Skin Adnexal Tumors Research Articles

Hyaline cell-rich chondroid syringoma: A potential pitfall on cytology.

Chondroid syringoma is a rare adnexal tumor of skin, with few cases diagnosed on fine needle aspiration cytology (FNAC). Hyaline cell-rich chondroid syringoma (HCRCS) is a very uncommon variant of chondroid syringoma described in histopathologic studies. This variant differs from the usual chondroid syringoma in its site of presentation, cytohistologic features, and morphologically mimics malignant neoplasms. To the best of our knowledge, cytologic features of this entity have never been described. This case report highlights some unusual features of this tumor and discusses the cytologic features of HCRCS along with neoplastic mimics.

Can We Recognize Skin Adnexal Tumours? Retrospective Evaluation of Clinical and Histopathologic Data in a Tertiary Dermatology Clinic

Can We Recognize Skin Adnexal Tumours? Retrospective Evaluation of Clinical and Histopathologic Data in a Tertiary Dermatology Clinic

Eccrine Porocarcinoma: Clinical and Histopathological Study of 14 Patients with Special Emphasis on Sentinel Lymph Node Biopsy.

Eccrine porocarcinoma is a rare skin adnexal tumour that affects elderly people. Most eccrine porocarcinomas are stage I or II according to the American Joint Committee on Cancer. The prognosis is good in early stages, but worsens when advanced. Since information on the use of sentinel lymph node biopsy in these patients is scarce, this study examined the records of all patients with eccrine porocarcinoma treated at Helsinki University Hospital during a 17-year period and focused on sentinel lymph node biopsy patients. The study identified 14 patients (9 male, 5 female). There were 2 metastases to the lymph nodes and 2 recurrences at initial referral to our institution. All primary tumours had wide local excision and 6 patients also had sentinel lymph node biopsy, of whom none had positive lymph nodes. There were no new metastases or recurrences during follow-up. Three patients died of causes other than eccrine porocarcinoma. When comparing the wide local excision only and wide local excision with sentinel lymph node biopsy groups, no parameters reached statistical significance. The decision process of the multidisciplinary tumour board meeting on whether to perform sentinel lymph node biopsy was not clear, perhaps due to the limited knowledge of eccrine porocarcinoma. Further studies and international collaboration are warranted.

Histomorphological patterns of skin adnexal tumours with an insight into molecular updates - A single institutional study

Background: Skin adnexal tumors are a spectrum of benign and malignant tumors that differentiate toward or arise from the adnexal unit of the skin. These rare tumors pose a challenge in diagnosis, and often, a discrepancy is seen between clinical and histopathological diagnosis. Materials and methods: This single institutional study was carried out among 36 patients who presented with swelling. An initial diagnosis was considered based on the clinical history followed by histopathological examination. Results: Among the 36 patients, only 4 had malignant tumors. Among them, 3 had sebaceous differentiation, and 1 had apocrine and eccrine differentiation. Among the benign, 14 had follicular differentiation, 12 had apocrine and eccrine differentiation, and 6 had sebaceous differentiation. The clinic-pathological correlation was 65%. Conclusions: An accurate diagnosis is not possible with just the clinical features. Histopathologic examination is considered the gold standard for diagnosis and categorization.

New information about tumours of the salivary glands : WHO classification 2022

The WHO 2022 classification of head and neck tumours contains anotherslight increase in the number of listed benign and malignant tumour entities of the salivary glands. This includes conceptual changes and alterations in the terminology of some entities. While some new features are regarded as preliminary or provisional, others are strongly disputed (for example the terminology of intraductal carcinoma). The impact of molecular findings, mainly recurrent gene fusions, continues to increase rapidly and some have been included in the definition of certain tumour entities. The significance of molecular findings is, however, still largely restricted to diagnostic aspects. Newly included entities include microsecretory carcinoma (defined by an SS18::MEF2C fusion), sclerosing microcystic adenocarcinoma (similar to skin adnexal tumours of the same name) and mucinous adenocarcinoma (characterized by AKT1 mutations with heterogeneous morphology).

