Adnexal Tumors Research Articles

Population-Based Incidence and Clinical Characteristics of Ocular Adnexal Tumors in Olmsted County, Minnesota

ABSTRACT Purpose To determine the incidence and clinical characteristics of ocular adnexaltumors in Olmsted County, Minnesota. Methods Retrospective population-based cohort study of all patients residing in Olmsted County, Minnesota diagnosed with any ocular tumor from January 1, 2006, to December 31, 2015. The medical records of all patients with an incident diagnosis of any ocular adnexal tumor were reviewed using the Rochester Epidemiology Project medical record linkage system for patient demographics, tumor type, and histopathologic confirmation. Incidence rates were calculated per 100,000 person-years. Poisson regression analysis was used to analyze changes in incidence over time. Results There were 717 patients diagnosed with ocular adnexal tumors during the 10-year study period, yielding an age- and sex-adjusted incidence rate of 59.7 per 100,000 (95% CI 55.4 to 64.0, p < 0.05) per year. In total, 764 tumors were diagnosed. Most tumors were eyelid lesions (N = 756, 99.0%), which were mostly benign (N = 512, 67.8%) with epidermal inclusion cysts (N = 275, 36.0%), hidrocystoma (N = 70, 9.2%), and eyelid sebaceous cysts (N = 46, 6.1%) accounting for the majority. Malignant eyelid lesions (N = 244, 31.9%) were relatively common with basal cell carcinoma (N = 184, 24.1%) and squamous cell carcinoma (N = 49, 6.4%) having the highest frequencies. Orbital tumors (N = 8, 1.0%) were infrequent. Of the orbital tumors, the most common was lacrimal gland adenoidcystic carcinoma (N = 2, 25.0%). Conclusions In a population-based setting, most ocular adnexal tumors were benign eyelid lesions. Understanding the epidemiology of ocular adnexal tumors is important to aid providers in diagnosing and facilitating appropriate referrals of potentially vision- and life-threatening malignancies.

Minimally Invasive Plasma Device Management of Multiple Benign Skin Cancers Associated with Rare Genodermatoses-Case Series and Review of the Therapeutic Methods.

Background: Non-melanocytic benign skin tumours encompass a diverse group of lesions, classified based on their cellular origin, such as epidermal, vascular, fibrous, neural, muscle, and adnexal tumours. Though they often reveal solitary lesions, multiple skin tumours focus on genodermatoses. Each syndrome exhibits distinct clinical characteristics and potential complications, including cutaneous and extra-cutaneous malignancies, some of which are potentially life-threatening. Diagnosing genetic syndromes is complex and requires numerous histopathological and immunohistochemistry tests due to similarities between the adnexal tumours and basal cell carcinoma upon pathology. Methods: To illustrate the clinical practice, we conducted a retrospective case study that included eleven patients with genodermatoses referred to a tertiary dermatology clinic from September 2018 to April 2024. We have also conducted a research study on available treatment modalities in this setting. Results: Five patients with excellent aesthetic results were treated using a recently approved FDA plasma device. After searching SCOPUS and PubMed database records, we assessed 96 original articles to present current knowledge regarding the dermato-surgical approach. Conclusions: Multiple skin tumours, especially on the face, may significantly affect patients' quality of life and have psychological consequences. An appropriate treatment selection tailored to the patient's needs should be provided. There is no standardised treatment for multiple benign tumours in genodermatoses, and selected methods with varying efficacy are employed. We presented the utility of a new plasma device in these settings.

Agreement between frozen section and histopathology to detect malignancy in adnexal masses according to size and morphology by ultrasound.

