Adnexal Tumors Research Articles

A Case of Ovarian Hyperthecosis in a Postmenopausal Woman

Abstract We report a case of a 55-year-old postmenopausal woman who presented with symptoms of fatigue, male pattern hair loss, and hirsutism over 3 years. Investigations showed elevated total testosterone levels of 5.0 nmol/L (1.44 ng/mL; range, 0.3-3.1 nmol/L) using Beckman-Unicel-DXI-800 immunoassay. Testosterone levels were repeated by liquid chromatography-tandem mass spectrometry and were found to be elevated at 7.3 nmol/L (2.10 ng/mL). Estradiol was detectable and free androgen index was elevated. Dehydroepiandrosterone sulfate levels and androstenedione were within normal range, suggesting a nonadrenal source. Computed tomography scan of the abdomen showed no evidence of adrenal or adnexal tumor. GnRH analog stimulation test led to reduction of gonadotrophins and normalization of testosterone within 4 weeks. She had a biopsy of a cranial hair follicle, which showed androgenic alopecia. These investigations confirmed an ovarian source of androgens. Subsequently, she underwent bilateral salpingo-oophorectomy. Histological study of gonadal tissue confirmed the diagnosis of ovarian hyperthecosis. Four weeks after oophorectomy, her testosterone levels normalized and clinical symptoms improved. Ovarian hyperthecosis is a rare cause of hyperandrogenism in postmenopausal women and can pose a diagnostic and therapeutic challenge. Careful history and physical examination along with critical analysis of biochemistry and imaging studies is crucial for correct diagnosis.

Epidemiological and Pathological Profile of Cutaneous Adnexal Tumors, Central Laboratory of Pathological Anatomy and Cytology of Ibn Sina Hospital, Rabat Morocco: Report of 35 Cases

Skin appendix tumors are rare and highly varied tumors. Are mostly benign characters, rarely malignant and dominated from the morphological point of view by their lesional polymorphism. These tumors may present with follicular, apocrine/eccrine, sebaceous and sometimes mixed differentiation, posing diagnostic problems. The aim of this study is to describe the epidemiological profile and the different anatomopathological aspects of this group of tumors and to compare them with data from the literature. We carried out a descriptive study with a retrospective stage, of 35 cases of cutaneous adnexal tumors collected at the service of the Central Laboratory of Pathological Anatomy and Cytology of Ibn Sina Hospital, CHU of Rabat during a period of 3 years, from 2019, 2020 and 2021. The result of this study shows the peak frequency of these lesions, which is located between 60 years and older, occupying 34.2% of all cases; the average age of the patients studied is 41 years and we find the predominance of the female sex which corresponds to 62.9% of the cases; the predilection seat of the lesions is the region of the head and neck, which is occupied by 51.4%; tumor differentiation is divided into apocrine/eccrine which represents 68.6% of cases; follicular in 20% of cases and sebaceous in 11.4% of cases; the most common histological type is poroma 25.7% followed by pilomatricoma 14.2% and papilliferous syringocystadenoma 11.4%; benign tumors are frankly in the majority, occupying 91.5%, against 8.5% of malignant tumors.

Dermoscopic Diagnosis of a Non-Pigmented Skin Tumor: Eccrine Poroma

Dear Editor, Eccrine poroma stands as a benign adnexal neoplasm that originates from the acrosyringium. It typically emerges as solitary, flesh-colored, or erythematous papules, plaques, or nodules, primarily appearing in areas with sweat glands. As well as pigmented lesions, dermoscopy has proven to enhance the clinical diagnosis of numerous non-pigmented skin tumors, including eccrine poroma. Herein we present a case of eccrine poroma located on the dorsal aspect of the left foot, with characteristic dermoscopic features. A 60-year-old woman was admitted with an asymptomatic lesion on the dorsum of her left foot, which had manifested approximately four years before. Clinically, the lesion presented as a well-circumscribed, violaceous, 0.9x0.9 cm papule (Figure 1a). Dermoscopic examination revealed flower-like and leaf-like vascular patterns, white interlacing areas, glomerular vessels, and milky red globules (Figures 1c-d). The lesion was excised and histopathologic findings were consistent with eccrine poroma (Figure 1b). Eccrine poroma (EP) is an adnexal tumor originating in the intraepidermal part of the eccrine sweat gland duct. Dermoscopy and histopathology help to differentiate EP from pyogenic granuloma, seborrheic keratosis, verruca vulgaris, basal cell carcinoma, squamous cell carcinoma, and amelanotic melanoma. Well-defined dermoscopic features in EP are: White interlacing areas around vessels, milky-red globules, flower-like and leaf-like vascular patterns, glomerular vessels, hairpin vessels, yellow structureless areas, poorly visualized vessels, and well-circumscribed globular or lacuna-like structures separated by white to pink mesh bands [1-3]. Histologically, EP manifests as a well-contained tumor constituted of proliferative cuboidal or poroid cells, often extending from the basal epidermis into the dermal layer. Shave, electrosurgical destruction or simple excision may be the treatment of lesions, depending on the depth of the lesion. Kind Regards