CHONDROID SYRINGOMA :A RARE UPPER EYELID TUMOR

Chondroid syringoma is a benign adnexal mixed tumor of skin characterized by sweat gland elements in a cartilaginous stroma1. It is a tumor found to be arising from the sweat glands which can be apocrine (found throughout the surface of lid) or eccrine (glands of moll) with a mean age of 50 years2. Chondroid syringoma is a rare benign tumour that accounts for 0.01% of all primary skin tumours3 and occurs rarely in the upper eyelid region. Head and neck region involvement is common (nose is the most common site).It is morphologically similar to pleomorphic adenoma or benign mixed tumour of the salivary gland4. A 18-year-old male patient presented to us with a slow growing, painless mass on right upper eyelid since 6 months. Complete surgical excision of the mass was done under local anaesthesia. This report aims to discuss about this rare benign tumor of the eyelid and to study the histopathological aspects of it.

Clinicopathological Spectrum of Benign Skin Adnexal Tumors in the Pakistani Population: A Single-Center Study.

Background Skin adnexal tumors (SATs) are categorized per the site of origin, for example, hair follicles, sebaceous glands, and sweat glands. In our population, there is limited information related to the clinicopathological characteristics of these tumors. Management and prognosis depend largely upon the morphological type of the tumor. In this study, we assessed the disease spectrum and most prevalent subtypes of benign SATs. Methodology An analysis of 565 cases was conducted in this cross-sectional study between January 2018 and December 2022, using a non-probability consecutive sampling approach. Patient age, gender, site of involvement, and diagnosis were documented according to the fourth edition of the WHO Classification of Skin Tumors published in 2018. Data were entered and analyzed using SPSS Version 26.0 (IBM Corp., Armonk, NY). Results Our study had 565 patients, out of which 271 (47.9%) were males and 294 (52.1%) were females. The mean age was 40.97±19.3 years (range, 2-100 years). Anatomical site variations were as follows, head and neck (n=336, 59.4%), extremities (n=124, 22%), trunk (n=84, 14.9%), and genital areas (n=21, 3.7%). The most common histological subtypes of benign SATs were sweat gland origin (n=350, 62.0%), followed by hair follicle origin (n=161, 28.5 %), and sebaceous gland origin (n=54, 9.5%). Conclusion Sweat gland tumors were the most prevalent class of benign SATs in our study, in which hidradenoma and poroma were the most frequent subtypes. Hair follicle origin was the second most prevalent class of tumors with pilomatricoma being the most frequent. Sebaceous tumors were overall uncommon; nevus sebaceous of Jadasshon was the most common tumor in this class.

Poroid hidradenomas – a case series

Introduction: Poroid hidradenomas (PH) are rare benign skin adnexal tumours with eccrine differentiation. PH have features of both poroma and hidradenoma, and are wholly intradermal. Few PH have been reported in the literature, and here we present two cases of PH localised to the left knee. The common histological examination finding was a circumscribed cyst lined by basaloid cells resembling poroma, with occasional ductal structures. Case reports: Patient 1 is a 27-year-old male who underwent resection of a cyst on the left knee. A fragment of tan tissue was received. Microscopic examination showed a cyst surrounded by fibrous stroma, with no solid component. There was evidence of rupture with granulomatous inflammation and cholesterol clefts. The cyst lining showed basaloid to squamoid cells resembling poroma, with occasional ductal structures. The case was signed out as a poroid hidradenoma. Patient 2 is a 63-year-old male who underwent resection of a cyst on the left knee. A 5 mm cyst was evident macroscopically. Microscopic examination demonstrated a cystic lesion lined by choroid and cuticular type cells. There were duct like structures within the cyst wall, and the cyst contained eosinophilic material. The case was signed out as a cystic poroid hidradenoma.

