Badehauben-großes mikrozystisches Adnexkarzinom in Kollision mit einem Bowenkarzinom nach photodynamischer Therapie

Abstract

Microcystic adnexal carcinoma (MAC) is a rare, often over years slowly growing tumor of the sweat glands with an aggressive infiltrative growth. It is histologically characterized by superficial epithelial nests with central keratin horn cysts. In the deeper regions syringoid epithelial nests with perineural growth are typical for this tumor entity. We report on a 71-year-old male patient applied to our outpatient clinic with multiple carcinomata in situ on his head. Seven years ago he underwent a photodynamic therapy (PDT). Again we performed a PDT and excised a lesion on the occipital area of the head suspected as squamous cell carcinoma. After nine micrographically controlled excisions a defect resulted which involved the complete scalp. A R0 situation would only have been achievable with a destruction of the face. Therefore the wound was closed by mesh graft and a subsequent radiation therapy was started. Six months after radiation there is no histological evidence for a recurrence of the MAC. This case report demonstrates that MAC can develop to an extreme dimension notwithstanding its clinical invisibility. Due to the rareness of the tumor only little is known about etiology and pathogenesis. An induction by UV exposure or ionising radiation is discussed. If PDT had an influence of the appearance of the MAC in this case, remains speculative.