in eccrine epithelioma.     

Basal cell tumor with eccrine differentiation (eccrine epithelioma)

A case of eccrine epithelioma is presented. A 62-year-old woman was seen for with a lesion on the left forearm present for 36 years, and complicated by multiple recurrences. Histopathologically, it was composed of numerous small nests of basaloid cells, cystic and syringoid epithelial structures within the reticular dermis and invading the contiguous fat mid muscle tissues. Tubular structures and cystic spaces contained PAS-positive, diastate-resistant, and alcian blue-positive material. Although the tumor was very aggressive locally, no metastasis had occurred throughout its long course.     

Sweat gland carcinoma ex eccrine spiradenoma

We herein report two cases of sweat gland carcinoma that arose in association with eccrine spiradenoma. These lesions presented as enlarging masses that previously had been stable for many years. One produced widespread metastasis and death 5 months after diagnosis. Immunohistochemical studies demonstrated an antigenic relationship between the benign and malignant components of sweat gland carcinoma ex eccrine spiradenoma, but ultrastructural analyses showed a paucity of specialized differentiation. This neoplasm appears to display a range of microscopic appearances and has proven fatal in 20% of reported cases.     

Clear cell acanthoma

Clear cell acanthoma is a rarely diagnosed tumor with variable clinical morphology that is usually only recognized by its histopathological features. The primary lesion is a red papule a few millimeters in diameter that often occurs as a single lesion on the lower extremities. In dermoscopy, resemblance of the vessels to a string of pearls is a largely specific finding of clear cell acanthoma. In contrast to the initially uncharacteristic clinical findings, histopathology of clear cell acanthomas is characterized by a typical compact, well‐demarcated acanthosis consisting of pale‐staining, PAS‐reactive keratinocytes. As etiology and pathogenesis are both unclear, nosology of clear cell acanthoma is also controversial, with an ongoing debate as to its classification as cutaneous neoplasia or reactive inflammatory dermatosis.     

透明细胞丘疹病

透明细胞丘疹病(clear cell papulosis,CCP)是1987年认识的一种新的皮肤病,患者是中国台湾的2个小兄弟[1],随后陆续有15例报道[2-8].CCP临床特征是多发的色素减退斑或扁平丘疹,大多数分布于下腹部,沿乳线(milk-line)对称分布,病理特征为透明细胞散在或2～4个成簇分布于基底层的角质形成细胞之间,而基底上层较少.     

Clear cell myoepithelial carcinoma of the skin. A case report

Myoepitheliomas are tumors of myoepithelial cells, most frequently diagnosed in the salivary glands. Cutaneous location is very rare, especially for malignant variant. We report a case of recurrent cutaneous myoepithelial carcinoma of the femoral region in a 51-year-old woman. Histologically, the tumor was confined to the dermis and superficial subcutaneous fat tissue, exhibiting typical multinodular pattern. The majority of tumor cells were of clear cell type, although rare epithelioid and spindle cells were also present. Nuclear atypia, mitotic activity of 12 mitoses per 10 microscopic high power fields and Ki-67 labeling index of 20%, as well as three recurrences, corroborated the malignant nature of the tumor. Immunohistochemistry showed positivity for cytokeratin, epithelial membrane antigen, vimentin, S-100 protein and myogenic markers (α-smooth muscle actin and muscle-specific actin HHF-35) in keeping with the myoepithelial cell immunophenotype. Staining for CD34, desmin and HMB-45 was negative. Myoepithelial carcinoma should be considered in the differential diagnosis of cutaneous neoplasms composed predominantly of clear cells.