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              Path Quiz Case-30    

                        Microcystic Adnexal Carcinoma

                      Dr  Sampurna Roy  MD

             Case history and images:

 

 

    Skin Appendage Tmour

       

http://www.histopathology-india.net/SAClass.htm

              

Poroma represents a group of benign tumours characterised by monomorphous neoplastic epithelial cells that show ductal differentiation.

This tumour shows histological overlap with hidradenoma.

Previously some authors have grouped them together under the term 'acrospiroma'.

Some authors have subdivided Poroma into:   

Three subtypes of poroid neoplasia in a single lesion: eccrine poroma, hidroacanthoma simplex, and dermal duct tumor. Histologic, histochemical, and ultrastructural findings.Am J Dermatopathol. 1994;16(1):66-72.

1.Hidroacanthoma group:  Hidroacanthoma simplex or intraepidermal poroma (Smith and Coburn 1956) is a form of poroma in which nests of cells with tubular differentiation are confined to surface epidermis.

There is no evidence of dermal involvement. 

Differential diagnosis:  Includes melanocytic neoplasm and clonal seborrheic keratosis. Differentiation of hidroacanthoma simplex from clonal seborrheic keratosis-an immunohistochemical study.Am J Dermatopathol.2004;26(3):188-93.

2. Poroma group:  Intraepidermal and dermal

3. Dermal duct tumour - Intradermal lesion. 

Poroma containing prominent ductal lumina are known as "Dermal ductal tumour." (Winklemann RK and Mcleod WA 1966).

But the tendency , nowadays is to classify all forms as Poroma.

Recent analysis suggests that poromas can be of either eccrine or apocrine lineage.  Poroma of apocrine lineage are more common.

Clinically presents as solitary papule or nodule.

Site:  Poromas are usually located on the hands and feet .

Microscopic features: 

Image Link1 ; Image Link2 ; Image Link3 ; Image Link4 .

Well circumscribed lesions composed of small cuboidal epithelial cells with abundant eosinophilic cytoplasm, monomorphic ovoid nuclei and inconspicous nucleoli and distinct cytoplasmic margins  ; 

Cells are smaller than squamous cells and are connected by intercellular bridges ;

Tumour extends into the dermis as broad columns of cells from the epidermis ;  

Narrow ductal luminas within columns of tumour cells ;  

Cytoplasmic vacuolation - intracytoplasmic lumen formation - within some centrally located tumour cells ; 

Occasionally cystic spaces within lobules of tumour cells ;

Amorphous, eosinophilic material is often present in the cystic spaces ;

Backround stroma contains eosinophilic hyalinized collagen and blood vessels ; 

Focal sebaceous, pilar and rarely apocrine differentiation may be identified.

Immunohistochemistry:  

Immunopositivity to CEA, specially in the ductal areas. Cytokeratin is also positive. 

IMAGE LINK:(Dr Weems)           

Hidroacanthoma Simplex: CLICK HERE

Poroma:                      
  CLICK HERE

Dermal duct tumour:          CLICK HERE

                 

Abstracts:

Clinical and histological characteristics of poroid neoplasms: a study of 25 cases in Taiwan.Int J Dermatol. 2006 Jun;45(6):722-7.

A rapidly growing eccrine poroma in a pregnant woman.J Am Acad Dermatol. 2004 Jan;50(1):124-6.

Eccrine poroma: a differential diagnosis in chronic foot lesions.Foot Ankle Int. 2003;24(10):789-92.

Cytokeratin expression of apocrine and eccrine poromas with special reference to its expression in cuticular cells.J Cutan Pathol 2001;28(1):55.

Apocrine poroma of the breast.Breast J. 2001;7(3):195-8.

"Apocrine" poroma: review of the literature and case report.J Cutan Pathol. 2001 Feb;28(2):101-4.

Eccrine poroma of the eyelid.Clin Experiment Ophthalmol. 2001;29(4):253-5.

Poromas of the head and neck.J Am Acad Dermatol. 2001 ;44(1):48-52.

P53 protein expression in eccrine poroma and porocarcinoma.Am J Dermatopathol. 2001;23(5):402-6.

Benign and malignant eccrine poroma--a flow cytometric comparison.Isr J Med Sci. 1996;32(12):1151-3.

Eccrine or apocrine poroma? Six poromas with divergent adnexal differentiation.Am J Dermatopathol. 1996 Feb;18(1):1-9.

Calcification of eccrine poroma.J Dermatol. 1994 Dec;21(12):979-81

Tumours of the Hair Follicle

Hair Germ Differentiation:

Trichoepithelioma  ; Desmoplastic Trichoepithelioma  ; Trichofolliculoma ;

Trichoblastoma; Cutaneous lymphadenoma ;

                          
    
Infundibular differentiation:

Trichoadenoma; Dilated Pore of Winer ; Pilar Sheath Acanthoma ;

Tumour of Follicular Infundibulum;

Outer root sheath differentiation:
                    
Trichilemmoma ; Trichilemmal Carcinoma ; Proliferating Trichilemmal Cyst (Pilar Tumour) ;

Matrical differentiation: Pilomatrixoma and Pilomatrix Carcinoma

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Sebaceous tumours ; Fordyce's Spots  ; Steatocystoma ; Nevus Sebaceous  ; Folliculosebaceous Cystic Hamartoma ;Sebaceous Hyperplasia ;Sebaceoma ; Sebaceous Adenoma; Sebaceous Carcinoma ;
Benign sweat gland tumours

Cysts:

Hydrocystoma -Eccrine/Apocrine

Hamartomas:

Eccrine/Apocrine naevus

Eccrine Angiomatous Hamartoma

Porokeratotic eccrine ostial naevus

Benign Neoplasms:

Syringocystadenoma Papilliferum

Hidradenoma Papilliferum

Nipple Adenoma

Syringoma

Spiradenoma

Cylindroma

Chondroid Syringoma 

Poroma

Hidradenoma

Apocrine adenoma

Papillary eccrine adenoma

Syringofibroadenoma

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


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