Management of suspect adnexal masses involves surgery to define the best treatment. Diagnostic choices include a two-stage procedure for histopathology examination (HPE) or intraoperative histological analysis - intraoperative frozen section (IFS) and formalin-fixed and paraffin-soaked tissues (FFPE). Preoperative assessment with ultrasound may also be useful to predict malignancy. We aimed at determining the accuracy of IFS to evaluate adnexal masses stratified by size and morphology having HPE as the diagnostic gold standard. A retrospective chart review of 302 patients undergoing IFS of adnexal masses at Hospital de Clínicas de Porto Alegre, between January2005 and September2011 was performed. Data were collected regarding sonographic size (≤10cm or >10cm), characteristics of the lesion, and diagnosis established in IFS and HPE. Eight groups were studied: unilocular lesions; septated/cystic lesions; heterogeneous (solid/cystic) lesions; and solid lesions, divided in two main groups according to the size of lesion, ≤10cm or >10cm. Kappa agreement between IFS and HPE was calculated for each group. Overall agreement between IFS and HPE was 96.1% for benign tumors, 96.1% for malignant tumors, and 73.3% for borderline tumors. Considering the combination of tumor size and morphology, 100% agreement between IFS and HPE was recorded for unilocular and septated tumors ≤10cm and for solid tumors. Stratification of adnexal masses according to size and morphology is a good method for preoperative assessment. We should wait for final HPE for staging decision, regardless of IFS results, in heterogeneous adnexal tumors of any size, solid tumors ≤10cm, and all non-solid tumors >10cm.

Pilomatrixoma of the Periorbital Region: A Retrospective Review.

Pilomatrixoma is a benign cutaneous adnexal tumor that differentiates toward hair follicle cells. It infrequently occurs in the periorbital region. In the periorbital area, it is often located in the upper eyelid and eyebrow region. Periorbital pilomatrixoma is often misdiagnosed clinically and is less common than other benign skin tumors. In this retrospective review, we evaluate the demographic, clinical, and histopathological data of patients with periorbital pilomatrixoma, treated from 2010 to 2023. A retrospective analysis of periorbital pilomatrixoma cases treated during a period of 13 years was performed. Deidentified data in relation to the age at surgical excision, gender, location, size, histopathological features, treatment, and recurrence were collected. All histological slides were reviewed by an attending histopathologist. A total of 77 cases of periorbital pilomatrixoma were diagnosed by histopathological examination and treated from 2010 to 2023. A slight female preponderance (56%) was noted, and the majority of cases (52%) were presented in the first 2 decades of life. The left periorbital region was involved in 45.5% of cases, and 54.5% in the right. The upper lid was the most affected site. Two cases of recurrence were reported. No malignant transformation was noted. Pilomatrixoma is an uncommon benign periorbital tumor, commonly misdiagnosed clinically. Ophthalmologists and surgeons should suspect pilomatrixoma in the periorbital region, especially in children or young adults. Complete surgical excision is curative, and recurrence is rare.

O-026 Development of deep learning-based model for differential diagnosis of ovarian neoplasm using pelvic ultrasonography

Abstract Study question Can the deep learning-based diagnostic algorithms of pelvic ultrasonography be a useful clinical tool for evaluating the malignancy risk of ovarian neoplasms? Summary answer AI-based deep learning diagnostic algorithm for pelvic ultrasonography is a potential clinical aid, as it exhibits excellent performance in the differential diagnosis of ovarian neoplasm. What is known already Transvaginal ultrasonography serves as a primary diagnostic tool for adnexal neoplasms due to its widespread availability and user-friendly nature within gynecologic clinics. There have been attempts to employ artificial intelligence algorithms for identifying ovarian malignancy through sonographic evaluations, yet the existing literature is limited, and the optimal processing method for constructing ultrasound-based AI images is not known. This study aims to address this gap by constructing a comprehensive AI-based model and comparing the various input methods for the development of the ultrasound-based diagnostic model. Study design, size, duration A retrospective cohort study was conducted on the clinical records of 1,171 patients diagnosed with ovarian neoplasms through pelvic ultrasonography from May 2002 to August 2021 at our institution. Inclusion criteria mandated that patients undergo pelvic ultrasonographic examination in our department, followed by surgical excision, with a requisite availability of pathologic diagnosis for the identified ovarian neoplasm. Participants/materials, setting, methods The dataset was divided into training, validation, and testing subsets with a distribution ratio of 8:1:1 (2373, 297, 298 images). Pre-processing of ultrasound input was done after removing text annotations and unnecessary non-image data. Deep learning methods with different architectures were utilized, including Swin Transformer, ConvNeXt, MobileNet, ResNet18, EfficientNet V2, and VGG16. Main results and the role of chance This performance analysis encompasses a comparison of various deep learning architectures applied to classification tasks within ultrasound imaging data. The metrics evaluated include Sensitivity, Specificity, Positive Predictive Value (PPV, also known as Precision), Negative Predictive Value (NPV), F1 Score, Accuracy, and the Area Under the Receiver Operating Characteristic curve (AUROC). For Sensitivity, the sequence MobileNet, ResNet-18, EfficientNet-V2, VGG-16, Swin Transformer, and ConvNext is 0.830, 0.851, 0.879, 0.835, 0.883, 0.877; Specificity values follow as 0.848, 0.840, 0.877, 0.866, 0.893, 0.906; PPV (Precision) is reported as 0.848, 0.840, 0.877, 0.866, 0.893, 0.906; NPV metrics are 0.830, 0.851, 0.877, 0.835, 0.879, 0.883; F1 Score progression is 0.838, 0.845, 0.878, 0.848, 0.888, 0.890; Accuracy rates are 0.865, 0.865, 0.895, 0.875, 0.906, 0.909; and finally, AUROC scores span 0.920, 0.920, 0.930, 0.920, 0.930, 0.960. These metrics collectively highlight the nuanced efficacy of each model in ultrasound image classification, with ConvNext demonstrating exceptional performance across the board. Limitations, reasons for caution An external validation of our model using datasets outside our institution has not been carried out yet. Also, the clinical validity of our model in real-life practice has not been investigated. These issues will be addressed subsequently through our continued investigation. Wider implications of the findings A deep-learning model utilizing ConvNeXt yielded excellent diagnostic performance in the differential diagnosis of ovarian neoplasms. The integration of AI-based deep learning models in clinical settings has the potential to significantly enhance the diagnostic accuracy of ultrasonography for ovarian neoplasms. Trial registration number not applicable

