Malignant Clear Cell Hidradenoma Research Articles

Apocrine hidradenocarcinoma in eyelid with corneal invasion

Abstract Purpose Apocrine hidradenocarcinoma has been named with different terms as apocrine carcinoma, malignant clear cell hidradenoma, nodular hidradenocarcinoma, eccrine acrospiroma, and some others. This wide terminology, together with the rarity of the tumour and variability of the cells that compose it, make it difficult to diagnose. Methods Description of a case. Results 81 years‐old female, with a history of pterygium, subject to enucleation of the eye globe after a preoperative diagnosis of squamous cell carcinoma affecting ocular adnexa, this tumor infiltrated bulbar conjunctiva and cornea. Conclusion Malignant tumours of sweat glands are rare. Among these, hidradenocarcinoma has been described in multiple cutaneous locations and exceptionally in the eye. The frequency is not easy to determine because the terminology that has been used makes difficult to compare the data. In the eye, it may originate from glands of the eyelid or from lacrimal gland. The immunohistochemical study is not important for diagnosis. The neoplastic cells express low molecular weight cytokeratins, and cytokeratin 19. EMA and CEA are expressed in the luminal edge of glandular structures. It is an aggressive tumour, which can widely metastasize and can be cause of death.

Malignant Clear Cell Hidradenoma of the Vulva

Clear cell hidradenoma (CCH) is a rare tumor derived from eccrine sweat glands with a predilection for the head, face, and upper extremities. Its biologic behavior is unpredictable, although frank malignant transformation is reportedly rare (prevalence rate, 6.7% in a review). Malignant CCH (MCCH) exists only as case reports or very small series in the literature. We present a unique case of MCCH of the vulva with completely bland cytological features. A previously healthy 39-year-old woman underwent marsupialization of a presumed left-side vulval Bartholin gland cyst. Microscopy revealed a tumor with the features of CCH; no atypia, necrosis, or mitoses were observed. Ten months later, she developed enlarging left groin nodes, one of which contained a metastatic clear cell tumor. Radiological examination did not reveal any other primary source, and the diagnosis of MCCH was confirmed through an expert review. A reexcision of the vulval primary site, which contained residual tumor, was performed. The patient is currently free of any further recurrence 10 months after the excision of the lymph node metastasis. The case highlights the difficulty in predicting the behavior of CCH on the basis of histological examination alone. It also highlights the importance of considering MCCH in the differential diagnosis of a lymph node containing a metastatic clear cell tumor or an apparent metastatic clear cell lesion in the skin. We review the current literature on MCCH and discuss the problems in the differential diagnosis and treatment of this rare tumor.

Immunohistochemical Differentiation of Extra‐Ocular Sebaceous Carcinoma from Other Skin Cancers

We performed an immunohistochemical study using routinely processed formalin-fixed and paraffin-embedded tissue specimens from 26 cases of extra-ocular sebaceous carcinoma (EOSC) and eight easily available antibodies. They were polyclonal anti-carcinoembryonic antigen (CEA) antibody, monoclonal anti-CEA antibody, anti-breast carcinoma associated antigen-225 antibody (CU18), anti-CA15.3 antibody (CA15.3), anti-CD15 antibody (CD15), anti-breast carcinoma associated antigen antibody (B6.2), anti-gross cystic disease fluid antigen-15 antibody (GCDFP15) and anti-Thomsen-Friedenreich antigen antibody (TFA). Squamous cell carcinoma, porocarcinoma, syringomatous carcinoma, malignant clear cell hidradenoma, apocrine adenocarcinoma, and extramammary Paget's disease with underlying adenocarcinoma were used as controls. EOSC was positive for CU18 and CA15.3 in most cases, and for CD15 in a few cases. Squamous cell carcinoma of the skin was positive for CA15.3 in only one case. Porocarcinoma, syringomatous carcinoma and malignant clear cell hidradenoma were positive for CEA, CU18, CA15.3, and B6.2 in most cases. Apocrine adenocarcinoma and extramammary Paget's disease with underlying adenocarcinoma were positive for CEA, CU18, CD15, GCDFP15, CA15.3, and B6.2 in most cases. TFA was positive not only in EOSC but also in other skin cancers. Immunohistochemical examinations using these seven of eight antibodies except for TFA and routinely processed formalin-fixed and paraffin-embedded tissue specimens are beneficial in differentiating EOSC from other skin cancers.

Assessment of cellular proliferation of eccrine acrospiromas and eccrine sweat gland carcinomas by AgNOR counting and immunohistochemical demonstration of proliferating cell nuclear antigen (PCNA) and Ki-67.

Argyrophil nucleolar organizer regions (AgNORs) were counted and immunostaining using antibodies raised against proliferating cell nuclear antigen (PCNA) and Ki-67 was carried out on eccrine acrospiroma and eccrine sweat gland carcinoma, to determine the malignant potential and prognosis of these tumours. Formalin-fixed and paraffin-embedded tissue specimens surgically excised from 25 patients with eccrine sweat gland carcinoma (20 cases of eccrine porocarcinoma, four cases of ductal sweat gland carcinoma and one case of malignant clear cell hidradenoma) and 25 patients with eccrine acrospiroma (16 cases of eccrine poroma, four cases of poroid hidradenoma and five cases of clear cell hidradenoma) were used. PCNA and Ki-67 labelling indices were categorized semiquantitatively into four grades. Significant differences were noted between eccrine sweat gland carcinoma and eccrine acrospiroma with these three methods (P < 0.01). When a cut-off of 5 was chosen, the AgNOR value distinguished eccrine sweat gland carcinoma from eccrine acrospiroma with high specificity and sensitivity. Moreover, we compared the results of these three methods between stages 1 or 2 (17 cases) and stage 3 (eight cases) eccrine sweat gland carcinomas, and no significant differences were observed. From these findings, these three methods are useful in discriminating malignant from benign lesions of eccrine tumours, but have no value in estimating the aggressiveness of eccrine sweat gland carcinomas.

