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Dermpath-India

Malignant Sweat Gland Tumours

Dr Sampurna Roy MD   

 

                                                                                                                      

 

Malignant sweat gland tumours are a rare and heterogeneous group of tumours.

Because of their rarity, their definition and categorization is difficult.

These are primary cutaneous malignant tumours which show glandular/ductal formation that is presumed to reflect differentiation toward eccrine or apocrine ducts and/or glands.

Most benign sweat gland tumours have a malignant counterpart (Example: Malignant eccrine poroma, malignant mixed tumour, hidradenocarcinoma).

An accurate diagnosis depends on the identification of the residual benign component.

A small number of malignant sweat gland tumours do not have a benign counterpart and their identification rests on recognition of distinctive histological features (i.e Aggressive Digital Papillary Adenocarcinoma).

Diagnosis:

- To make a diagnosis of sweat gland carcinoma one should first establish that the tumour shows sweat gland differentiation.

-  Sweat gland differentiation is recognized by identification of extracellular ductal or intracytoplasmic lumen formation.

This can be highlighted by their diastase-resistant PAS, EMA and CEA positivity.

Demonstration of S100 protein may be useful pointer to sweat gland differentiation.

- Distinction of some types of sweat gland carcinoma from metastatic adenocarcinoma is not possible on morphological grounds.

Immunohistochemistry except for a few cases (prostate and thyroid) does not allow distinction between a primary malignant adnexal tumour and a metastatic tumour.

Malignant sweat gland tumour are often positive for oestrogen and progesterone receptors and these markers are therefore of limited usage in differential diagnosis.

- Diagnosis of malignancy is based on a combination of histological findings which include infiltrative growth pattern, cytological atypia, mitotic count, necrosis and vascular and perineural invasion.

- Diagnosis of malignancy should not be made based on a single  histological finding as benign tumours have frequent mitotic figures and focal  cytological atypia which is often degenerative in nature.

Classification of malignant sweat gland tumours is necessary because:

-Different types of tumour have different natural history and clinical behaviour.

Low grade  - Locally aggressive, but little risk of metastases.

Intermediate grade - Locally aggressive, increasing risk of metastases.

High grade - High risk of metastases

-Some cases may be clearly distinguished histologically from metastatic tumours, whereas others cannot.

 

     

Low grade:

Microcystic adnexal carcinoma

Eccrine epithelioma

Adenoid cystic carcinoma

Mucinous carcinoma

Primary extramammary Pagetís disease

 

  

Intermediate grade:

Porocarcinoma

Digital papillary adenocarcinoma

 

High grade:

Hidradenocarcinoma

Apocrine adenocarcinoma

Eccrine ductal carcinoma

Spiradenocarcinoma

Malignant cylindroma

 

Further reading:  

Apocrine-eccrine carcinomas: molecular and immunohistochemical analyses.

A brief review of different types of sweat-gland carcinomas in the eyelid and orbit.

Endocrine mucin-producing sweat gland carcinoma: report of two cases of an under-recognized malignant neoplasm and review of the literature.

An immunohistochemical panel to differentiate metastatic breast carcinoma to skin from primary sweat gland carcinomas with a review of the literature.

[Sweat gland carcinomas of the skin].

Skin adnexal neoplasms--part 2: an approach to tumours of cutaneous sweat glands.

Carcinomas of sweat glands: report of 60 cases.  

Adnexal carcinomas of the skin.

Eccrine sweat gland carcinoma: an histologic and immunohistochemical study of 32 cases.

Carcinoma of eccrine sweat gland: experience with chemotherapy, autopsy findings in a patient with metastatic eccrine carcinoma, and a review of the literature.

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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