Eccrine Differentiation Research Articles

Case Report: Thigh hidradenoma masquerading as lipoma

Background: Hidradenomas are benign adnexal neoplasms which were recently been subdivided into two groups: eccrine differentiation (poroid hidradenomas) or apocrine differentiation (clear cell hidradenomas) with the latter being rarer. These types of tumors have been associated with recurrence and malignant transformation, however; recurrence and malignancy are considered very rare. We present a case report of a 35-year-old male who presented with two lumps, clinically representing simple lipomas but one of them turned to be a hidradenoma.

Epidermodysplasia verruciformis-associated eccrine neoplasm: a rare entity with distinctive clinical and histopathologic features.

Most tumors are caused by inherited or acquired genetic changes. However, a subset of tumors is driven by viral infection including Kaposi sarcoma, nasopharyngeal carcinoma, and others. Human papillomavirus (HPV) is an especially common cause of epithelial cancers and hyperplasias. Epidermodysplasia verruciformis (EDV) is a rare type of HPV infection with characteristic histopathologic features and a unique spectrum of HPV subtypes. We report here a distinctive form of EDV-associated eccrine neoplasia. Seven tumors from two patients were analyzed and show highly uniform features including multiple clustered clinical lesions, multifocal epidermal origin, eccrine differentiation with close association with the acrosyringium, an anastomosing growth pattern, and a bland monotonous poroid-to-basaloid cytomorphology. Clinical follow-up for one patient has been benign to date. These tumors show strong similarity to two previously reported cases, suggesting that this type of EDV-associated eccrine neoplasia may represent a rare but reproducible form of skin adnexal tumor with distinctive clinicopathologic features.

Malignant Adnexal Carcinoma of the Face: A Case Report

Malignant adnexal tumors (MAT) form a group of rare, typically low-grade- malignancy carcinomas with follicular, sebaceous, apocrine, or eccrine differentiation or a combination of the first 3 subtypes, the biopsy is required to establish the differentiation subtype and the definitive diagnosis. our case is a 67 years old female presented to our department of maxillofacial surgery of Ibn Sina hospital in Rabat with a left frontal skin lesion that had begun evolving 6 months ago. An excisional biopsy was performed afterwards using an elliptical excision with 1 cm of margins laterally and including the periost deeply, and then the sking defect was sutured in 3 layers. Malignant pilosebaceous tumors are more rare, especially those of the hair follicle. Sebaceous gland carcinoma commonly arises in the periorbital area. Surgical resection is the most commonly implemented treatment modality in MATs.

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.

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.

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.

Nodulo-Ulcerative Plaque Over the Vertex of Scalp.

A 45-year-old man presented with a 12-year-old swelling in the vertex region of his scalp that had gradually grown in size for the last few years. Pus discharge and minor pain had been present for the previous 10 days. Patient had received treatment with oral and topical antibiotics. There was no history of preceding trauma, nevoid lesions, or associated comorbidities. Cutaneous examination revealed a hard non-tender fixed plaque of 3 cm × 2 cm size over vertex area of scalp with central ulceration and yellowish white discharge. It was separated from surrounding skin with a sharp demarcation [Figure 1]. There was no regional lymphadenopathy.Figure 1: Single hard, non-tender fixed plaque of 3 cm × 2 cm size over vertex area of scalpSkin biopsy from the lesion revealed an epithelial neoplasm in the dermis reaching up to the base and both lateral margins without any connection with the epidermis [Figure 2]. Upper dermis and mid-dermis showed numerous dilated keratin cysts and orthokeratotic corneocytes [Figure 2]. Mid- and lower dermis showed numerous small rounded and elongated tumor islands made up of basaloid cells without too much atypia with ductal structures or differentiation at their center and surrounded by dense fibroblastic stroma. Some of these ducts were elongated and dilated but were lined by cuboidal basaloid cells without any signs of apocrine differentiation [Figure 3].Figure 2: An epithelial neoplasm in the dermis reaching up to the base and both lateral margins but showing no connection with surface epidermis (H & E 40x)Figure 3: In the mid-dermis and lower dermis, the neoplasm shows numerous keratin cysts, many of which are dilated and show orthokeratotic corneocytes, majority of the tumor islands are small and rounded, while others are small irregular and surrounded by dense fibroblastic stroma, numerous rounded and elongated tumor islands made up of basaloid cells without too much atypia (H&E 100x)What is the diagnosis? Answer Microcystic adnexal carcinoma. Discussion Microcystic adnexal carcinoma (MAC) is a rare, slow-growing but locally aggressive malignant neoplasm with low mortality rate and it rarely metastasizes.[1] It arises from pluripotent keratinocytes and shows characteristic pilar and eccrine differentiation.[1] It was first described in 1982 by Goldstein et al. as a distinct clinicopathologic entity.[2] It is reported mainly in adults between 55 and 60 years of age with a slight female preponderance. Clinically, it presents as a solitary asymptomatic plaque or nodule most commonly on the head and neck areas. Occasionally, patients may present with pain, itching, burning sensation, numbness, and tingling as a result of perineural invasion by the tumor.[2] Immunosuppression, UV radiation exposure, and radiotherapy are the predisposing factors.[2] MAC is commonly misdiagnosed as desmoplastic trichoepithelioma (DT), syringoma, morpheaform basal cell carcinoma (mbcc), and desmoplastic squamous cell carcinoma (SCC) on histopathology.[3] It is often difficult to clinically distinguish MAC from other skin-colored growths on the head and neck including BCC. Histopathologically, the presence of ductal structures helps to differentiate MAC from DT, whereas the presence of calcification, prominent horn cysts, and single-file strand formation differentiates MAC from syringoma. Among all these tumors, perineural and subcutaneous involvement is characteristic feature of MAC on histopathology. MAC is also characterized by presence of normal tissue between epidermis and dermis.[4] Immunohistochemical markers that help to distinguish MAC from morpheaform BCC and SCC include cytokeratin 15 (CK15), carcinoembryonic antigen (CEA), and BerEP4 [Table 1].[5]Table 1: Immunohistochemical markers to distinguish MAC from morpheaform BCC and SCCThe most definitive treatment for MAC is complete surgical excision. Mohs micrographic surgery (MMS) is the preferred option as it is associated with low recurrence rate.[6] MAC has a high recurrence rate that ranges from 15% to 60% depending on the treatment option used. Recurrence may occur many years following the excision; hence, long-term follow-up is mandatory. Other treatment options include wide local excision, adjuvant or definitive radiotherapy, and chemotherapy.[7] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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 of Nodular Skin Lesions with Special Reference to the Ethnic Population of Northeast India in a Tertiary Care Hospital

