Malignant Adnexal Tumors Research Articles

Comparison of the value of contrast enhanced ultrasound and International Ovarian Tumor Analysis (IOTA) simple rules in the differential diagnosis of adnexal tumors

Objective To campare the diagnostic value of contrast-enhanced ultrasound(CEUS) and International Ovarian Tumor Analysis (IOTA) simple rules in the differential diagnosis of adnexal tumors. Methods For the 101 suspicious malignant adnexal tumors discovered by conventional ultrasound, IOTA simple rules and CEUS were performed before operation. Tumors were divided into benign, uncertain and malignant according to IOTA simple rules. Tumors were scored by CEUS according to the membrane integrity, coating thickness uniformity, separation enhancement, enhance strength(no enhancement, low enhancement, equal or high enhancement), and enhanced performance(uniform and non-uniform). The ROC curve was drawn with the pathological results as the gold standard, and the best boundary value was obtained. Finally, the diagnostic efficiency of the diagnostic methods were analyzed. Results ①According to the ROC curve analysis, the area under the curve of IOTA simple rules was 0.757(P=0.000). When the uncertainty type was classified as benign, the random index was 0.41, the sensitivity was 61.54%, and the specificity was 79.59%. When the uncertainty type was classified as malignant, the random index was 0.31, the sensitivity was 96.15%, and the specificity was 34.69%. When the uncertain types were excluded the Youden index was 0.77, the sensitivity was 76.19%, and the specificity was 89.47%. ②The differences in the membrane integrity, coating thickness uniformity, separation enhancement, enhance strength, enhanced performance between benign and malignant tumors were statistically significant(P<0.01). ③According to the ROC curve analysis, the area under the curve of CEUS was 0.914(P=0.000), cut-off value was 3 score. The Youden index, sensitivity and specificity of evaluating benign and malignant adnexal tumors were 0.80, 78.85% and 91.84% respectively. ④The tumors evaluated as benign by IOTA simple rules was classified as benign. The tumors evaluated as malignant by IOTA simple rules were classified as malignant. The tumors evaluated as uncertain by IOTA simple rules and scored less than or equal to 3 points according to CEUS were classified as benign. The tumors evaluated as uncertain by IOTA simple rules and scored more than 3 points according to CEUS were classified as malignant. According to the ROC curve analysis, the area under the curve of CEUS combined with IOTA simple rules was 0.831(P=0.000). The Youden index, sensitivity and specificity in evaluating benign and malignant adnexal tumors were respectively 0.66, 86.54% and 79.59% respectively. Conclusions CEUS has a higher diagnostic efficiency than IOTA Simple Rules and the two combined in the diagnosis of adnexal tumors. Key words: Contrast-enhanced ultrasound; Neoplasms, adnexal; IOTA Simple Rules

Abstract B68: Adnexal tumors associated with endometriosis: Experience from an academic institution

Abstract Background: Endometriosis affect pelvic organs in ~10% of cases. The question of endometriosis being a precancerous lesion versus an incidental association with adnexal (fallopian tubes and ovaries) tumors is a point of debate. This study aimed to determine the frequency of adnexal tumors in cases with histologically proven endometriosis of adnexal structures at our institution. Methods: A retrospective chart review of patients diagnosed with adnexal endometriosis from 2013-2017 was performed. Patients’ age, demographic data, and associated ipsilateral benign or malignant adnexal tumors were obtained from the pathology notes. Results: 151 cases with a histologically verified endometriosis of fallopian tubes and/or ovaries were retrieved. The average age of the patients was 42 years (range of 22-78 years). The race/ethnic groups of the patients were white, black, and others in 120 (79%), 17 (11%) and 14 (9%), respectively. Associated malignant tumors were identified in 8 (5.3%) cases while 10 (6.6%) cases were found to have benign neoplasms in the ipsilateral site of endometriosis. The malignant tumors were endometrioid adenocarcinoma (n=4), high-grade serous carcinoma (n=3), and clear cell carcinoma (n=1). The benign neoplasms were serous cystadenoma/ cystadenofibroma (n=7) and seromucinous tumors (n=3). Conclusions: The incidence of malignant neoplasms, especially endometrioid and high-grade serous carcinoma, is relatively high in cases with histologically verified endometriosis in our experience. Among benign tumors, serous cystadenoma and seromucinous neoplasms appear to be frequently associated with endometriosis. More studies are needed to further highlight the significance of adnexal endometriosis in causation of malignant and benign adnexal tumors. Citation Format: Mohamed Mokhtar Desouki. Adnexal tumors associated with endometriosis: Experience from an academic institution. [abstract]. In: Proceedings of the AACR Conference: Addressing Critical Questions in Ovarian Cancer Research and Treatment; Oct 1-4, 2017; Pittsburgh, PA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(15_Suppl):Abstract nr B68.