Diagnostic Accuracy of GATA6 Immunostaining in Sebaceous Tumors of the Skin

The accurate diagnosis of skin adnexal neoplasms is sometimes challenging but is necessary because medical management and follow-up may differ between tumors. GATA6 transcription factor has been identified as a new marker of the upper folliculosebaceous compartment (lower infundibulum, junctional zone and isthmus, and upper sebaceous gland) in the human skin. We aimed to determine the diagnostic accuracy of GATA6 immunostaining to diagnose sebaceous tumors compared with that to diagnose other adnexal and nonadnexal cutaneous neoplasms. We conducted a retrospective, evaluator-nonblinded study comparing the reference standard (diagnosis by an expert dermatopathologist) with GATA6 immunostaining to identify sebaceous tumors in a cohort containing 234 different tumors. The GATA6 expression score was significatively higher in sebaceous than that in nonsebaceous tumors. In addition, tumors originating from the upper hair follicle showed positive results for GATA6 staining; however, they showed lower GATA6 expression scores. Detection of sebaceous tumors using GATA6 positivity had a sensitivity of 95.7% (95% CI, 85.8-99.2), specificity of 80.8% (95% CI, 74.5-85.8), positive predictive value of 55.6% (95% CI, 44.7-65.9), and negative predictive value of 98.7% (95% CI, 95.4-99.8). GATA6 showed similar sensitivity to adipophilin, the reference marker; however, the specificity of GATA6 was higher, as observed in a cohort of 106 tumors enriched in squamous cell carcinomas with clear-cell histology. In addition, GATA6 positivity was assessed in 39 sebaceous carcinomas and compared with epithelial membrane antigen (EMA), CK7, and androgen receptor (AR) staining results. Although CK7 staining displayed lower diagnostic performances, GATA6 staining showed comparable results as EMA and AR. Finally, we found GATA6 expression in skin metastases of gastrointestinal origin, whereas GATA6 was absent in metastases originating from breast or lung cancers. Overall, our work identified GATA6 immunostaining as a new diagnostic tool for sebaceous tumors.

Histomorphological Spectrum of Adnexal Tumours of the Skin: A Descriptive Study from a Tertiary Care Centre in Karnataka, India

Introduction: Skin Adnexal Tumours (SAT) are a category of rare and most uncommon tumours. They could display multiple lines of differentiation such as follicular, eccrine, apocrine, sebaceous, and sometimes mixed differentiation, generating a mistaken diagnosis that might lead to unwarranted and unnecessary interventions. Aim: To describe the types and microscopic features of adnexal tumours. Materials and Methods: The present study was a retrospective study on SAT received for histopathology at the Department of Pathology, Mandya Institute of Medical Sciences, Mandya, Karnataka, India, from January 2018 to June 2022 during the study period of September 2022 to March 2023. The records of patients including age, gender and site were retrieved from the registers maintained at the department and Haematoxylin and Eosin (H&E) stained slides were examined and the data was analysed by descriptive statistics. Results: A total of 62 cases were included in the study out of which, 59 (95.2%) cases were found to be benign and 3 (4.8%) cases were malignant. The mean age was found to be 43.87 years. A total of 28 (45.1%) cases were seen in the age group of 21 to 40 years. Females outnumbered the males with 32 cases (51.6%). A maximum number of cases belonged to the group of sweat gland tumours (29/62, 46.8%) followed by hair follicle tumours (21/62, 33.9%) and sebaceous gland tumours (12/62, 19.3%). Nodular hidradenoma was the commonest sweat gland tumour (12/29, 41.4%), pilomatricoma was the commonest hair follicle tumour (10/21, 47.6%) and sebaceous adenoma was the commonest sebaceous gland tumour (10/12, 83.3%). The most common malignancy was sebaceous carcinoma (2/3, 66.67%). The male-to-female ratio was found to be 1:1.06. Conclusion: The incidence of SAT was low with the majority being benign tumours. Malignant tumours are even rarer and are often mistaken for cutaneous epithelial malignancies. These lesions may prompt the clinician towards unwanted surgery or treatment for the patient. They exhibit a wide variety of morphological patterns which may be confused for primary from other sites. In such cases, histopathological examination becomes necessary. Hence, a combination of good clinical expertise and histopathological confirmation by the pathologist helps appropriately manage the patient.

Clinicopathological Profile of Nodular Hidradenoma: A ten year Study in a Tertiary Care Center.