A clinico-histopathological study of skin appendageal tumours in a tertiary health care centre in western Odisha– A case series

Skin appendageal tumours (SATs) are those neoplasms that arise from pilosebaceous, apocrine, or eccrine sweat glands. These are a diverse group of tumours with both benign and malignant counterparts. They can be single, multiple, or have a syndromic association with internal malignancies. Benign adnexal tumours are more common, while malignant adnexal tumours are rare, usually locally aggressive, and have the potential for nodal involvement and distant metastasis with a poor clinical outcome. Therefore, proper diagnosis of SATs is important for therapeutic and prognostic reasons.This study aims to determine the clinico-histopathological correlation in cases of SATs in our hospital. It is a case series conducted over a one-and-a-half year period from January 2021 to July 2022. All clinically suspected cases of SATs were examined, biopsied, and subjected to histopathological examination. Histopathologically confirmed cases of SATs were finally analysed. Among twenty-four thousand two hundred twenty-four new patients attending OPD, 30 suspected cases of ATs underwent histopathological examination. Histopathology was confirmatory in only 12 cases (40%). 10 cases were benign, and two were malignant. Out of 10 benign cases, hidradenoma was noted in 3 (25%), trichoepithelioma in 2 (16%), proliferating pilar tumour, apocrine hidrocystoma, steatocystoma multiplex, hidradenoma papilliferum, and pilomatrixoma were seen in one each. Females (75%) outnumbered males (25%) in our study population.: SATs are infrequent and are not frequently observed in the field of surgical pathology. Histopathology is the gold standard for diagnosis.

Dermatoscopic shiny white structures in benign cutaneous tumours.

The dermatoscopic characteristics of shiny white structures (SWS) in malignant skin tumours are well described, but data on benign skin neoplasms are scarce. To evaluate the dermatoscopic features of SWS in common benign tumours, we reviewed our database for histopathologically confirmed cases. Dermatoscopic images were evaluated for the presence of any type of SWS. Images with SWS were further analysed for their quantity, distribution and shape. Of 2420 evaluated benign tumours, 357 (14.8%) displayed SWS. The highest frequencies were observed in pyogenic granuloma (n = 62/100; 62%), angioma (n = 63/113; 55.8%) and adnexal tumours (n = 42/84; 50%). The lowest frequency was found in common naevi (n = 16/1032; 1.6%) and solar lentigo (n = 0). The presence of SWS was not associated with sex or anatomical location. SWS were usually diffuse and multiple. SWS may be present in a broad spectrum of benign tumours and therefore they should not be considered as de facto indicators of malignancy.

Detection of wildtype Merkel cell polyomavirus genomic sequence and VP1 transcription in a subset of Merkel cell carcinoma.

Merkel cell carcinoma (MCC) is frequently caused by the Merkel cell polyomavirus (MCPyV). Characteristic for these virus-positive (VP) MCC is MCPyV integration into the host genome and truncation of the viral oncogene Large T antigen (LT), with full-length LT expression considered as incompatible with MCC growth. Genetic analysis of a VP-MCC/trichoblastoma combined tumour demonstrated that virus-driven MCC can arise from an epithelial cell. Here we describe two further cases of VP-MCC combined with an adnexal tumour, i.e. one trichoblastoma and one poroma. Whole-genome sequencing of MCC/trichoblastoma again provided evidence of a trichoblastoma-derived MCC. Although an MCC-typical LT-truncating mutation was detected, we could not determine an integration site and we additionally detected a wildtype sequence encoding full-length LT. Similarly, Sanger sequencing of the combined MCC/poroma revealed coding sequences for both truncated and full-length LT. Moreover, in situ RNA hybridization demonstrated expression of a late region mRNA encoding the viral capsid protein VP1 in both combined as well as in a few cases of pure MCC. The data presented here suggest the presence of wildtype MCPyV genomes and VP1 transcription in a subset of MCC.