Polymorphous Sweat Gland Carcinoma: An Immunohistochemical and Molecular Study.

Polymorphous sweat gland carcinoma is an uncommon low-grade malignant adnexal tumor with a marked predilection for the distal extremities. Histologically, the lesions are characterized by a cellular proliferation showing a combination of growth patterns, including trabecular, solid, tubular, cribriform, or adenoid cystic and pseudopapillary. The immunohistochemical and molecular profile of these tumors has not yet been properly addressed. We have studied 3 cases of polymorphous sweat gland carcinoma using a broad panel of immunohistochemical markers including cytokeratin AE1/AE3, CK5/6, MOC31, p40, p63, p16, chromogranin, synaptophysin, CD56, MIB-1, estrogen receptor, progesterone receptor, androgen receptor, BER-EP4, smooth muscle actin, epithelial membrane antigen, carcinoembryonic antigen, CD117, S100 protein, HBME-1, DOG1, vimentin, and mammaglobin. We also examined for the MYB-NFIB fusion by fluorescent in situ hybridization (ISH) and for human papilloma virus by ISH. Our studies show that cytokeratin AE1/AE3, CK5/6, p40, p63, p16, chromogranin, and CD56 stains were positive in all 3 cases. All 3 cases were negative for MYB-NFIB fusion by fluorescent ISH which rules out adenoid cystic carcinoma. DNA ISH studies for high-risk human papilloma virus were negative in all cases. MIB-1 proliferation index was very high (30%-70% nuclear positivity), supporting a malignant phenotype. The positivity for chromogranin and CD56 suggests partial neuroendocrine differentiation. The differential diagnosis includes metastases from internal malignancies, basal cell carcinoma, and other benign and malignant adnexal neoplasms such as adenoid cystic carcinoma, ductal eccrine carcinoma, and microcystic carcinoma. Positivity for p16 in combination with chromogranin and CD56 may be potentially good markers for differentiating this tumor from other adnexal tumors.

A rare presentation of primary cutaneous basaloid squamous cell carcinoma of scalp

Basaloid squamous cell carcinoma (BSSC) is a rare and aggressive variant of squamous cell carcinoma (SCC). It has predilection for the upper aero digestive tract with common metastasis to regional lymph node and common distant metastasis to lungs. While metastasis to scalp has rarely been reported, primary occurrence of BSCC arising from scalp has hardly ever been reported. We are reporting a case of 70 year female patient, who presented with an ulceroproliferative growth in posterior scalp. Biopsy from the edge of growth was reported as malignant adnexal tumor. A wide local excision was done and that biopsy was reported as Basaloid squamous cell carcinoma. We intend to present this case, considering its rarity and its primary presentation in an very unusual and unique location for this variant.

Hydrochlorothiazide use and risk for Merkel cell carcinoma and malignant adnexal skin tumors: A nationwide case-control study

