阴囊皮脂腺增生1例

报告1例阴囊皮脂腺增生,患者男,20岁。阴囊散在多个皮色或淡黄色粟粒大兵疹1年,无自觉症状,皮肤组织病理显示表皮正常,真皮浅层可见单个增生、成熟的由18个皮脂腺小叶组成的团块,中心有扩大的皮脂腺导管,未见明显的细胞异形性。     

Microcystic adnexal carcinoma with sebaceous differentiation: Three cases

Microcystic adnexal carcinoma (MAC) is a low‐grade malignant tumor of the skin. Histologically, this tumor shows a biphasic pattern, with cords and nests of basaloid cells, as well as keratin horn cysts. This biphasic histological appearance has been interpreted by some authors as a sign of double eccrine and folliculosebaceous‐apocrine differentiation, whereas some other authors defend a solely eccrine differentiation. In this context, sebaceous differentiation in MAC would support the first option. However, there are only 3 cases of MAC with sebaceous differentiation in the literature, and all of them were reported before adipophilin was available, which in the appropriate context (eg, testing clear cells for sebaceous vs eccrine differentiation) is very useful. In this study, we present 3 cases of MAC with focal sebaceous differentiation confirmed by immunoexpression of adipophilin in the sebaceous foci.     

眼外型皮脂腺癌一例

患者,女,27岁。因头皮斑块2个月就诊。组织病理示：肿瘤呈水平及垂直方向生长,累及表皮、真皮至脂肪组织浅层。可见细胞异型性及病理性核分裂相。肿物扩大切除术后再次行组织病理示表皮内肿瘤细胞呈paget病样生长,一侧切缘仍有肿瘤细胞残留。免疫组织化学：肿瘤细胞EMA(+)、AR(-),CAE(-)、ER(-),Ki67增殖指数为30%。诊断：皮脂腺癌。拟再次行切除术并辅以放疗或化疗。     

A tumor with sebaceous differentiation showing intraepidermal epithelioma

A sixty-year-old woman had a small papule within a plaque on the left arm. Histologically, the papule was similar to irritated seborrheic keratosis or inverted follicular keratosis and the plaque was intraepidermal epithelioma. However, both lesions included mature sebaceous cells showing sebaceous differentiation. This tumor may be closely related to the pilo-sebaceous unit or sebaceous gland. To our knowledge, no similar tumor has been reported in the literature.     

Cutaneous lymphadenoma with ductal differentiation

Cutaneous lymphadenoma (CL) is a recently described neoplasm of unknown histogenesis. Histologically, these tumors typically present as well-circumscribed nodules with scant or no epidermal connections. They are composed of multiple rounded lobules of basaloid cells with some degree of peripheral palisading. These epithelial lobules characteristically show a dense lymphoid infiltrate within them. In cases of CL previously described, there was no obvious adnexal differentiation except for isolated cells showing apparent sebaceous differentiation or hints of follicular differentiation. We report two typical cases of CL that were studied histologically and immunohistochemically. In some of the tumor lobules, there were foci of ductal differentiation, with luminal positivity for CEA and EMA. We postulate that some CL represent a form of immature sweat gland tumor with ductal differentiation.     

Sebaceous mantleoma (mantle adenoma): reappraisal of the myth of the problematic benign neoplasm with sebaceous mantle differentiation

Few cases of a true benign neoplasm with sebaceous mantle differentiation have been reported, and little is known about this tumor. Herein, we present a rare case of the neoplasm called sebaceous mantleoma, along with a comparison of the histology and immunoprofile with those of normal sebaceous mantles. A pedunculated polyp occurred on the scalp of a 51‐year‐old woman. Histopathologically, the tumor showed lobulated epithelial‐mesenchymal units that were separated from the normal dermis by clefts. The lesion was composed of cords and columns of basaloid cells containing a few mature sebocytes, with a focal connection to infundibulocystic structures as well as dense fibrotic or fibromyxoid stroma. Immunohistochemically, androgen receptor, estrogen receptor, and CD117 were partially positive for the tumor, and CD8 (C8/144B) and epithelial membrane antigen were focally positive. Additionally, cytokeratin 20‐positive Merkel cells were individually admixed in the tumor nests as well as in normal sebaceous mantles. This case report reveals the characteristic histology and immunoprofile of this problematic benign neoplasm and helps to understand this entity.     