Extra-digital glomus tumour of the forehead: a case report of a solitary solid histopathologic subtype

Background: Glomus tumours (GT) are benign neoplasms that develop from neuro-myoarterial structures known as “glomus bodies” involved in temperature and blood pressure control. GT rarely occur in the head and neck region, and the specific location of the glomus tumour on the forehead is even more uncommon. Case presentation: We report the case of a 36-year-old female who presented with painless swelling on the forehead of one year duration with a progressive increase in size. Physical examination showed a small forehead swelling with an initial clinical diagnosis of a sebaceous cyst. The patient had local excision of forehead swelling which was submitted for histopathologic examination. Discussion: The initial histological differential diagnosis included glomus tumour, benign skin adnexal tumour and PEComa. The formalin-fixed-paraffin embedded tissue blocks of the lesion were then subjected to immunohistochemical analysis. The tumour cells were negative for cytokeratin and positive for SMA and S100. Based on the morphology and immunohistochemical staining characteristics of the tumour cells, a diagnosis of glomus tumour was made. Conclusion: Glomus tumour occurring on the forehead is uncommon. Therefore, a high index of suspicion is needed for diagnosis. Immunohistochemistry may be needed to confirm the diagnosis and rule out other close differential diagnoses.

Female Adnexal Tumor of Probable Wolffian Origin (Wolffian Tumor): A Potential Mimic of Peritoneal Mesothelioma.

Wolffian tumor and its nosologic relative, the recently defined STK11 adnexal tumor are rare neoplasms thought to arise from mesonephric remnants. These tumors typically arise in the broad ligament, fallopian tube, and ovarian hilum and although most are associated with a good prognosis, up to 50% of STK11 adnexal tumors demonstrate aggressive clinical behavior. The chief differential diagnoses include endometrioid adenocarcinoma and sex cord stromal tumors. However, the morphologic and immunohistochemical features of these tumors exhibit considerable overlap with peritoneal mesothelioma. To fully characterize their immunophenotypic signature, we examined a total of 21 cases (18 Wolffian and 3 STK11 adnexal tumors) with standard markers used in the diagnosis of mesothelioma. Morphologic and immunohistochemical (IHC) features were reviewed and additional IHC performed for cases with available material. Patient age ranged from 25 to 73 (mean: 51) years. Sites included adnexa/broad ligament (6, 28%), paratubal (5, 24%), ovary/paraovarian (5, 24%), tubal (intraluminal) (2, 9.5%), pelvis (2, 9.5%), and liver (1, 5%). The mean tumor size was 9.3cm (range: 0.2 to 22cm). The histomorphology in most cases (14/21, 66%) consisted of tubular to solid sheets of neoplastic cells lined by columnar to cuboidal cells containing uniform round to oval nuclei. Compressed tubules with slit-like lumens and sieve-like pattern were also seen in at least 7 (33%) cases. Three cases demonstrated interanastomosing cords and trabeculae of epithelioid cells with cribriform and microacinar patterns growing within prominent myxoid stroma as described in STK11 adnexal tumors. In the cases with available IHC for 3 mesothelial markers (calretinin, WT1, D2-40), 55.5% (5 of 9) showed reactivity with all 3 markers. In cases with at least 2 available mesothelial markers, 69% (11/16) were positive for 2 markers (mostly calretinin and WT1). Claudin-4, MOC31, and BER-EP4 were negative in most cases tested (78% [7/9], 71.4% [5/7], and 100% [6/6], respectively). Given the resemblance to mesothelioma, there was initial strong consideration and/or actual misdiagnosis of mesothelioma in 3 cases (14%). In summary, the morphologic and immunohistochemical features of Wolffian tumor and its recently defined relative, STK11 adnexal tumor, can lead to misdiagnosis of mesothelioma, particularly when encountered in the disseminated or metastatic setting. Wolffian tumor and STK11 adnexal tumor should be considered in the differential diagnosis of all pelvic and peritoneal mesotheliomas.