Hydrochlorothiazide use has been associated with markedly increased risk for squamous cell carcinoma. No previous studies have investigated the association between hydrochlorothiazide use and the risk for Merkel cell carcinoma (MCC) and malignant adnexal skin tumors (MAST). To examine the association between hydrochlorothiazide use and the risk for MCC and MAST. Using Danish nationwide health registries, we identified all patients with incident MCC or MAST during 2004-2015 and matched the cases individually to cancer-free population controls by risk set sampling. Using conditional logistic regression, we estimated the odds ratios (ORs) and confidence intervals (CIs) associated with cumulative use of hydrochlorothiazide. The adjusted ORs for MCC and MAST associated with high use (≥50,000mg) of hydrochlorothiazide was 2.3 (95% CI 1.1-4.8) and 3.6 (95% CI 1.9-7.0), respectively, which increased to 3.3 (95% CI 1.3-8.3) and 5.6 (95% CI 2.4-13.3), respectively, with highest use (≥100,000mg). We found no increased risk for these tumors in analyses of drugs with similar indications as hydrochlorothiazide, except there was a tendency toward an increased risk for MCC associated with the use of furosemide (OR 1.9, 95% CI 0.9-4.0). No data on sun exposure was available. Hydrochlorothiazide use is associated with an increased risk for MCC and MAST.

Behavior of Cutaneous Adnexal Malignancies: a Single Institution Experience.

Cutaneous adnexal malignancies are biologically and pathologically diverse, and associated with a range of clinical outcomes. Given their rarity, the prognosis and optimal treatment of these neoplasms remains unclear. A single institution database from a tertiary care cancer center of patients treated for malignant cutaneous adnexal tumors was retrospectively analyzed. Clinicopathologic variables and outcome measures were analyzed in patients undergoing wide excision with or without sentinel node biopsy. 103 patients were analyzed; the majority of tumors were of eccrine sweat gland derivation (n = 69, 70%), and these exhibited a higher rate of nodal involvement and overall worse outcome. Sixteen patients (16%) demonstrated nodal metastasis, which included 10 (10%) with nodal disease at presentation and 6 who developed nodal metastasis during followup. 20 patients underwent sentinel node biopsy, and 2 (10%) had a positive sentinel node. 62% of nodal metastases occurred in patients with porocarcinoma. Seven patients died of disease (7%) with a median time from diagnosis to death of 48months (range, 10-174). After a median follow up of 44.7months, age > 70years and larger tumor size were significantly associated with worse overall survival. Adnexal malignancies are rare tumors, and there is a paucity of information to guide the clinician in determining optimum surgical and medical treatment. Tumors of eccrine derivation, especially porocarcinomas, have a high risk of nodal involvement and may be considered for sentinel node biopsy.

Histopathological Evaluation of Tumours And Cysts of The Epidermis and Dermal Adnexae in a Tertiary Care Hospital

Background: Skin tumours are a challenging group of conditions ,it is difficult to classify and these are diagnosed chiefly by histopathology. The aim of our study was to analyze the incidence and classify the histopathological pattern of tumours and cysts of the epidermis and dermal appendages. Methods: The current study was a retrospective observational study of epidermal and adnexal tumours and cysts over a period of five and half years from January2007 to December 2012 reported in the department of Pathology ,SMVMCH,Pondicherry over a 5 year period from were analysed and correlated statistically. Result: Out of 160 skin lesions 62 were found to be epidermal and dermal adnexal tumours, among these benign adnexal tumours(14%) were the commonest followed by benign epidermal tumours(12.5%) ,malignant epidermal tumours(10.5%) and malignant adnexal tumours(2%).The ratio of benign(42) to malignant(22) tumour was 1.9:1.the ratio of benign(20) to malignant(17) epidermal tumour was 1.17:1 .The ratio of benign adnexal(22) to malignant counterpart (3) was 7.3:1 and the ratio of skin tumours (62) to cystic lesion(98) was 1:1.5. The commonest epidermal tumour was seborrheic keratosis. Epidermal cysts were the commonest type of cyst in the epidermis. Common skin appendage tumours were nodular hidradenoma followed by pilomatrixoma. The common malignant tumour was basal cell carcinoma. Conclusion: Cutaneous tumours represent the complexity of the epidermal and dermal adnexae since they have a similar morphology to their cell of origin .Hence the histopathological examination is mandatory for diagnosis and categorization of these tumours.

Carcinome annexiel microkystique : à propos d’une observation

We report a case of microcystic adnexal carcinoma in a 80-year-old woman. This is a rare malignant adnexal cutaneous tumor with glandular and follicular differentiation, rare, often asymptomatic, with late diagnosis and slow growth, locally aggressive and rarely metastatic. The distinction with other benign and malignant skin tumors is difficult.

