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Pathology of Apocrine Adenocarcinoma of the Skin

 

Dr Sampurna Roy MD      

 

Dermatopathology Quiz Case 6

Diagnosis: Apocrine Carcinoma of the Skin

 

                                                                                                                      

 

Apocrine adenocarcinoma comprises a group of rare primary cutaneous carcinomas, which show features of apocrine differentiation.

Site: Axilla or inguinal region and rarely in the nipple, finger and the scalp. 

Rarely, the tumour may arise in the Mollís glands of the eyelids.

Tumours arising from the anogenital region are regarded as carcinomas of the anogenital glands by some pathologists.

Clinical presentation: Slow growing lesions can be present as painless, solitary, or multiple, solid to cystic masses, ranging in size from 1 to over 5 cm.

Colour may vary from red to purple, and show ulceration of the overlying skin.

Microscopic features:  

       

Dermatopathology Quiz Case 6 

Non-encapsulated, infiltrative tumour located in the lower dermis and subcutaneous tissue  and consists of multiple ductal structures ; 

Different growth patterns include papillary, tubular, cribriform, cord-like and solid ; 

Eosinophilic cells with granular and sometimes vacuolated cytoplasm ; 

At least focal decapitation secretion ;

Variable mitotic activity and pleomorphism ;

Normal or hyperplastic apocrine glands are often identified close to the invasive tumour ;

Cells contain PAS-positive, diastase resistant granules ;

Hemosiderin granules may be present in the cytoplasm.

Non-encapsulated, infiltrative tumour located in the lower dermis and subcutaneous tissue  and consists of multiple ductal structures ; 

Different growth patterns include papillary, tubular, cribriform, cord-like and solid ; 

Eosinophilic cells with granular and sometimes vacuolated cytoplasm ; 

At least focal decapitation secretion ;

Variable mitotic activity and pleomorphism ;

Normal or hyperplastic apocrine glands are often identified close to the invasive tumour ;

Cells contain PAS-positive, diastase resistant granules ;

Hemosiderin granules may be present in the cytoplasm.

Immunohistochemistry: 

Tumour cells usually express cytokeratin, epithelial membrane antigen and gross cystic  disease fluid protein-15. 

Carcinoembryonic antigen is usually negative.

Some cases demonstrate positivity with S100 protein.

The tumours are initially locally invasive, and systemic dissemination is often associated with regional lymph node metastases.

Wide, local excision is the standard treatment for such lesions.

Adjuvant radiotherapy may be used in cases with advanced local or regional lesions.

Adjuvant radiotherapy may be used in cases with advanced local or regional lesions.

Differential diagnosis:

Metastatic breast carcinomas may be indistinguishable; Eccrine ductal carcinoma.

 

Further reading:

Unusual axillary apocrine carcinoma of the skin: histological diagnostic difficulties.

Primary cutaneous cribriform apocrine carcinoma on a typical location.

Primary cutaneous apocrine carcinoma versus metastasis, a plea to the dermatopathology community.

Primary cutaneous apocrine carcinoma arising within a congenital nevus: Keratins and filaggrin expression suggesting differentiation into the secretory cells of apocrine glands.

Apocrine carcinoma of the scrotum with extramammary Paget's disease.

Apocrine carcinoma of the scalp with aggressive clinical course--a case report and review of the literature.

Cutaneous metastases from breast carcinoma: calretinin expression and estrogen, progesterone and Her2/neu status of the metastases, compared to primary cutaneous apocrine tumors.

Cutaneous and mammary apocrine carcinomas have different immunoprofiles.

Apocrine carcinoma developing in a naevus sebaceous of scalp.

Apocrine-eccrine carcinomas: molecular and immunohistochemical analyses.

Cutaneous apocrine carcinoma masquerading as head and neck cellulitis: an ominous sign.

Cutaneous apocrine adenocarcinoma: defining epidemiology, outcomes, and optimal therapy for a rare neoplasm.

 

 

 

 

 


 

 

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