Cytomorphology of skin adnexal tumors and its correlation with histopathology in a tertiary care center

Objectives: Even though fine-needle aspiration cytology (FNAC) can be successfully used for describing the cytomorphology of skin adnexal tumors and can help in identification of them as benign or malignant, histopathology remains the gold standard in confirmation of diagnosis. Skin adnexal tumors are a large and diverse group and are relatively less commonly encountered in routine practice; hence, knowledge of cytological features of these lesions is crucial for their appropriate management. The present study aims to evaluate the cytomorphological features of skin adnexal tumors on FNAC smears and their correlation with the histopathology. Material and Methods: This is a retrospective study of FNAC of 60 cases of subcutaneous and dermal swellings over a period of 4 years from August 2018 to August 2022 in a tertiary care center. Results: In the 60 cases of skin adnexal tumors evaluated, most cases were within the 2nd to 4th decade with male predominance. The FNA smears were helpful in picking up the nature of skin adnexal tumors, as in our case series, malignant lesions were 8.3% and benign were 91.7%. Majority adnexal lesions were of follicular or sebaceous differentiation. Histological diagnosis was available in 38 cases. Cytological diagnosis in 34 cases was concordant with histopathology. There was discrepancy observed in two cases which were reported as benign skin adnexal tumor but later turned out to be sebaceous carcinoma on histopathology. Conclusion: Even though histopathology being the gold standard for confirmation of diagnosis, in the current era of minimally invasive procedures, FNAC stands out as a valuable modality and can be a promising alternative to diagnose skin adnexal tumors and understand their cytomorphology as the data are limited about it.

Dermoscopy of Cutaneous Neoplasms in Skin of Color - A Systematic review by the International Dermoscopy Society "Imaging in Skin of Color" Task Force.

Over the last few decades, dermoscopy has been showed to facilitate the non-invasive diagnosis of both benign and malignant skin tumors, yet literature data mainly comes from studies on light photo-types. However, there is growing evidence that skin neoplasms may benefit from dermoscopic assessment even for skin of color. This systematic literature review evaluated published data in dark-skinned patients (dermoscopic features, used setting, pathological correlation, and level of evidence of studies), also providing a standardized and homogeneous terminology for reported dermoscopic findings. A total of 20 articles describing 46 different tumors (four melanocytic neoplasms, eight keratinocytic tumors, 15 adnexal cutaneous neoplasms, seven vascular tumors, four connective tissue tumors, and eight cystic neoplasms/others) for a total of 1724 instances were included in the analysis. Most of them showed a level of evidence of V (12 single case reports and six case series), with only two studies featuring a level of evidence of IV (case-control analysis). Additionally, this review also underlined that some neoplasms and phototypes are underrepresented in published analyses as they included only small samples and mainly certain tones of "dark skin" spectrum (especially phototype IV). Therefore, further studies considering such limitations are required for a better characterization.

Ultrasonographic diagnosis of adnexal masses: interobserver agreement in the interpretation of videos, using IOTA terminology

ObjectivesAim of this study is to estimate interobserver agreement in classifying adnexal tumors using IOTA terms, simple rules and subjective assessment. In addition, we related observers’ accuracy with their experience in gynecological ultrasonography and the year of IOTA certification.MethodsEleven observers with three different levels of experience evaluated videoclips of 70 adnexal masses, defining tumor type according to IOTA terms and definitions, classifying the mass using IOTA Simple rules and Subjective assessment as well as providing Color Score evaluation. Sensitivity, specificity and area under the ROC curve were calculated and the year of IOTA certification was related with operators’ accuracy through Pearson correlation coefficient. Interobserver agreement was estimated calculating percentage of agreement, Fleiss kappa and Cohen’s kappa.ResultsWe found a positive correlation between the year of IOTA certification and operators’ accuracy (Pearson coefficient 0.694), especially among the observers with the least experience, the residents (p = 0.003). For tumor type classification, identification of papillary projections and classification of tumors using subjective assessment, agreement among all observers was moderate (Fleiss kappa 0.455, 0.552, and 0.476, respectively) and increased with the years of experience. Agreement in the application of Simple Rules was moderate in all examiners with IOTA certification, with Fleiss kappa in the range of (0.403, 0.498). For Color Score assignment interobserver agreement among all observers was fair (Cohen’s kappa 0.380).ConclusionsEven among expert examiners, the results of adnexal lesion assessment can be inconsistent. Experience impacts on accuracy and agreement in subjective assessment, while the application of Simple Rules can mitigate the role of experience in interobserver agreement. The knowledge of IOTA models among residents seams to improve their diagnostic accuracy, showing the benefits of IOTA terminology for in training sonographers.