Superficial epithelioma with sebaceous differentiation

Five cases of superficial epithelioma with sebaceous differentiation (SESD) are reported. They occurred as solitary papules on the face of 5 patients, aged 57 to 72. The tumor is characterized by a superficial platelike proliferation of basaloid to squamoid cells with broad attachments to the overlying epidermis. Clusters of mature sebaceous cells are present within the tumors. None of the tumors have recurred or spread following simple excision. SESD is a non-aggressive tumor of uncertain histogenesis with a tendency toward sebaceous differentiation.     

皮脂腺癌八例临床及病理分析

回顾性分析我院2017年5月至2022年4月诊断的8例皮脂腺癌临床病理资料,其中男3例,女5例,发病年龄平均72岁,临床表现为单个无痛性肿块,病程2个月～3年。6例位于眼睑,1例在面部,1例在耳后,8例患者中2例复发,均在眼睑部位。镜下见肿瘤细胞巢排列成不规则的小叶或结节状。胞质较少的嗜碱性基底样细胞,略呈栅栏状排列,主要位于周边,中央为胞质空亮的皮脂腺细胞。免疫组化CK、EMA、p63、AR阳性,Ki-67阳性率约20%～90%。     

Rippled-pattern sebaceous trichoblastoma

BACKGROUND: There is a large spectrum trichoblastoma; of which, several histologic variants have been described including a rippled-pattern variant. Three cases of rippled-pattern trichoblastoma are described which also exhibited definitive foci of sebaceous differentiation. METHODS: Three cases were retrieved from the archives of the Dermatopathology Laboratory at the University of California Irvine (Orange, CA, USA). All specimens were stained with hematoxylin and eosin (H&E). In addition, sections were submitted for immunohistochemical studies with epithelial membrane antigen (EMA). RESULTS: All three biopsies were composed of well-circumscribed multiple variously sized tumor lobules present in the upper to deep dermis comprised of with rounded or slightly elongated basaloid cells with scant eosinophilic cytoplasm. The lobules were separated by a slightly hyalinized stroma. The unique finding present in all three specimens was a peculiar arrangement of the basaloid cells in linear rows parallel to one another. This gave the tumors a rippled pattern similar to the palisading of nuclei of Verocay bodies seen in schwannomas. In addition all three biopsies showed definite sebaceous differentiation. CONCLUSIONS: Three additional cases of rippled-pattern trichoblastoma are presented. All three were located on the scalp and showed additional features of foci of sebaceous differentiation. No associations with Muir-Torre Syndrome were found in these patients. Because this appears to be a distinct variant within the large spectrum of trichoblastoma, the term rippled-pattern sebaceous trichoblastoma is suggested.     

Reticulated acanthoma with sebaceous differentiation: another sebaceous neoplasm associated with Muir–Torre syndrome?

Reticulated acanthoma with sebaceous differentiation (RASD) represents a rare benign cutaneous epithelial neoplasm with sebaceous differentiation. There has been much speculation about the relationship between RASD and Muir–Torre syndrome (MTS). We report a 53 year‐old man who presented with RASD in addition to a prior history of sebaceous adenomas. Immunohistochemically, the tumour cells in the RASD and sebaceous adenomas showed a significantly reduced MSH6 protein expression, whereas there was no loss of MLH1, MSH2 and PMS2. This benign neoplasm, which can be mistaken for various other cutaneous lesions with sebaceous differentiation, deserves wider recognition for its possible association with MTS.     

A case of sebaceous carcinoma diagnosed in an adolescent male

Sebaceous carcinoma is an uncommon and potentially aggressive malignancy that exhibits sebaceous differentiation. Approximately 75% of cases arise in the periocular region. Sebaceous carcinoma is rare in the pediatric population and its presentation in this age group is not well documented in the dermatopathology literature. We report the case of a 15-year-old male with sebaceous carcinoma who was first seen with a nodular lesion involving the skin of the left orbit/temporal area. A shave biopsy was performed which showed an infiltrative proliferation of basaloid cells that focally exhibited sebaceous differentiation, including the formation of incipient sebocytes. Immunohistochemically, the tumor cells expressed epithelial membrane antigen (EMA) and CK5/6, while a lack of Ber-EP4 was observed. Based upon these attributes, the diagnosis of sebaceous carcinoma was rendered. Subsequent immunohistochemical analysis for a possible DNA mismatch repair enzyme defect revealed that all four mismatch repair gene products showed retained expression, thereby providing no support for the presence of underlying Muir-Torre syndrome. Sebaceous carcinomas are exceptional in the pediatric age group and are rarely documented in the dermatopathology literature. Knowledge that this adult carcinoma can occur mostly in the pediatric age group may aid in the recognition of this uncommon malignancy.     