GATA3 staining in primary cutaneous apocrine cribriform carcinoma: Usefulness to differentiate it from breast cancer metastasis.

Primary cutaneous apocrine cribriform carcinoma (PCACC) is a rare tumor, clinically appearing as a solitary nodule, mostly involving extremities of females and this lesion usually raises a differential diagnosis with metastatic cribriform carcinomas, especially breast cancer. To study GATA3 expression in a series of 14 primary cutaneous cribriform carcinomas and to test its usefulness to differentiate this tumor from metastatic breast cancer. We retrieved 14 cases with PCACC (each from a different patient) from the files of the authors. Cases were dated from 1994 to 2014. We also evaluated 6 cases of cutaneous breast cancer metastasis RESULTS: No PCACCs expressed GATA3. Breast cancer metastases expressed GATA3 in 100% of our studied cases. Even though GATA3 expression has been reported in many benign and malignant adnexal tumors (mostly of sebaceous, follicular, and apocrine differentiation), as well as in many other neoplasms, GATA3 staining to differentiate PCACC from skin breast cancer metastasis has a high negative predictive value. A positive GATA3 staining in this context should permit one to rule out PCACC with a high level of confidence.

Evaluation of gray-scale and color Doppler sonography accuracy in discrimination between benign and malignant adnexal tumors

Introduction: Adnexal tumors are third common neoplasms in female reproductive ages and the fifth cause of death in women. Objectives: The aim of the study was to evaluate sonography accuracy in discrimination between adnexal malignancies. Patients and Methods: This is a retrospective study in women with adnexal masses. Sonography findings were compared with histopathology diagnoses. Results: Around 67 masses were involved in the study and accuracy of sonography was 92%. Conclusion: The accuracy of gray-scale and color Doppler sonography in discrimination between malignant and benign adnexal masses were high and proved to be valuable diagnostic tools.

Treatment of Malignant Cutaneous Adnexal Neoplasms

Malignant cutaneous adnexal neoplasms 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. Their clinical presentation is usually unremarkable, and biopsy is required to establish the differentiation subtype and the definitive diagnosis. Due to their rarity, no clear consensus has been reached on which treatment is most effective. Mohs micrographic surgery is considered to be the best option to prevent recurrence in the majority of patients. Radiotherapy and chemotherapy have been studied in very few cases and have rarely been shown to be effective.

Tratamiento de las neoplasias anexiales cutáneas malignas

Malignant cutaneous adnexal neoplasms 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. Their clinical presentation is usually unremarkable, and biopsy is required to establish the differentiation subtype and the definitive diagnosis. Due to their rarity, no clear consensus has been reached on which treatment is most effective. Mohs micrographic surgery is considered to be the best option to prevent recurrence in the majority of patients. Radiotherapy and chemotherapy have been studied in very few cases and have rarely been shown to be effective.

Eyelid trichilemmal carcinoma

Trichilemmal carcinomas are rare malignant adnexal tumors which can involve the head and, rarely, the eyelid. Accurate diagnosis and differentiation from basal cell carcinoma or trichoepithelioma are dependent on histopathological and immunohistochemical analysis. We report a case of an eyelid mass, initially diagnosed by incisional biopsy as a trichoepithelioma, later found on excisional biopsy to be a trichilemmal carcinoma and present a review of the literature of the histopathology, differential diagnosis and management. Consideration of these entities will be useful to the histopathologist and clinician to better identify and treat these challenging lesions.