Cytomorphological features of syringocystadenoma papilliferum mimicking pilomatricoma at a rare location and in an unusual age group: A cytological diagnostic challenge.

Syringocystadenoma papilliferum (SCAP) is a rare, benign skin adnexal tumor of apocrine or eccrine differentiation usually occurring in the head and neck region of children. It is a difficult entity to diagnose clinically and even cytological diagnosis remains challenging due to overlapping and masquerading cyto-morphological features with other benign cutaneous adnexal tumors. Here we present, one such intriguing case of SCAP with its cytological features mimicking those of pilomatricoma. Moreover, the lesion was located at the right lower abdomen, which in itself is a rare site and its presentation was in an adult male which is an unusual age group. However, fine needle aspiration cytology still remains a very useful investigation for cutaneous tumors as it helps in differentiating benign lesions from malignant and metastatic neoplasms and therefore aids in correct treatment and follow-up of patients.

Subjective assessment and IOTA ADNEX model in evaluation of adnexal masses in patients with history of breast cancer.

To evaluate the performance of subjective assessment and the Assessment of Different NEoplasias in the adneXa (ADNEX) model in discriminating between benign and malignant adnexal tumors and between metastatic and primary adnexal tumors in patients with a personal history of breast cancer. This was a retrospective single-center study including patients with a history of breast cancer who underwent surgery for an adnexal mass between 2013 and 2020. All patients had been examined with transvaginal or transrectal ultrasound using a standardized examination technique and all ultrasound reports had been stored and were retrieved for the purposes of this study. The specific diagnosis suggested by the original ultrasound examiner in the retrieved report was analyzed. For each mass, the ADNEX model risks were calculated prospectively and the highest relative risk was used to categorize each into one of five categories (benign, borderline, primary Stage I, primary Stages II-IV or metastatic ovarian cancer) for analysis of the ADNEX model in predicting the specific tumor type. The performance of subjective assessment and the ADNEX model in discriminating between benign and malignant adnexal tumors and between primary and metastatic adnexal tumors was evaluated, using final histology as the reference standard. Included in the study were 202 women with a history of breast cancer who underwent surgery for an adnexal mass. At histology, 93/202 (46.0%) masses were benign, 76/202 (37.6%) were primary malignancies (four borderline and 72 invasive tumors) and 33/202 (16.3%) were metastases. The original ultrasound examiner classified correctly 79/93 (84.9%) benign adnexal masses, 72/76 (94.7%) primary adnexal malignancies and 30/33 (90.9%) metastatic tumors. Subjective ultrasound evaluation had a sensitivity of 93.6%, specificity of 84.9% and accuracy of 89.6%, while the ADNEX model had higher sensitivity (98.2%) but lower specificity (78.5%), with similar accuracy (89.1%), in discriminating between benign and malignant ovarian masses. Subjective evaluation had a sensitivity of 51.5%, specificity of 88.8% and accuracy of 82.7% in distinguishing metastatic and primary tumors (including benign, borderline and invasive tumors), and the ADNEX model had a sensitivity of 63.6%, specificity of 84.6% and similar accuracy (81.2%). The performance of subjective assessment and the ADNEX model in discriminating between benign and malignant adnexal masses in this series of patients with history of breast cancer was relatively similar. Both subjective assessment and the ADNEX model demonstrated good accuracy and specificity in discriminating between metastatic and primary tumors, but the sensitivity was low. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Malignant Skin Tumors seen in Nigeria Nnamdi Azikiwe University Teaching Hospital Nnewi: A 10-year Review (January 2008 to December 2017)

