Abstract
A rare case of an apocrine tumor in the male perineal region is reported. A dermal cystic lesion developed in the region between the anus and scrotum of a 74-year-old Japanese male. The cystic lesion, measuring 3.5 × 5.0 cm in size, was lined by columnar or flattened epithelium with occasional apocrine features and supported by a basal myoepithelium lining. A mural nodule, measuring 1 × 1.5 cm in size, protruded into the cystic space and consisted of a solid proliferation of tubular glands with prominent apocrine secretion and basal myoepithelial cells. Immunohistochemical examination showed that the luminal cells were partially positive for gross cystic disease fluid protein 15 and human milk fat globulin 1, and the basal myoepithelial cells were positive for alpha-smooth muscle actin and S-100 protein. Estrogen and progesterone hormone receptors were focally and weakly positive for luminal epithelium. Although no mammary-like glands were present in the dermis around the tumor, this unusual apocrine tumor has been suggested to be derived from male anogenital mammary-like glands and mimic a mammary-like gland adenoma in the male perineum.
Highlights
Mammary-like glands (MLGs) are present in the skin of the anogenital region of males as well as females
We describe a rare apocrine tumor in the anogenital region of a male and suggest that it is derived from male anogenital MLGs
As the present case partly exhibits apocrine differentiation, unusual anogenital glandular lesions showing a minor or no apocrine differentiation have been reported under various diagnoses including apocrine cystadenoma, fibroadenoma, ductal adenoma and adenosis tumor in addition to hidroadenoma papilliferum and syringocystadenoma papilliferum [1,4]
Summary
Mammary-like glands (MLGs) are present in the skin of the anogenital region of males as well as females. The inner surface of the cyst wall was lined by two rows of cells of luminal columnar to cuboidal or flattened epithelium with occasional apocrine snouts and basal myoepithelial cells (Figure 2a). A low papillary projection of columnar cells with apocrine features was observed in the cystic epithelium (Figure 2b). The myoepithelial cells were positive for alpha-smooth muscle actin (α-SMA; Dako) (Figure 3b). Both cystic and glandular parts were lined by two rows of epithelial linings: luminal epithelium with apocrine differentiation and basal myoepithelium. Normal MLGs were absent in the resected specimen, the diagnosis of an apocrine tumor with apocrine cystadenoma-like and intra-cystic tubular adenoma-like features was made
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