An Immunohistochemical Study of BCA‐225 in Various Skin Cancers

We performed an immunohistochemical study of BCA-225, which is a glycoprotein secreted by the T47D breast carcinoma cell line and recognized by monoclonal antibody BRST-1 (clone name: CU-18), in normal skin and various skin cancers. In normal skin, BCA-225 was positive only in the secretory portion of both eccrine and apocrine glands and in mature cells of the sebaceous gland. We observed 10 cases of squamous cell carcinoma of the skin, 10 cases of basal cell carcinoma without sebaceous differentiation, 3 cases of basal cell carcinoma with sebaceous differentiation, 6 cases of malignant trichilemmoma, 8 cases of eccrine porocarcinoma, 3 cases of ductal carcinoma, 1 case of malignant clear cell hidradenoma, 1 case of apocrine adenocarcinoma, 6 cases of extra-ocular sebaceous carcinoma, 5 cases of extramammary Paget's disease with underlying adenocarcinoma, and 11 cases of extramammary Paget's disease without underlying adenocarcinoma. Most of the cases of sweat gland carcinoma, basal cell carcinoma with sebaceous differentiation, sebaceous carcinoma, and extramammary Paget's disease were positive for BCA-225, while none of the cases of squamous cell carcinoma, basal cell carcinoma without sebaceous differentiation, or malignant trichilemmoma were positive. Based on these findings, we believe that BCA-225 is useful in distinguishing tumors with sweat gland and sebaceous differentiation and extramammary Paget's disease from tumors without such differentiation.

A histochemical and immunohistochemical study of extra‐ocular sebaceous carcinoma

A histochemical and immunohistochemical study of five cases of extra-ocular sebaceous carcinoma was performed using formalin-fixed and paraffin-embedded tissue specimens. Histochemically, the clear cells of sebaceous carcinomas were negative with periodic acid-Schiff and alcian blue staining. Immunohistochemically, the tumour cells of sebaceous carcinomas showed positive reactions for epithelial membrane antigen, human milk fat globules subclass 1, human milk fat globules subclass 2 and Leu M1, but did not express carcinoembryonic antigen, breast carcinoma associated antigen, S-100 protein, gross cystic disease fluid protein-15 or Dako M1. These histochemical and immunohistochemical findings were compared with those of other skin cancers which must be distinguished histopathologically from sebaceous carcinoma. We conclude that sebaceous carcinoma can be distinguished from eccrine porocarcinoma, malignant clear cell hidradenoma, extramammary Paget's disease, malignant trichilemmoma, squamous cell carcinoma and basal cell carcinoma by histochemical and immunohistochemical techniques using formalin-fixed and paraffin-embedded tissue specimens.

エクリン汗器官癌２１例の臨床病理学的研究

Clinicopathological studies of 21 cases of eccrine sweat gland carcinoma were performed. The average of 8 men and 13 women was 71.7 years. The tumors were mostly located on the face occuring next in frequency on the extremities and scalp. Clinically, they were separated into 3 different types. Regional lymph node metastases and local reccurences were mostly seen in type B. There was only one case died of these tumors with the treatments according to those of squamous cell carcinoma of the skin. Histopathologically, we separated these tumors into 3 types-eccrine porocarcinoma (EPC), syringomatous carcinoma (SC) and malignant clear cell hidradenoma (MCCH) . EPC was composed of poroma like cells (PC) that had small and basophilic cytoplasm, and clear cell (CC) . SC contained the cells similar to PC and MCCH consisted of both PC and CC. The keratinization was not seen in any types and tubular structure was the characteristic of this tumor. SC often showed local recurrences and regional lymph node metastases.

頬部に発生した悪性澄明細胞汗腺腫の１例

We reported a 72-year-old man developed a malignant clear cell hidradenoma of the cheek. One year ago, the tumor was rice grainsized, but in a few months the tumor grew rapidly.It was treated by resection but recurred soon thereafter. The lesion distended capillary and red-dish colored with ulceration in the center part. The tumor invaded from the skin into the subcutaneous tissue, showing big and small tubular as well as cystic stractures. The tumor was consisted mainly of clear cells. Therefore, the diagnosis of clear cell hidradenoma was made. We report a case of malignant clear cell hidradenoma and a review of the literatureconcerned.

Malignant clear cell hidradenoma: a case report

A 73-year-old man developed a malignant clear cell hidradenoma on the nose. Although it was treated solely with diathermy and curettage it did not recur. These rare tumours are histologically malignant but do not always behave aggressively. In some patients local growth and recurrence may occur, while in others the tumour metastasizes widely. There is no way of predicting how these tumours will behave.