Malignant cutaneous adnexal neoplasms of the face and scalp: Diagnostic and therapeutic update

Malignant cutaneous adnexal neoplasms are rare and have been characterized only recently. They can occur at any age but preferentially in elderly. There are 3of them: trichoblastic carcinoma, trichilemmal carcinoma and malignant pilomatricoma. The aim of our study was to make a diagnostic and therapeutic update about these tumors when located at the face or at the scalp. A bibliographic research was made on PubMed using following keywords: appendage skin carcinoma AND pathology AND/OR therapeutic. Articles published before 2000were considered outdated and were excluded. Twenty-five articles met the inclusion criteria. Clinical presentation was non-specific. Histological examination only allowed for diagnosis. Lesions were locally or loco-regionally aggressive. Lymphatic or hematogenous metastasis were reported. No consensus about treatment was found. When surgery was used, it consisted in resection with safety margins ranging from 0.5to 3cm depending on the teams. In case of metastasis, treatment consisted in chemo- and/or radiotherapy. A quarterly medical monitoring was recommended. Malignant cutaneous adnexal tumors are rare. There is nowadays no treatment consensus. An initial staging by mean of a head and neck, chest, abdominal and pelvic CT-scan is mandatory. Treatment has to be decided in a multidisciplinary cancer committee. In the absence of metastasis, the reference treatment is surgical resection, possibly by Mohs micrographic technique, with large safety margins. In case of metastasis or if the loco-regional extension does not allow for a complete excision, chemotherapy and/or radiotherapy may be proposed. A close monitoring is essential.

Eccrine Porocarcinoma: A Case Report of a Rare Skin Malignancy (Dermatopathologic View)

Eccrine porocarcinoma is extremely rare malignant skin adnexal tumor histogenetically derived from the sweat gland ducts and acrosyringium. The authors described a 66-year-old woman, who was diagnosed to have a malignant cutaneous neoplasia arising in the lateral side of the right shin. The lesion displayed exophytic growth with central ulceration, it was rounded and well-defined having 25 mm in diameter. Microscopically, it exhibited a mixture of atypical basaloid and clear cell population arranged in solid-nodular fashion, that grew out from the epidermis and infiltrated the corium. Ductal formations were sporadically present as well. Tumor was immunohistochemically positive for HMWCK, CK7, EMA, weakly positive for pCEA and negative for mCEA and BerEP4. The spectrum of histomorphologic and immunophenotypic findings favored a diagnosis of primary eccrine porocarcinoma. Having made the retrospective analysis, the authors found only this single one biopsy-proven case of EP during the last seven years suggesting exclusive diagnosis in a routine dermatopathologic practice.

Retrospective study of rare cutaneous malignant adnexal tumors of the head and neck in a tertiary care cancer hospital: a case series

BackgroundAdnexal tumors of the skin are a large and diverse group of benign and malignant neoplasms, which exhibit morphological differentiation toward one of the different types of adnexal epithelium present in normal skin and they pose a diagnostic challenge. The purpose of this study is to share our experience with these rare but aggressive tumors at a tertiary care cancer hospital in a developing country. A retrospective review of 11 patients diagnosed with rare adnexal tumors and their variants from January 2005 to December 2014, treated either surgically or non-surgically, was performed to describe the clinicopathological characteristics and outcome of the disease.Case presentationA total of 11 patients were diagnosed with adnexal carcinoma and its variants: a 34-year-old Sindhi man, a 59-year-old Punjabi woman, a 32-year-old woman from Khyber Pakhtunkhwa, a 43-year-old Punjabi woman, a 64-year-old Punjabi man, a 51-year-old man from Khyber Pakhtunkhwa, a 51-year-old Punjabi woman, a 74-year-old Punjabi woman, a 75-year-old Punjabi man, a 61-year-old man from Khyber Pakhtunkhwa, and a 53-year-old man from Khyber Pakhtunkhwa. The male to female ratio was 1.2:1. The histological variations were sebaceous differentiation (n = 4), microcystic adnexal carcinoma (n = 4), trichilemmal carcinoma (n = 1), pilomatrix carcinoma (n = 1), and hidradenocarcinoma (n = 1). The mean age at presentation was 54 years (range 32 to 75). The primary subsite of involvement was the scalp in nine patients followed by eyelids in two patients. Surgery was the primary treatment modality in almost all patients; postoperative radiotherapy (PORT) was offered to eight patients. The median dose of radiation was 45 Gy to the primary site. Indications for radiotherapy included close margins (n = 2), positive margins (n = 1), high grade histology (n = 4), and multifocal disease (n = 1). On follow-up, two patients presented with local, one regional and two patients developed distant metastasis.ConclusionsAdnexal carcinomas are rare tumors with diverse histological patterns and a tendency for locoregional and distant metastasis. Surgery should be the mainstay of treatment reserving radiotherapy for adjuvant, palliative, and re-treatment scenarios.