Differentiation of Cutaneous Metastatic Breast Cancer from Cutaneous Adnexal Tumors Using Wnt9b Polyclonal Antibody Stain

Objective: The histologic diagnosis of cutaneous metastatic breast cancer can be challenging as the differentials can include primary cutaneous glandular neoplasms and metastases from other glandular neoplasms which present very similar on H&amp;E. Many immunohistological markers including GATA3 and CK7 have been employed to screen for primary or metastatic breast cancer cells and because of this, we wanted to develop a stain capable of differentiating these diagnoses quickly and accurately. Methods: We utilized 61 archived dermatopathology laboratory specimens of various benign and malignant cutaneous adnexal and breast tissues for analysis with a polyclonal Wnt9b antibody stain. Results: The average staining in benign categories (cutaneous adnexal and benign breast tissue) as well as metastases from non-breast carcinomas was negative. Among the malignant cutaneous adnexal and metastatic breast tissues, a significant difference was observed in staining as adnexal carcinomas were weakly positive (0.53+) and primarily seen in the outer layer of glandular structures, while metastatic breast tissues were strongly positive (3.63+) (P&lt;0.01). The specificity in both adnexal and metastatic breast tissues was 100% while the sensitivity for adnexal carcinomas was 37% and metastatic breast was 94%. A larger sample size could greatly improve these values. Conclusion: These results demonstrate that Wnt9b has specific staining for cutaneous metastatic breast cell nuclei and could be utilized as a diagnostic to differentiate from cutaneous adnexal tumors in routine dermatopathological applications. Keywords: Metastatic Breast Carcinomas; Cutaneous Adnexal Tumor; Staining; Polyclonal Antibody; Histological Markers

Complicated Garengeot’s Hernia Associated with an Adnexal Tumor in a High-Rise Hospital

Complicated Garengeot’s Hernia Associated with an Adnexal Tumor in a High-Rise Hospital

TRPS1 Is Consistently Expressed in Hidradenoma Papilliferum.

TRPS1 is a novel immunohistochemical marker, so far quite specific and sensitive for breast cancer and especially useful for the diagnosis of triple-negative breast cancer. TRPS1 expression has recently been reported in normal skin appendages, as well as in a variety of benign and malignant cutaneous tumors, including adnexal tumors. However, it has not yet been reported in hidradenoma papilliferum (papillary hidradenoma), a benign adnexal neoplasm, accepted to originate from mammary-like glands in the vulvar or anogenital region of middle-aged women. We report consistent nuclear expression of TRPS1 in the epithelium of 9/9 cases of hidradenoma papilliferum, while in 2/2 cases with foci of oxyphilic metaplasia, these foci were consistently negative for TRPS1 immunohistochemistry. Our findings are in line with the theory that hidradenoma papilliferum is derived from mammary-like glands and showed that TRPS1 can be an additional sensitive immunohistochemical marker for hidradenoma papilliferum.

High-throughput viable circulating tumor cell isolation using tapered-slit membrane filter-based chipsets in the differential diagnosis of ovarian tumors.