Nodular hidradenoma is a rare skin adnexal tumor of eccrine differentiation with predominant site being scalp and axillae. Due to its variable locations and unusual clinical presentation and no definite radiological criteria, histopathology seems to be the mainstay in diagnosing these tumors. Most of the lesions present as a cystic swelling and was clinically thought to be a sebaceous cyst/metastasis/carcinoma/sarcoma. In our study, we have included 37 cases and compared its varied clinical and radiological presentation.

A study on clinicopathological spectrum of nodular hidradenoma

<p>Nodular hidradenoma (NH) is an uncommon benign skin adnexal tumor that presents usually as solitary intradermal nodule. This study aims to discuss the various clinicopathological features of NH as it mimics other adnexal tumors, malignancies or metastasis particularly in uncommon sites. Twenty-four cases of histo-pathologically diagnosed NH during study period from 2016 to 2021were taken up for study. Their clinical, gross and microscopic findings were collected from records. Most tumors occurred in head in fifth decade. Cystic change was seen in majority of the cases. Tumor had dual population of cells with predominant clear cell component in five cases. Definitive cytological diagnosis was difficult requiring excision biopsy. Characteristic clinical and histological features help to distinguish NH from other potential mimickers NH need wide excision as they can recur and rarely transform in to malignancy.</p>

“ CHONDROID SYRINGOMA OF NOSE-AN UPDATE OF MIXED ADNEXAL SKIN TUMOR.”

Chondroid Syringoma is a rare benign adnexal skin tumor arising from sweat glands(apocrine or eccrine) situated in the dermis. They are often mistaken for other benign adnexal tumors of the skin and are most commonly seen in the head and neck region and, in individuals above the age of 40 years and predominantly in males. Rarely they can turn malignant and diagnosis is only by histopathology. We had an occasion to treat a 50 years old female patient with this tumor occupying the entire right alanasi. We could treat her well by complete excision with out any deformity of the alanasi. We are reporting this case, since this is the rst case reported arising from the alanasi in the world literature and also review the available literature.

Dermatoscopic “Mimickers” of Basal Cell Carcinoma - Adnexal Skin Tumors

Background: Adnexal skin tumors (AST) are numerous and various, and in their appearance give dermoscopic and clinical features similar to basal cell carcinoma (BCC). Differential diagnosis is difficult, as clinical alteration seems insufficient to distinguish between BCC and many skin lesions that mimic BCC. However, the validity and usefulness of dermatoscopic criteria enable differentiation between BCC and AST. The purpose of this paper was to present the basic dermatoscopic criteria for diagnosis of BCC as well as minimally invasive methods for treatment and clinical management, with a better aesthetic outcome. Methods and Results: This study consisted of a retrospective review of 50 skin lesions collected in our institution over a 3-year period. We analyzed the dermoscopic images of 29 skin lesions with a clinical diagnosis of BCC and 21 cases with a clinical diagnosis of AST. All lesions were assessed for the presence of various dermatoscopic criteria using a manual photo dermatoscopy system DermLite (DermLite 3, Gen). Each case was evaluated by the presence of dermatoscopic features. We compared dermatoscopic and clinical features between the BCC and AST groups. In the AST group, there were 5(23.8%) premalignant and 16(76.2%) benign lesions. Compared to the AST group, the BCC group had a significantly higher frequency of dermatoscopic features (vascular pattern, ulceration, and additional dermatoscopic features). All lesions included in this study showed more than one of the following characteristics of BCC: arborizing vessels, short fine telangiectasia, translucency, ulceration, blue-gray globules, flecked pigmentation, and rolled borders. Cutaneous lesions with 2 or fewer dermatoscopic features of BCC were much more likely to be an adnexal tumor. Conclusion: The results of this study could be valuable for the differential diagnosis of BCC and BCC-mimicking cutaneous lesions, because dermatoscopy can be especially helpful in better describing, recognizing, and differentiating these lesions.