Validación de criterios ecográficos IOTA (International Ovarian Tumor Analysis Group) para caracterizar masas anexiales y determinar riesgo de malignidad en un grupo de mujeres con sospecha de cáncer de ovario

Epithelial carcinoma of the ovary is a gynecological malignancy associated with high mortality&#x0D; rate due to diagnosis in advanced stages, which occurs in more than 75% of the cases.&#x0D; Recent strategies in reducing mortality have been studied, however screening tests have not&#x0D; demonstrated to help in the diagnosis at early stages. Subjective impression of the examiner&#x0D; using transvaginal ultrasound is considered the best method to discriminate between benign&#x0D; and malignant adnexal tumors. The International Ovarian Tumor Analysis Group (IOTA) based&#x0D; on ultrasound features of the adnexal masses, has developed robust rules and prediction&#x0D; models that can be used by different examiners in various clinical settings.In Chile during&#x0D; 2012, national guidelines about epithelial ovarian cancer were published, establishing referral&#x0D; and management criteria. Little mention about ultrasound exam was included: all “solid&#x0D; tumors or complex adnexal masses” are sonographic criteria to refer patients to gynecologic&#x0D; oncology units. Considering that many functional or benign pathologies can be classified as&#x0D; “complex tumors”, it is important to use validated prediction models to improve accuracy of&#x0D; ultrasonography and therefore optimize the referral to gynecological oncologists and avoid&#x0D; surgeries of misclassified adnexal pathologies.

MYB, CD117 and SOX-10 expression in cutaneous adnexal tumors.

Elevated MYB expression has been documented in adenoid cystic carcinoma (ACC), cylindroma, and spiradenoma, but the specificity of this finding is unknown. CD117 and SOX-10 expression also occurs in some cutaneous adnexal tumors. This study assesses MYB, CD117 and SOX-10 expression in cutaneous adnexal tumors. Retrospective analysis of 184 benign adnexal tumors (140 eccrine/apocrine, 40 follicular and 10 sebaceous), and 30 malignant adnexal tumors was performed with MYB, SOX-10 and CD117 immunostaining. In the benign adnexal tumors, 16% (23/140) significantly expressed MYB. MYB expression was limited to cylindromas and to a lesser extent, spiradenomas in the benign cohort. Elevated MYB expression was detected in mucinous carcinoma, endocrine mucin-producing sweat gland carcinoma and 1 and 4 cases of extramammary Paget's disease (EMPD) in the malignant cohort. CD117 and SOX-10 had similar overall positivity rates in benign apocrine and eccrine tumors (45% and 68% respectively), and were generally negative in other benign and malignant adnexal tumors. Expression of MYB appears limited to a small number of cutaneous adnexal tumors, including cylindromas, spiradenomas, ACCs, mucinous carcinoma, endocrine mucin-producing sweat gland carcinoma and some cases of EMPD.

Retrospective study of rare cutaneous malignant adnexal tumors of head and neck in a tertiary care cancer hospital

Retrospective study of rare cutaneous malignant adnexal tumors of head and neck in a tertiary care cancer hospital

Fine-needle aspiration cytology of eccrine porocarcinoma of scalp – Report of a rare case with review of literature

Eccrine porocarcinoma is a rare malignant adnexal tumor of duct of eccrine sweat gland. Cytology of eccrine porocarcinoma has been described in very few literatures. Here, we are presenting a case of fine-needle aspiration cytology (FNAC) of eccrine porocarcinoma of scalp, confirmed subsequently by histology. Accurate preoperative diagnosis of eccrine porocarcinoma by FNAC is difficult but determining the malignant nature of the lesion is crucial for a curative surgery. FNAC can be a convenient, safe, and effective approach to solve difficult diagnostic dilemma.