To evaluate the diagnostic performance of circulating tumor cells (CTCs) using tapered-slit membrane filter (TSF)-based chipsets for the differential diagnosis of adnexal tumors. A total of 230 women with indeterminate adnexal tumors were prospectively enrolled. The sensitivity, specificity, and accuracy of the CTC-detecting chipsets were analyzed according to postoperative pathological results and compared with those of cancer antigen (CA)-125 and imaging tests. Eighty-one (40.3%) benign tumors, 31 (15.4%) borderline tumors, and 89 (44.3%) ovarian cancers were pathologically confirmed. The sensitivity, specificity, and accuracy of CTC-detecting chipsets (75.3%, 58.0%, and 67.1%) for differentiating ovarian cancer from benign tumors were similar to CA-125 (78.7%, 53.1%, and 66.5%), but lower than CT/MRI (94.2%, 77.9%, and 86.5%). "CTC or CA125" showed increased sensitivity (91.0%) and "CTC and CA-125" revealed increased specificity (77.8%), comparable to CT/MRI. CTC detection rates in stage I/II and stage III/IV ovarian cancers were 69.6% and 81.4%, respectively. The sensitivity to detect high-grade serous (HGS) cancer from benign tumors (84.6%) was higher than that to detect non-HGS cancers (68.0%). Although the diagnostic performance of the TSF platform to differentiate between ovarian cancer and benign tumors did not yield significant results, the combination of CTC and CA-125 showed promising potential in the diagnostic accuracy of ovarian cancer.

Porocarcinoma: Clinical and Histological Features, Immunohistochemistry and Outcomes: A Systematic Review.

Porocarcinoma (PC) is a rare adnexal tumor, mainly found in the elderly. The tumor arises from the acrosyringium of eccrine sweat glands. The risk of lymph node and distant metastasis is high. Differential diagnosis with squamous cell carcinoma is difficult, although NUT expression and YAP1 fusion products can be very useful for diagnosis. Currently, wide local excision is the main surgical treatment, although Mohs micrographic surgery is promising. To date, there is no consensus regarding the role of sentinel lymph node biopsy and consequential lymph node dissection. No guidelines exist for radiotherapy, which is mostly performed based on tumor characteristics and excision margins. Only a few studies report systemic treatment for advanced PC, although therapy with pembrolizumab and EGFR inhibitors show promise. In this review, we discuss epidemiology, clinical features, histopathological features, immunohistochemistry and fusion products, surgical management and survival outcomes according to stage, surgical management, radiotherapy and systemic therapy.

Malignant proliferating trichilemmal tumor post-chemotherapy: A case report

The malignant proliferating trichilemmal tumor (MPTT) is an exceptional adnexal neoplasm of the skin, primarily observed in the scalp of elderly women, often precipitated by local trauma or chronic inflammation. Notably, MPTT exhibits a propensity for local aggressiveness, frequently leading to diagnostic challenges reminiscent of squamous cell carcinoma. The primary treatment modality entails surgical excision with adequate margins, yielding a relatively low local recurrence rate. Herein, we present the case of a 50-year-old woman diagnosed with MPTT of the scalp several years subsequent to undergoing chemotherapy for breast cancer, initially misdiagnosed as squamous cell carcinoma upon biopsy. This case marks only the third reported instance associating MPTT with chemotherapy following breast cancer treatment. We aim to draw attention to this particularly aggressive tumor and its potential origination from benign trichilemmal cysts due to chemotherapy.

Radiomics analysis of ultrasound images to discriminate between benign and malignant adnexal masses with solid ultrasound morphology.