450 Clonal history of skin adnexal neoplasms inferred by multi-sampling, whole exome sequencing

Eccrine porocarcinoma is a rare malignant skin tumor that often presents as the transformation of an underlying poroma. Nevus sebaceous is a benign skin hamartoma, from which various secondary neoplasm may arise. Since these tumors arise from long-standing precursor benign lesions, multi-sampling, genomic analysis of these tumors may provide us with insight into the life history of these tumors. Whole exome sequencing analysis of porocarcinoma showed high intra-tumor heterogeneity. The reconstructed phylogenetic tree showed a short trunk having the KRAS p.G12V mutation, and showed long branches, which may or may not have secondary driver mutations.

Ossifying pilomatricoma: A rare entity

Pilomatricomas are rare benign skin adnexal tumors usually occurring in the head, neck or upper extremities of children and young adults. Ossifying pilomatricoma is a still rarer entity. Here, a case of a 22-year-old lady is reported, who presented with a firm to hard swelling in the right side of the neck. Histopathological examination of the resected specimen showed features of ossifying pilomatricoma with the formation of bone marrow elements. The patient was free of recurrence on 6-month follow-up. The case highlights a rare entity with characteristic histopathological features.

Significance of Dermoscopy in Association with Clinical Features in Differentiation of Basal Cell Carcinoma and Benign Trichoblastic Tumours.

Simple SummaryAlthough basal cell carcinoma (BCC) can, in the majority of cases, be diagnosed based on clinical and dermoscopic assessment, a potential overlap with benign adnexal skin tumours seems to exist, including trichoblastic tumours (TT). The aim of this study was to analyse clinical and dermoscopic features of benign TT and BCC to develop a diagnostic algorithm with a potential utility in clinical practice. Despite differences in frequency of clinical and dermoscopic features between BCC and TT in the studied group, differential diagnosis based on these variables is not reliable. Histopathological examination remains a diagnostic gold standard in differentiation of BCC and TT.Background: Although basal cell carcinoma (BCC) can, in the majority of cases, be diagnosed based on clinical and dermoscopic assessment, a potential overlap with benign adnexal skin tumours seems to exist, including trichoblastic tumours (TT). Methods: Retrospective analysis of clinical and dermoscopic features of benign TT and BCC cases was performed to develop a diagnostic algorithm with a potential utility in clinical practice. Results: In the study, 502 histopathologically confirmed BCC cases were compared with 61 TT (including 44 TB (72.13%), 10 TE (16.39%) and 7 DTE (11.48%]). Patients in the BCC group were statistically older (mean age was 71.4 vs. 64.4 years, respectively; p = 0.009). BCC presented generally as larger tumours (mean tumour size 11.0 vs. 8.2 mm for the TT group; p = 0.001) and was more frequently associated with clinically visible ulceration (59.4% vs. 19.7%, respectively; p < 0.001). Comparison of lesion morphology, clinically visible pigmentation, and anatomical location did not show significant differences between the analysed groups. Dermoscopically visible ulceration was significantly more common in the BCC group compared to the TT group (52.2% vs. 14.8%; p < 0.0001). Pigmented structures, specifically brown dots and brown globules, were significantly more prevalent in the TT group (32.8% vs. 11.4%; p = 0.0001 and 29.5% vs. 8.2%; p <0.0001). Similarly, TT more commonly than BCC showed the presence of cloudy/starry milia-like cysts (26.2% vs. 11.6%; p = 0.0031) and yellow globules (16.4% vs. 7.2%; p = 0.033). Conclusions: Despite differences in frequency of clinical and dermoscopic features between BCC and TT in the studied group, differential diagnosis based on these variables is not reliable. Histopathological examination remains a diagnostic gold standard in differentiation of BCC and TT.

Clinicopathological Study of Skin Adnexal Tumors with Special Emphasis on the Line of Differentiation