Abstract Background: Skin malignancy rank among the most common malignancies involving both sexes. Basal cell carcinoma is reported as the commonest malignancy even though studies have implicated Squamous cell carcinoma as the commonest especially in the tropic regions of the world. Aims and Objectives: This study aims at determining the base line data, frequency and trends of malignant skin tumours in Nnewi, Nigeria. It also implores the use of World Health Organization (WHO) in classification of skin malignancy. Materials and Methods: This study reviewed all histologically diagnosed skin malignancies at Histopathology department of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria from 2008 to 2017 and classified them using 2021 World Health Organization (WHO) skin tumour book. Results: A total of 387 skin biopsies were received in the Histopathology department during the study period. Out of these, 110 cases were malignant skin lesions (28.4%) majority were benign lesions. Keratinocytic or epidermal tumours were the most common (n: 54 cases; 49.1%) with squamous cell carcinoma being the commonest in the group (n: 34; 30.9%) followed by mesenchymal or soft tissue neoplasm (n:31 cases; 28.1%), melanocytic tumours (19.1%), skin adnexal tumour (2.7%) and haematolymphoid tumour (0.9%). The head and neck region (n: 49; 44.5%) was the commonest site of occurence of cutaneous neoplasms followed by lower limb (n: 32; 29.1%), groin (n:10; 9.1%), upper limb and trunk with 6 cases each (5.5%) Four (4) cases of Albinos with skin malignancies were seen in this research with a frequency of 3.6%. Fifty nine cases (53.6%) out of 110 malignant skin tumour were seen in males, while 51 (46.4%) of them were females, therefore the male to female ratio was 1.2:1. The mean age of those with malignant skin tumours was 52.9 years. Patients above 60 years of age constituted 57.3% while those less than 30 years constituted 14.5 % of the total malignant skin tumours. Conclusion: The frequencies of different morphologic patterns of malignant skin tumours in our environment were different from those reported in western countries. However, it is similar to most studies done in the Midwestern Nigeria tertiary hospitals with squamous cell carcinoma being the commonest skin malignancy followed by kaposi sarcoma.

Multi-Disciplinary Management of Hidradenocarcinoma

Hidradenocarcinoma makes up 6% of eccrine malignancies, and is an uncommon eccrine sweat gland tumour. The etiology is due to genetic alterations and transformation from an existing lesion or hidradenoma. It typically affects the face and scalp, although it can also cause nodal involvement and show up on the trunk, abdomen, or groin. Due to its similarities to other skin tumours, it is challenging to diagnose histopathologically. Therefore, immunohistochemical markers, such as p53, Ki-67, keratin AE1/AE3, and cytokeratin 5/6, are crucial for the diagnoses. There are no prospective randomized trials available to direct treatment of hidradenocarcinoma. A key component of therapy is early diagnoses and case discussion in multidisciplinary tumor board. Wide local excision with clear margins is the mainstay of treatment. Adjuvant treatment like chemo radiation therapy is incorporated if nodal disease or positive margins are present. Recurrences are treated by re-excision followed by adjuvant radiation therapy. Adjuvant hormonal therapy depends on the receptor status of the disease. These tumors have a 50% recurrence rate and up to 60% of the time they metastasize to the brain, bone, lung, liver, mediastinum, or peritoneum in a two-year period. The overall five year survival rate is around 30%. Keeping in view the aggressive course of this disease, research based clinically evident new treatment strategies are the need of time to optimize overall survival and local disease control. Keywords: Sweat gland tumors, Adnexal tumors, Hidradenocarcinoma, Adjuvant therapy, Multidisciplinary team, Radiation therapy.

Spiradenoma With Adenoid Cystic Carcinoma-like Changes: A Case Series of This Rare Variant With a Potential Diagnostic Pitfall.