Our primary aim was to identify radiomic ultrasound features that can distinguish benign from malignant adnexal masses with solid ultrasound morphology, and primary invasive from metastatic solid ovarian masses, and to develop ultrasound-based machine learning models that include radiomics features to discriminate between benign and malignant solid adnexal masses. Our secondary aim was to compare the diagnostic performance of our radiomics models with that of the ADNEX model and subjective assessment by an experienced ultrasound examiner. This is a retrospective observational single center study. Patients with a histological diagnosis of an adnexal tumor with solid morphology at preoperative ultrasound examination performed between 2014 and 2021 were included. The patient cohort was split into training and validation sets with a ratio of 70:30 and with the same proportion of benign and malignant (borderline, primary invasive and metastatic) tumors in the two subsets. The extracted radiomic features belonged to two different families: intensity-based statistical features and textural features. Models to predict malignancy were built based on a random forest classifier, fine-tuned using 5-fold cross-validation over the training set, and tested on the held-out validation set. The variables used in model building were patient's age, and those radiomic features that were statistically significantly different between benign and malignant adnexal masses (Wilcoxon-Mann-Whitney Test with Benjamini-Hochberg correction for multiple comparisons) and assessed as not redundant based on the Pearson correlation coefficient. We describe discriminative ability as area under the receiver operating characteristics curve (AUC) and classification performance as sensitivity and specificity. 326 patients were identified and 775 preoperative ultrasound images were analyzed. 68 radiomic features were extracted, 52 differed statistically significantly between benign and malignant tumors in the training set, and 18 features were selected for inclusion in model building. The same 52 radiomic features differed statistically significantly between benign, primary invasive malignant and metastatic tumors. However, the values of the features manifested overlap between primary malignant and metastatic tumors and did not differ statistically significantly between them. In the validation set, 25/98 tumors (25.5%) were benign, 73/98 (74.5%) were malignant (6 borderline, 57 primary invasive, 10 metastases). In the validation set, a model including only radiomics features had an AUC of 0.80, and 78% sensitivity and 76% specificity at its optimal risk of malignancy cutoff (68% based on Youden's index). The corresponding results for a model including age and radiomics features were 0.79, 86% and 56% (cutoff 60% based on Youden's method), while those of the ADNEX model were 0.88, 99% and 64% (at 20% malignancy cutoff). Subjective assessment had sensitivity 99% and specificity 72%. Even though our radiomics models had discriminative ability inferior to that of the ADNEX model, our results are promising enough to justify continued development of radiomics analysis of ultrasound images of adnexal masses. This article is protected by copyright. All rights reserved.

Primary Cutaneous Apocrine Carcinoma: Diagnostic and Management Difficulties of an Uncommon Neoplasm

Primary cutaneous apocrine carcinoma (PCAC) is a rare adnexal neoplasm. Due to its clinical presentation, it can mimic other tumors, especially metastasis. We present a case of primary apocrine carcinoma of the axilla mimicking breast carcinoma metastasis in a 54-year-old woman. The patient presented with a painless, lobed, and erythematous nodule in the left axilla of one year duration. We suspected an adnexal neoplasm but also considered metastasis from breast carcinoma. Histological examination revealed apocrine proliferation. Immunohistochemistry stains of tumor cells were positive for AE1/AE3, and negative for CK7, CK20, p63 and GATA3. Radiological explorations did not reveal any signs of malignancy. Considering all these features, the conclusive diagnosis was primary cutaneous apocrine carcinoma. Treatment was wide excision without adjuvant therapy, and no recurrence was noted. Due to the rarity of this carcinoma, its various clinical presentations, and histological overlaps with breast cancer metastasis, making the diagnosis may be challenging. A comprehensive evaluation of all findings is necessary to rule out other tumors. There is any consensus on the management strategy. The standard treatment is surgical excision, but adjuvant therapies such as radiotherapy or chemotherapy can be proposed in advanced stage disease.

Histopathological analysis of skin adnexal tumors: An experience at a tertiary center.

Skin appendage tumors (SATs) are benign and malignant neoplasms. Although there are many studies on their clinical features and epidemiology in the literature, most of these studies have a small number of patients and are not classified according to the WHO 2018 classification. This study aimed to reveal the clinical and histopathological features of the SATs and compare the pre-diagnosis. Cases diagnosed with SATs in the last 7 years in the Pathology Department were re-evaluated according to the WHO 2018 classification. Patients' ages and genders, as well as the location and pre-diagnosis of the lesion, were all recorded. A total of 437 patients, 198 (45.3%) male and 239 (54.7%) female, were included in the study. Of 437 patients, 399 (91.3%) were diagnosed with benign SATs and 38 (8.7%) were diagnosed with malignant SATs. Most of the cases were benign tumors with follicular differentiation. Malignant SATs were seen in patients significantly older than benign ones. The majority of SATs were in head and neck localization. Mammary Paget's disease was the most common malignant SAT (n = 14, 36.8% of patients diagnosed with malignant SATs). It was noted that clinicians were less likely to consider a specific diagnosis of SAT before excision. SAT, a diagnosis that can be seen at any age and is difficult to predict clinically, may be malignant, especially in elderly patients. Histopathology is the gold standard in diagnosing SATs, and immunohistochemical staining may be useful in diagnosing tumors with uncertain histopathological features.

