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Apocrine Adenocarcinoma of the Skin

Dr Sampurna Roy MD

Dermatopathology Quiz Case 6

Diagnosis: Apocrine Carcinoma of the Skin

March 2014

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

 

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Benign sweat gland tumours

Cysts:

Hydrocystoma -Eccrine/Apocrine

Hamartomas:

Eccrine/Apocrine naevus

Eccrine  Angiomatous Hamartoma

Porokeratotic  eccrine ostial naevus

Benign Neoplasms:

Syringo cystadenoma Papilliferum

Hidradenoma Papilliferum

Nipple Adenoma

Syringoma

Spiradenoma

Cylindroma

Chondroid Syringoma (benign mixed tumour)

Poroma

Hidradenoma

Apocrine adenoma

Papillary eccrine adenoma

Syringo fibroadenoma

Malignant sweat gland tumour 

Low grade:

Microcystic  adnexal carcinoma

Eccrine  epithelioma

Adenoid cystic carcinoma

Mucinous carcinoma

Primary extramammary Paget’s disease

Intermediate grade:

Porocarcinoma

Digital papillary adenocarcinoma

High grade:

Hidradenocarcinoma

Apocrine adenocarcinoma

Eccrine ductal carcinoma

Spiradenocarcinoma

Malignant cylindroma

Sebaceous tumours

Fordyce's Spots

Steatocystoma

Nevus Sebaceous

Folliculosebaceous Cystic Hamartoma

Sebaceous Hyperplasia

Sebaceoma

Sebaceous Adenoma

Sebaceous Carcinoma

                                                                              
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 Moll’s 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.

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.

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.

Podoplanin immunostaining in cutaneous apocrine carcinoma and in cutaneous metastasis from the breast.

Apocrine gland carcinoma of the mammary skin concomitant with pagetoid phenomenon.

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.

Advanced vulvar apocrine carcinoma expressing estrogen receptors that responds to tamoxifen therapy.

Successful treatment of HER-2-positive metastatic apocrine carcinoma of the skin with lapatinib and capecitabine.

Primary apocrine carcinoma of scalp: report of primary scalp cutaneous apocrine carcinoma indistinguishable from cutaneous metastasis of breast carcinoma.

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.

Cartilaginous matrix-producing apocrine carcinoma of the skin.

Primary cutaneous cribriform apocrine carcinoma: a clinicopathologic and immunohistochemical study of 26 cases of an under-recognized cutaneous adnexal neoplasm.

Axillary apocrine carcinoma with benign apocrine tumours: a case report involving a pathological and immunohistochemical study and review of the literature.J Clin Pathol. 2005;58(7):757-61.

Perianal apocrine adenocarcinoma arising in a benign apocrine adenoma; first case report and review of the literature.J Clin Pathol. 2005 ;58(2):217-9.

Apocrine carcinoma of the vulva in a band-like arrangement with inflammatory and telangiectatic metastasis via local lymphatic channels.Int J Dermatol. 2003 ;42(1):71-4.

Apocrine adenocarcinoma of the eyelid with aggressive biological behavior: report of a case.Pathol Int. 2002 ;52(2):169-73.

Cytologic features of pleural effusion in apocrine sweat gland carcinoma. A case report.Acta Cytol. 2001 Jan-Feb;45(1):74-8.

Apocrine gland carcinoma of the axilla: review of the literature and recommendations for treatment. Am J Clin Oncol. 1999 ;22(2):131-5.

Two cases of cutaneous apocrine ductal carcinoma of the axilla. Case report and review of the literature. Dermatology 1999;199 (4): 332-337

Adenocarcinoma with signet ring cells of the axilla showing showing apocrine features: a case report. Am J Dermatopathol. 1999; 21(1): 37-41

Tubular apocrine carcinoma arising in a nevus sebaceus of Jadassohn.Am J Dermatopathol. 1998 Aug;20(4):389-92.

Apocrine adenocarcinoma presenting as a large ulcerated axillary mass.  Dermatol  Surg. 1997; 23(7) : 585-587

Apocrine carcinoma of the lip: a case report including immunohistochemical and ultrastructural study, discussion of differential diagnosis, and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82(2):193-9.

A case of apocrine adenocarcinoma associated with hamartomatous apocrine gland hyperplasia of both axilla. Am J Surg Pathol  1994; 18: 832-836 

A unique case of apocrine carcinoma on the male pubis skin: histopathologic and ultrastructural observations. J Cutan Pathol 1993; 20(4) : 378-383   

Apocrine carcinoma of the skin. A clinicopathologic, immunocytochemical and ultrastructural study. Cancer 1993; 71(2) : 375-381 

A unique case of apocrine carcinoma on the male pubic skin: histopathologic and ultrastructural observations.J Cutan Pathol. 1993 Aug;20(4):378-83.

Apocrine adenocarcinoma of the bilateral axillae. Acta Pathol Jpn 1991; 41:927-932

Apocrine adenocarcinoma: case report and review of the literature. J Dermatol Surg Oncol  1990 ;16: 468-470

Perianal apocrine gland adenoma. Arch Dermatol 1980;116:1051–3.

Apocrine adenoma versus apocrine adenocarcinoma. J Am Acad Dermatol 1980;2(4):322–6.

Apocrine gland adenoma and adenocarcinoma of the axilla. Arch Dermatol 1978; 114(2): 198-203. 


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