Spiradenomas are benign cutaneous adnexal neoplasms with sweat gland differentiation that can manifest a broad spectrum of histomorphologic appearances. While they show a characteristic histopathologic phenotype and clinical management involves surgical excision with a low risk of recurrence, there have been unusual histopathologic variants of spiradenoma reported, including cases with adenoid cystic carcinoma (ACC)-like changes. Primary cutaneous ACC is a low-grade malignancy presenting as a subcutaneous mass with the potential for local invasion, perineural invasion, and high rates of local recurrence after excision. The diagnosis of spiradenomas with ACC-like features can be challenging, especially when only the ACC-like component is present for evaluation. A retrospective analysis of 21 cases of spiradenoma with ACC-like changes were obtained from large academic institutions, was performed, and summarized below. All cases showed background of conventional spiradenoma, and the ACC-like areas represented a component in all lesions. The percentage of ACC-like component ranged from 5% to 40% in all cases. The ACC-like component was multifocal and without pleomorphism, perineural and/or vascular invasion, necrosis, or increased mitotic activity. MYB translocation and protein expression was studied in 16 cases by fluorescence in situ hybridization, polymerase chain reaction, and immunohistochemistry. All studied cases were negative for MYB / NFIB , MYB L1, and MYB F by fluorescence in situ hybridization and polymerase chain reaction and 3 cases were positive for MYB expression by immunohistochemistry. Our study expands on spiradenomas with ACC-like features that ought to be considered in the differential diagnosis of cutaneous neoplasms such as primary cutaneous ACC. Our results indicate that a thorough histopathologic inspection and strict application of well-defined histologic criteria are necessary to support the diagnosis of this unusual histopathologic variant. These tumors can be difficult to diagnose, and awareness of their histomorphologic spectrum will facilitate definitive diagnosis and avoid misdiagnosis with other conditions.

Trichilemmal carcinoma masquerading as a sebaceous cyst - A rare case report

ABSTRACT Trichilemmal carcinoma (TC) is a rare, malignant, cutaneous adnexal neoplasm derived from the external root sheath of hair follicle, commonly seen in elderly males in the seventh to ninth decade. It commonly affects the sun-exposed areas and has an indolent course. We report a case of TC in which a 67-year-old female presented with a swelling on the scalp, which was misdiagnosed as a case of sebaceous cyst. The patient underwent excision and based on histopathological examination and immunohistochemistry, the diagnosis of TC was obtained.

Meigs Syndrome and Elevated CA-125: Case Report and Literature Review of an Unusual Presentation Mimicking Ovarian Cancer.

Background and Objectives: Meigs syndrome is represented by a benign adnexal tumor, ascites, and hydrothorax. Even though the ovarian mass is often characterized by a fibroma-like origin, cancer antigen-125 (CA-125) serum levels could be elevated as in the development of ovarian cancer. Here, we present the case of a patient with Meigs syndrome and increased CA-125. Materials and Methods: We performed systematic research for articles including similar cases in PubMed, EMBASE, and Scopus in February 2023, adopting the string of idioms: "Meigs syndrome AND Cancer antigen 125", and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Eligible records were 25. Hydrothorax was right-sided in 10 cases over 25; left-sided in two patients over 25. Concerning ascites, two patients showed more than 6 L of ascitic fluid, whereas three patients had 6 L or less. CA-125 elevation ranged from 149 IU/mL to 3803 IU/mL. Adnexal mass histotypes were: struma ovarii (12 cases), thecomas (two cases), fibrothecomas (five cases), fibromas (five cases), and one sclerosing stromal tumor (SST). Conclusions: In postmenopausal women with elevated CA-125 serum levels and an adnexal mass suspicious for malignancy at ultrasound (US), ascites and pleural effusion, surgery, and histopathological examination are necessary. MS is a diagnostic option, with an excellent prognosis after exeresis of the mass.

Morphological perspective of skin adnexal tumours: A case series

Adnexal or appendageal tumours of skin comprise an important subcategory of cutaneous neoplasms, although thorough understanding of this entity is still in its early stages. The role of immunohistochemistry in diagnosis is particularly limited, and, it is morphology that actually guides pathologists for clinching diagnosis. Here, we present three uncommon cases of skin adnexal tumours- a case of retiform trichoblastoma, trichilemmal carcinoma and sebaceous carcinoma; especially highlighting the morphological approach of diagnosis and the associated clinical implications based on literature review.

Evolving Pink Papule in a Young Female

Eccrine porocarcinoma (EPC) is a rare cutaneous adnexal tumor derived from sweat glands. Typically, EPC presents as a nonspecific erythematous papule or nodule most commonly on the head, neck, or lower extremities of females in the sixth or seventh decade of life. This tumor may arise from an existing benign eccrine poroma or occur de novo. Herein, we report a case of a growing erythematous nodule with overlying telangiectasia on the lower extremity of a woman in her twenties. Biopsy revealed a cyst-like lesion beneath the epidermis comprised of clear fluid material. Both solid and cystic components were present alongside pleomorphic tumor cell aggregates characterized by mitotic figures, hyperchromasia, and necrosis. The combination of clinical presentation and the presence of ductal structures on histopathologic analysis led to a diagnosis of EPC. This case reinforces the critical importance of histopathologic analysis of a nonspecific lesion that has evolved over time and may resemble other forms of cutaneous malignancy.