S1‐Leitlinie Talgdrüsenkarzinom

Sebaceous gland carcinomas are rare malignant cutaneous adnexal tumors with sebocytic differentiation. The typical predilection area is the head and neck region, where sebaceous gland carcinomas are the most common malignant adnexal tumors of the skin. According to their localization a distinction is made between periocular and extraocular sebaceous gland carcinomas. Muir-Torre syndrome (MTS) should always be ruled out if it is suspected. In terms of prognosis, sebaceous gland carcinomas are potentially aggressive tumors with a clear tendency to recur and metastasize. Only small extraocular sebaceous gland carcinomas that have been completely resected have a very good prognosis. Sebaceous gland carcinomas most frequently metastasize lymphogenously to regional or distant lymph nodes; organ metastasis occurs less frequently. Periocular sebaceous gland carcinomas have a higher metastasis rate (up to 15%) than extraocular sebaceous gland carcinomas (up to 2%). Complete micrographically controlled surgery (MCS) of the primary tumor is the therapy of first choice, regardless of periocular or extraocular localization. Adjuvant or therapeutic radiotherapy may be considered. There is currently no established standard therapy for advanced, inoperable or metastatic sebaceous gland carcinomas. Local procedures and system therapies such as chemotherapy or immunotherapy can be considered. The procedure should be determined individually in an interdisciplinary tumor board. Close follow-up care is recommended for these potentially aggressive carcinomas.

Poroid Hidradenoma Presenting as a Malignant Neoplasm

Poroid hidradenoma is a rare adnexal neoplasm that presents with slow-growing solitary dermal or subcutaneous nodules with pink, red, or blue coloration. Malignant transformation has been reported in about 1%; however, clinical and histologic characteristics may present similarly with malignant neoplasms. A 60-year-old, Filipino, female presented with a 1-month history of a solitary, brownish-black papule on the right cheek progressing to a translucent friable nodule with associated bleeding after minimal trauma. The patient was initially assessed as a case of basal cell carcinoma due to its rapid growth. Hence, the patient was referred to a dermatologic surgeon for biopsy. Poroid hidradenoma was confirmed histologically and was managed with local excision. Poroid hidradenoma presenting with rapid growth is a very rare occurrence.

A case of trichoblastoma of the auricular cavity and review of the literature

Trichoblastoma（TB） is a rare germ cell skin adnexal tumor of the hair, and it is a rare follicular tumor of the skin that differentiates from the hair germ epithelium and is often regarded as a benign skin tumorHowever, it is poorly confined and has a local infiltrative growth pattern. tb occurs in the head and neck region, especially in the face, and presents clinically as a slow growing, well-defined and elevated nodule. TB is routinely treated surgically. Due to the lack of universally accepted treatment guidelines or protocols, the recurrence rate after surgery is high, which makes clinical cure more difficult. In this study, a 65-year-old female patient was found to have a swelling with recurrent rupture and pus flow from the right external auditory canal opening and the auricular cavity. After initial misdiagnosis as otitis externa, she was treated with conventional anti-infective therapy, but her symptoms did not resolve and gradually worsened before coming to our hospital. The condition presented in this case is relativelyrare,therepre,timely and accurate diagnosis and treatment are crucial for prognosis improvement of such diseases.

Recurring Hidradenocarcinoma of the Lower Extremity

ABSTRACT Hidradenocarcinomas are rare adnexal tumor of the sweat glands. They are typically found on the head and neck with a high rate of recurrence and metastasis. Here, we present a case of a 67-year-old woman who presented with long-standing subcutaneous mass over her right knee. She underwent initial surgical excision with positive margins, and histopathology of the resection specimen was consistent with hidradenocarcinoma. The patient completed 60-Gray adjuvant radiation to the surgical bed postoperatively. Eight months later, the patient returned with a concern for recurrence of the hidradenocarcinoma at the same site. Biopsy confirmed the recurrence, and the malignancy was excised with 2-cm margins along with surgical reconstruction with a local muscle flap. She has not had recurrence at follow-up 1 year after the reconstructive flap. This case highlights the histopathologic nature of hidradenocarcinomas and that, despite local excision and large-dose radiation, malignancy can recur.