Background: Skin is a complex organ composed of epidermis, dermis and skin adnexa producing multitude of tumors. The skin adnexal neoplasms are classified into sub-groups, depending on their differentiation towards hair follicles, sebaceous, apocrine and eccrine glands. Clinically adnexal neoplasm presents as asymptomatic papules or nodules, having non-specific morphological appearance and therefore histopathology is the gold standard for their confirmatory diagnosis. The aim is to assess clinico-histopathological characteristic features of the skin lesions, subtype and to pick up certain subtle features that clinch the diagnosis towards their line of differentiation. Methods: The study has been conducted in the Department of Pathology, for a period of one year. The total numbers of cases with histopathological diagnosis of skin adnexal lesions are 105. Ethical clearance for the same has been obtained by the Head of Institution. Skin biopsy specimen are received and processed in the histokinette; paraffin embedded blocks made and stained with Hematoxylin &amp; Eosin stain. Special stains when required have been used. Descriptive statistics have been used in analysis of the results. Result: The total number of cases with histopathological diagnosis of skin adnexal lesions is 105. Among them 99/105 cases (94.3%) are benign and malignant counterparts comprised of 6/105 cases (5.7%).Overall lesions with hair follicle differentiation comprised of 73.3% (77/105), followed by sebaceous differentiation of 15.3% (16/105) and eccrine differentiation of 11.4 % (12/105). Conclusion: This study emphasized that histopathological examination, plays an essential role in studying the skin adnexal tumors, owing to its indistinctive clinical presentation. Keywords: Adnexal, Eccrine, Skin, Tumor, Sebaceous, Apocrine

Study of clinicohistopathological correlation of skin adnexal tumours

Appendageal tumours (Appendageal tumours) are neoplasms which differentiate towards or arise from pilosebaceous apparatus, apocrine gland or eccrine sweat glands. Overall incidence of Appendageal tumours is low, yet they can be challenging to diagnose. The study aims at determining the frequency, profile, and distribution of skin adnexal tumours and association of their distribution with patient’s age and sex. Cross-sectional descriptive study, conducted over 1-year period. All clinically suspected cases of Appendageal tumours were evaluated and subjected to histopathological examination. Confirmed cases of Appendageal tumours were finally analyzed. : Out of 43586 new patients attending OPD, 64(0.14%) cases of Appendageal tumours were suspected. And 60 underwent histopathological examination. Histopathology was confirmatory in only 42 (70%) cases. Out of 42, the hair follicle tumors comprised of trichoepithelioma 18/42(42.85%), trichofolliculoma 1/42 (2.38%), pilomatricoma 4/42 (9.52%), and trichilemmal cyst 4/42 (9.52%). The sweat gland tumors are comprised of chondroid syringoma 12/42(28.57%), hidrocystoma 2/42(4.76%) and syringocystadenoma papilliferum 1/42(2.38%). Females (61.90%) outnumbered males (38.09%) in our study population. The incidence of benign skin Appendageal tumours is more as compared to the malignant ones as found in our study. Histopathology remains the gold standard for diagnosis of these tumours.

Epidermal Appendageal Tumours-Histopathological Study at a Tertiary Care Hospital

Background: Skin appendageal tumours are a heterogeneous group of tumours with considerable clinical and histopathological overlap. The overall incidence of Skin adnexal tumours (SATs) is low in Indian population. In some cases, the diagnosis of adnexal neoplasms poses unique difficulties due to complex nomenclature, and expression of one or more lines of appendageal differentiation in the same lesion. The study was aimed to evaluate the histopathological spectrum of skin appendageal tumours and to correlate SATs with various demographic and clinical data. Material and Methods: This observational and descriptive cross-sectional study was conducted on a total 55 skin biopsies diagnosed as SATs over a period of 2 years. Results: Peak age incidence of SATs was observed in the 5 th decade with marginal female preponderance (M: F = 1:1.11). The most commonly affected site was head and neck region (69%); followed by extremities (27%) and trunk (4%). Out of total 55 cases of SATs, 50 cases (90.91%) were benign tumours and 05 cases (9.09%) were malignant tumours. The sweat gland tumours constituted the largest group (43.64%); followed by hair follicle tumours (36.36%) and sebaceous gland tumours (20%). Amongst all SATs, nodular hidradenoma was the commonest benign tumour (16.36%) and sebaceous cell carcinoma (7.27%) was the most common malignant tumour. Conclusion: The study confirmed that skin appendageal tumours are rare tumours. Histopathology proves to be the gold standard tool to confirm the diagnosis. Key words: Skin adnexal tumour, Histopathology, Eccrine, Apocrine , Sebaceous, Hair follicle