Background: Nodular skin lesions vary significantly in size and colour/pigmentation. Most of these clinically resemble soft tissue lesions. Histopathology plays key role in categorizing the lesions based on which course of treatment is planned. The present study aims to find out incidence and variation of skin nodules and correlate the clinico-pathological details with special reference to ethnic population of Northeast India.
 Methods: The study is a retrospective and descriptive study conducted for a period of 2 years at a tertiary care centre. The clinical and demographic details were retrieved and H&E slides are studied for histomorphology.
 Result: A total of 50 cases were studied out of which five cases were diagnosed as malignant tumours and 45 cases were diagnosed as benign tumours. Seventeen cases (34%) of tumours with follicular differentiation, eight cases (16%) of melanocytic tumours, nine cases (18%) of vascular and neural tumours, thirteen cases (26%) of tumours with apocrine and eccrine differentiation, two cases (4%) of epidermal tumors and one case (2%) of tumour with sebaceous differentiation were included under the present study. Tumors with follicular differentiation, the most commonly encountered tumor in the present study, were seen in the fourth to sixth decades of life and seen more commonly among women. A total of 18 (36%) cases belonged to ethnic tribal communities of North-east India, out of which seven were tumors of follicular differentiation, five were melanocytic tumours and six were tumors of eccrine differentiation.
 Conclusion: H&E-stained sections stand as the most important tool for diagnosing and differentiating skin nodular lesions. A significant percentage (36%) of the lesions in the present study have been seen in the ethnic population of the Northeast region of India.

Poroid Hidradenoma over Dorsum of the Hand

Poroid hidradenoma is a rare, benign cutaneous neoplasm which presents as a solitary swelling. It has eccrine differentiation with features of both hidradenoma and poroma. We hereby present a case of a 50-year-old female patient with a slowly growing asymptomatic lesion over the dorsum of the left hand for 1½ years. Histopathology was consistent with poroid hidradenoma. The hidradenoma component consists of solid and cystic areas and poroma by poroid and cuticular cells. There was no recurrence of the lesion after 1 year of follow-up. Very few cases of poroid hidradenoma have been reported in the literature.