Rare malignant tumors of the ovary during pregnancy: a clinical case report

This article describes a clinical case of a malignant ovarian neoplasm, which was first detected during an urgent visit of a pregnant woman with signs of fetal distress in the third trimester of pregnancy. The relevance of this problem lies in the possibility of early diagnosis of adnexal tumors during routine ultrasound screenings, the lack of definitive recommendations for the management of such patients and the limited range of treatment methods during pregnancy. The aim of the study is to demonstrate a clinical case of pregnancy with late-detected ovarian malignancy. A 39-year-old pregnant woman at 35 weeks and 4 days' gestation consulted the antenatal clinic of a city maternity hospital with complaints of a decrease in the number and change in the nature of fetal movements over the past 24 hours. After assessment of the fetal condition (cardiotocography, ultrasound), the woman was hospitalized with a diagnosis: Pregnancy III, 35 weeks and 4 days. Fetal distress in the antenatal period. Fetal growth restriction, stage I. Gestational hypertension without significant proteinuria. Multicompartmental cyst of the right ovary. An urgent cesarean section was performed. Clinical diagnosis: рremature delivery by cesarean section. Medical care for the mother with fetal growth restriction of the first degree, fetal distress in the antenatal period. Cyst of the right ovary. Right-sided adnexectomy. Omental resection. Gestational hypertension. On the 5th day, the patient was discharged in a satisfactory condition with a recommendation for further examination in an oncology hospital. Pathological examination of the right ovary: morphological picture, taking into account the results of immunohistochemical examination, in favor of undifferentiated carcinoma; on repeated viewing - granular cell tumor of the ovary of adult type. The patient was routinely hospitalized at the city oncology center for surgical treatment and further examination. Clinical diagnosis: Bl ovarii gr I, adult-type granulosa cell tumor, T1Nx Mx. Condition after surgical treatment: lower midline laparotomy. Pangisterectomy, omentectomy. Sampling of the retroperitoneal lymph nodes on the right. Sanitation and drainage of the abdominal cavity. Clinical group II. The results of this article are of great practical importance for obstetricians-gynecologists, general surgeons and ultrasound diagnosticians in the differential diagnosis of indirect signs of malignant tumors during pregnancy, in the need to examine all pelvic organs during routine ultrasound screening of pregnant women and in establishing cause and effect relationships in the diagnosis of obstetric complications.

Strategic Approach to Heterogeneity Analysis of Cutaneous Adnexal Carcinomas Using Computational Pathology and Genomics

Cutaneous adnexal tumors are neoplasms that arise from skin appendages. Their morphologic diversity and phenotypic variability with rare progression to malignancy make them difficult to diagnose and classify, and there is currently no established treatment strategy. To overcome these difficulties, this study investigated the transcription factor SOX9 expression, morphology, and genetics of skin adnexal tumors for understanding their biology, especially their histogenesis. We showed that cutaneous adnexal tumors and their nontumor counterparts of skin and appendages exhibit expression patterns similar to that of SOX9. Its expression intensity and pattern, as well as histopathologic evaluation of tumors, were analyzed using digital images of 69 normal skin adnexal 9-type organs and 185 skin adnexal 29-type tumors as references. It was possible to distinguish basal cell carcinoma from squamous cell carcinoma, sebaceous carcinoma, and pilomatrixoma with significant differences, along with porocarcinoma from squamous cell carcinoma. Furthermore, unsupervised machine learning "computational pathology" was used to derive a multiregion whole-exome sequencing fusion method termed "genocomputed pathology." The genocomputed pathology of three representable adnexal carcinomas (porocarcinoma, hidradenocarcinoma, and spiradenocarcinoma) was evaluated for total nine cases. We showed that there was more heterogeneity than expected within the tumors as well as the coexistence of components lacking driver fusion genes. The presence or absence of potential driver genes, such as PIK3CA, YAP1, and PTEN, in each region was identified, highlighting a therapeutic strategy for cutaneous adnexal carcinoma encompassing heterogeneous tumors.