On the mechanism of sebaceous secretion

Summary Following the studies of Kligman, most investigators now believe that sebaceous glands function continuously in excreting sebum to the skin surface [7, 8]. Populations of differentiating cells are maintained by mitotic activity both in the peripheral cells of the sebaceous lobules and in aggregations of undifferentiated cells which extend through the body of the lobules. Once formed, and as long as maintained by circulating hormones, each lobule continues to produce a stream of differentiating cells which accumulate sebum as they move towards the sebaceous duct and finally disrupt to release their contents into the pilosebaceous canal.After intradermal injections of ³H-thymidine to label germinative cells during DNA replication, up to 28 days elapse before all labeled cells disappear from the glands. When differentiating cells are labeled with ³H-amino acids, much of the label is lost in 7 days. Likewise, when lipids are labeled with ¹⁴C-acetate, the average excretion time for the labeled sebum is 8 days. To this time may be added the renewal time of undifferentiated cells to give an average sebaceous cell transition time of 14 days [15].From knowledge of the time between synthesis and excretion of sebum, sebum production rates were calculated from the sebum content of punch biopsies. The transit time of sebum in the follicular canals was estimated to be 14 h. Production rates determined in this way agree with those measured by long-term absorption of sebum at the skin surface.This study was supported in part by a grant from the US Public Health Service (AM 22083)     

A case of multiple sebaceous epithelioma: analysis of microsatellite instability

Sebaceous gland tumor is a rare disease that is a sign of Muir-Torre syndrome, an autosomal, dominantly inherited genodermatosis characterized by the presence of at least one sebaceous gland tumor and a minimum of one internal malignancy. Recent studies have indicated that defective DNA mismatch repair occurs in Muir-Torre syndrome. Cutaneous lesions may occur before diagnosis of the internal cancer. We describe a 64-year-old male patient with multiple sebaceous epitheliomas with no evident internal malignancy. Microsatellite instability, determined by examining dinucleotide CA repeats at the microsatellite loci, was observed in DNA from one sebaceous epithelioma but not from the other two sebaceous epitheliomas or from one basal cell epithelioma with sebaceous differentiation, suggesting that this condition is unlikely to be due to germ-line mutation of mismatch repair genes.     

A Case of Tumor of the Follicular Infundibulum with Sebaceous Differentiation

Tumor of the follicular infundibulum (TFI) is an uncommon benign adnexal tumor that usually presents as a solitary keratotic papule on the face or scalp of elderly patients. Histopathologically, it typically manifests as a plate-like fenestrated proliferation of monomorphic pale-staining cells. A 76-year-old male presented with about a 2 cm, well-defined, yellowish to brownish, slightly elevated, twisted and bent, interrupted, cord-like plaque on his left lower abdomen. Microscopic examination revealed a sharply demarcated plate-like proliferation of pale cells localized in the papillary dermis with multiple connections to the overlying epidermis. The histopathological features were compatible with TFI, except for foci of sebaceous differentiation. There has been one previous case report of TFI with sebaceous differentiation in the English medical literature. Herein, we report on a singular case of TFI with sebaceous differentiation.     

Nuclear factor XIIIa staining (clone AC‐1A1 mouse monoclonal) is a sensitive and specific marker to discriminate sebaceous proliferations from other cutaneous clear cell neoplasms

Sebaceous carcinoma is a rare but serious malignancy that may be difficult to diagnose when poorly differentiated. Other epithelial tumors with clear cell change may mimic sebaceous carcinoma. Few useful or specific immunohistochemical markers for sebaceous differentiation are available. Nuclear staining with factor XIIIa (clone AC‐1A1) was recently found to be a highly sensitive marker of sebaceous differentiation. We evaluated nuclear factor XIIIa (AC‐1A1) staining in sebaceous neoplasms vs. other cutaneous clear cell tumors. We stained 27 sebaceous proliferations: sebaceous hyperplasia (7), sebaceous adenoma (8), sebaceoma (5), sebaceous carcinoma (7). We also stained 67 tumors with clear cell change: basal cell carcinoma (8), squamous cell carcinoma (8), hidradenoma (7), desmoplastic trichilemmoma (2), trichilemmoma (10), trichilemmal carcinoma (3), clear cell acanthoma (9), atypical fibroxanthoma (1), syringoma (8), trichoepithelioma (1), metastatic renal cell carcinoma (2), and nevi with balloon cell change (8). Nuclear factor XIIIa (AC‐1A1) staining was present in 100% of sebaceous proliferations; 96% displayed strong staining. Non‐sebaceous clear cell tumors were negative or only weakly positive with factor XIIIa (AC‐1A1) in 95.5%; only 4.5% showed strong staining. This suggests that strong nuclear factor XIIIa (AC‐1A1) staining is a sensitive and specific marker of sebaceous neoplasms vs. other clear cell tumors.     