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 & 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

NECTIN4 expression in sebaceous and sweat gland carcinoma

Sebaceous carcinoma and sweat gland carcinoma (malignant tumours with apocrine and eccrine differentiation) are rare malignant adnexal tumours that differentiate toward sebaceous glands and eccrine and apocrine glands, respectively. Because of the rarity of these malignancies, standard treatments for advanced disease have yet to be established. The outcomes of patients with systemic metastasis remain poor, highlighting the need for novel treatment strategies. Nectin cell adhesion molecule 4 (NECTIN4) and its antibody-drug conjugate, enfortumab vedotin, have attracted attention as potential treatments for solid tumours. To examine the potential use of NECTIN4-target therapy for sebaceous and sweat gland carcinoma. We immunohistochemically investigated NECTIN4 expression in 14 sebaceous carcinoma samples and 18 sweat gland carcinoma samples, and examined whether NECTIN4-targeted therapy could be applied to these cancers. We found strong and frequent expression of NECTIN4 in both cancers. All tumours exhibited positive staining at least in a part of the lesion, and the mean H-score, a semiquantitative score ranging from 0 to 300, was 259.4 for sebaceous carcinoma and 253.1 for sweat gland carcinoma. Our results suggest that both sebaceous carcinoma and sweat gland carcinoma could be potentially treated with NECTIN4-targeted antibody-drug conjugates, such as enfortumab vedotin.

TROP2 Expression in Sebaceous and Sweat Gland Carcinoma.

Sebaceous carcinoma and sweat gland carcinoma (malignant tumors with apocrine and eccrine differentiation) are rare malignant skin adnexal tumors that differentiate toward sebaceous gland and eccrine and apocrine glands, respectively. Owing to the rarity of these carcinomas, standard treatments for advanced disease have not been established. Because the prognosis of patients with systemic metastasis is poor, a new treatment for these diseases is eagerly desired. Trophoblast cell surface antigen 2 (TROP2) and sacituzumab govitecan, an antibody–drug conjugate of TROP2, have attracted attention in the treatment of various solid tumors. In the current study, we immunohistochemically investigated TROP2 expression in 14 sebaceous carcinoma and 18 sweat gland carcinoma samples and found strong and relatively homogeneous TROP2 staining in both cancer types. The mean Histoscore, a semi-quantitative scoring ranging from 0 (negative) to 300, was 265.5 in sebaceous carcinoma and 260.0 in sweat gland carcinoma. These observations directly suggest that both sebaceous carcinoma and sweat gland carcinoma could be potentially treated with TROP2-targeted antibody–drug conjugates such as sacituzumab govitecan.

Current Diagnosis and Treatment Options for Cutaneous Adnexal Neoplasms with Apocrine and Eccrine Differentiation.

Adnexal tumors of the skin are a rare group of benign and malignant neoplasms that exhibit morphological differentiation toward one or more of the adnexal epithelium types present in normal skin. Tumors deriving from apocrine or eccrine glands are highly heterogeneous and represent various histological entities. Macroscopic and dermatoscopic features of these tumors are unspecific; therefore, a specialized pathological examination is required to correctly diagnose patients. Limited treatment guidelines of adnexal tumor cases are available; thus, therapy is still challenging. Patients should be referred to high-volume skin cancer centers to receive an appropriate multidisciplinary treatment, affecting their outcome. The purpose of this review is to summarize currently available data on pathogenesis, diagnosis, and treatment approach for apocrine and eccrine tumors.

Magnetic Resonance Imaging Characteristics of Poroma and Porocarcinoma.

The purpose of this study was to evaluate magnetic resonance (MR) imaging findings of poroma and porocarcinoma. Six patients (3 male, 3 female; age range, 40-84 years; mean age, 61 years) with histologically confirmed skin appendage tumors with apocrine and eccrine differentiation (2 poromas and 4 porocarcinomas) were enrolled. All patients underwent preoperative MR imaging and the MR images were retrospectively reviewed. The configurations were classified as pedunculated solid in 5 lesions and subcutaneous cystic with mural nodules in 1. Well-demarcated deep tumor margins and smooth skin surfaces were observed in all 6 lesions, and peritumoral fat stranding was observed in 2. In all 5 pedunculated solid lesions, T2-hyperintense foci, T1 hyperintensity, and homogeneous solid components were observed within the lesions. Poroma and porocarcinoma usually exhibited pedunculated solid homogeneous lesion. Intratumoral T2-hyperintense foci and T1 hyperintensity were observed in pedunculated solid lesions.

Malignant skin adnexal tumor with eccrine differentiation– A rare case report with review of literature

Malignant skin adnexal tumor with eccrine differentiation– A rare case report with review of literature

Malignant skin adnexal tumor with eccrine differentiation– A rare case report with review of literature

Malignant skin adnexal tumor with eccrine differentiation– A rare case report with review of literature

Clinico-pathological study of skin adnexal tumours in a tertiary care hospital

Background: Skin adnexal tumours are heterogenous group of uncommon tumours having distinct histological features. They have varied clinical presentation and morphological differentiation towards one or more types of adnexal structures found in normal skin. The aim of this study was to study the different histomorphological patterns of appendageal tumours and correlate them with clinical presentations. Materials and Methods: This was a retrospective study of three year duration of all cases clinically diagnosed to be appendageal tumours and confirmed by histopathology in our department. The tumours were classified according to their differentiation after a detailed histopathological examination in haematoxylin and eosin sections. Results: The total number of cases in the study were 43,in which 28 were males and 15 females. Most of the tumours (97.7 %)were benign and there was only one case sebaceous carcinoma. The majority of the tumours had an eccrine differentiation (30.9%), nodular hidradenoma among them being the most common lesion (20.9%). Trichilemmal cyst (30.2%) constituted the maximum cases of pilar origin. Conclusion: Skin adnexal tumours are relatively rare with benign ones being more common than the malignant tumours. Proper clinical correlation and histopathological study helps in reaching a correct diagnosis. Keywords: Appendageal, Skin tumour, Eccrine, Nodular hidradenoma, Sebaceous carcinoma.

Malignant Cutaneous Adnexal Tumor in Posterior Occipital Region of a Child: A Case Report

Introduction: The most common cutaneous adnexal tumors in children were follicular, especially pilomatricoma, and a few were predominant glandular/ductal differentiation, malignant forms are occasionally encountered. Here, a case of a malignant cutaneous adnexal tumor with eccrine differentiation was reported. Case presentation: A 10-year-old male child was presented with a nodular in posterior occipital for half a year with no symptoms. Histopathology showed there was acanthosis in epidermis, partially with local ulceration and crusting; and in the dermis, there was irregular scattered or agglomerated infiltration of diffused epithelial cells, partly presenting as basaloid, but no obvious peripheral palisading arrangement; and in the center there was extensive necrosis; cellular pleomorphism, scattered mitotic figures, focal clear cell areas, and adenoid differentiation can also be seen, there was scattered infiltration of mixed inflammatory cells in the stroma. Immunohistochemistry showed cytokeratin (CK) 5/6+, CK 8/18+, epithelial membrane antigen +, gata3 transcription factor 3+, cell adhesion15 (focal +), Ki67 (+, 30%), carcinoembryonic antigen (focal+), CK 7 (focal+), gross cystic disease fluid protein-15−, P63+, S-100−. Final diagnosis was the malignant cutaneous adnexal tumor with eccrine differentiation, most likely the nodular clear cell hidradenocarcinoma. The patient has no special discomfort follow-up observation after extended resection and lymph node examination. Discussion: The histopathology showed infiltrative growth pattern, deep extension, necrosis, nuclear pleomorphism, mitoses, desmoplastic stromal reaction and the clear cell area and adenoid differentiation. Immunohistochemistry was positive for CK8/18, EMA, CK5/6, P63, gata3 transcription factor 3 and negative for S-100 and GCDFP-15, some gland-derived markers such as CK7, CEA were focal positive, and we have not found the preexisting benign poroma and porocarcinoma in situ, so we preferred the diagnosis of hidradenocarcinoma. The differential diagnosis such as porocarcinoma, clear cell squamous cell carcinoma, and basal cell carcinoma were taken into account. Conclusion: The diagnosis was challenging by clinical manifestations. Histopathology and immunohistochemistry should be combined with clinical presentation, history to reach the final diagnose.

Are clinicians successful in diagnosing cutaneous adnexal tumors? a retrospective, clinicopathological study

Background/aimCutaneous adnexal tumors (CAT) are rare tumors originating from the adnexal epithelial parts of the skin. Due to its clinical and histopathological characteristics comparable with other diseases, clinicians and pathologists experience difficulties in its diagnosis.We aimed to reveal the clinical and histopathological characteristics of the retrospectively screened cases and to compare the prediagnoses and histopathological diagnoses of clinicians.Materials and methodsThe data of the last 5 years were scanned and patients with histopathological diagnosis of CAT were included in the study.ResultsA total of 65 patients, including 39 female and 26 male patients aged between 8 and 88, were included in the study. The female to male ratio was 1.5, and the mean age of the patients was 46.15 ± 21.8 years. The benign tumor rate was 95.4%, whereas the malignant tumor rate was 4.6%. 38.5% of the tumors were presenting sebaceous, 35.4% of them were presenting follicular, and 18.5% of them were presenting eccrine differentiation. It was most commonly seen in the head-neck region with a rate of 66.1%. When clinical and histopathological prediagnoses were compared, prediagnoses and histopathological diagnoses were compatible in 45% of the cases. Most frequently, it was the basal cell carcinoma, epidermal cyst, and sebaceous hyperplasia identified in preliminary diagnoses.ConclusionCutaneous adnexal tumors are very important, as they can accompany different syndromes and may be malignant. Due to difficulties in its clinical diagnosis, histopathological examination must be performed from suspicious lesions for definitive diagnosis.