Poroma with sebaceous differentiation: Report of three cases

We herein report three cases of poroma, which showed sebaceous differentiation. The patients were two men and one woman, and the involved sites were the thigh, head and back. In all three cases, histopathological examination revealed anastomosing nests consisting of poroid cells proliferating into the dermis. Tubular structures lined by eosinophilic cuticular cells were scattered in the tumour nests. Furthermore, aggregations of mature sebocytes with vacuolated cytoplasm were also observed forming clusters, or intermingled with the poroma cells. Focal calcification was found within the nests in two cases. Sebaceous component were recognized in the presented three cases among the 62 cases (4.8%) examined in our department within the past 10 years. We also include a review of the 31 reported cases of poroma with sebaceous differentiation. None of them occurred in acral regions, where typical eccrine poromas predominate. The majority of cases were benign. This review indicates that some poromas may show sebaceous differentiation and be of apocrine lineage.     

Cutaneous Mixed Tumor Containing Ossification,Hair Matrix,and Sebaceous Ductal Differentiation

A 58-year-old Japanese male presented with a cutaneous mixed tumor containing ossification and hair matrix differentiation on the left side of the chin. Histologically, the tumor consisted almost exclusively of apocrine-type epithelial ductal structures and chondroid stroma. Strands and aggregation of basaloid cells which contained keratinous cystic structures with a column of shadow cells arising from basophilic basaloid cells, sebaceous duct-like structures, and ossification in the stroma were also evident. These findings suggest that cutaneous mixed tumors with ossification and hair matrix differentiation are related to both the whole hair follicle and the sweat aparatus.     

Intraepidermal benign sebaceous neoplasm: apocrine poroma (hidroacanthoma simplex type) with extensive sebaceous differentiation with sebaceoma‐like features

We herein report a patient who clinically presented with a yellowish, flat plaque that histopathologically showed a benign lesion mainly composed of intraepidermal basaloid nests with sebaceous differentiation. This lesion was considered to be fundamentally apocrine poroma (hidroacanthoma simplex type) with sebaceous differentiation. Nests composed of typical poroid cells were seen, and the results of immunostaining for lumican supported this diagnosis and excluded the possibility of clonal seborrheic keratosis. The sebaceous differentiation in apocrine poromas mostly occurs in Pinkus type lesions, and is usually seen in only part of the lesions, as solitary, mature sebocytes within the poroma nests. However, our apocrine poroma case was unique not only in that sebaceous differentiation occurred in the hidroacanthoma simplex type, but also in that it was observed extensively (approximately 60% of the nests). We therefore called this lesion an ‘intraepidermal benign sebaceous neoplasm’. Although it may be hard to differentiate sebaceous germinative cells (seen in sebaceoma) from poroid cells, in this case, some poroma nests could be judged to neighbor or contain the sebaceoma‐like areas. Therefore, the presented apocrine poroma was considered to have some features of (intraepidermal and dermal) sebaceoma.     

An Immunohistochemical Study of BCA-225 in Various Skin Cancers

We performed an immunohistochemical study of BCA-225, which is a glycoprotein secreted by the T47D breast carcinoma cell line and recognized by monoclonal antibody BRST-1 (clone name: CU-18), in normal skin and various skin cancers. In normal skin, BCA-225 was positive only in the secretory portion of both eccrine and apocrine glands and in mature cells of the sebaceous gland. We observed 10 cases of squamous cell carcinoma of the skin, 10 cases of basal cell carcinoma without sebaceous differentiation, 3 cases of basal cell carcinoma with sebaceous differentiation, 6 cases of malignant trichilemmoma, 8 cases of eccrine porocarcinoma, 3 cases of ductal carcinoma, 1 case of malignant clear cell hidradenoma, 1 case of apocrine adenocarcinoma, 6 cases of extra-ocular sebaceous carcinoma, 5 cases of extramammary Paget's disease with underlying adenocarcinoma, and 11 cases of extramammary Paget's disease without underlying adenocarcinoma. Most of the cases of sweat gland carcinoma, basal cell carcinoma with sebaceous differentiation, sebaceous carcinoma, and extramammary Paget's disease were positive for BCA-225, while none of the cases of squamous cell carcinoma, basal cell carcinoma without sebaceous differentiation, or malignant trichilemoma were positive. Based on these findings, we believe that BCA-225 is useful in distinguishing tumors with sweat gland and sebaceous differentiation and extramammary Paget's disease from tumors without such differentiation.