 Site created by Dr Sampurna Roy MD
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Dr Sampurna Roy
MD
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| Adnexal Tumours of the eyelid |
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Benign sweat gland tumours Cysts: Hydrocystoma -Eccrine/Apocrine Porokeratotic eccrine ostial naevus Benign Neoplasms: Syringocystadenoma Papilliferum Chondroid Syringoma (benign mixed tumour) Low grade: Primary extramammary Paget’s disease Intermediate grade: Digital papillary adenocarcinoma High grade: |
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Cutaneous infection and infestations Histopathological patterns in cutaneous infections |
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Aggressive digital papillary adenocarcinoma (Digital Papillary Adenocarcinoma) is a rare variant of sweat gland carcinoma of the digits and volar surfaces which has the potential for highly aggressive biological behaviour. Papillary lesions of the digits were first described in 1987. Aggressive digital papillary adenoma and adenocarcinoma. A clinicopathological study of 57 patients, with histochemical, immunopathological, and ultrastructural observations.J Cutan Pathol. 1987 Jun;14(3):129-46. Based mostly on histologic criteria these lesions were subtyped as: i) Aggressive digital papillary adenoma ii) Aggressive digital papillary adenocarcinoma . Subsequent follow-up has shown that it was not possible to distinguish reliably these two entities . Neither clinical nor histologic features were indicative of biologic behavior of these tumours. Metastatic disease occurred equally with either Aggressive digital papillary adenoma or Aggressive digital papillary adenocarcinoma . The term 'adenoma' was abandoned as all papillary digital neoplasms seemed to have an aggressive behaviour despite benign histologic appearance. Site: Occurs exclusively on fingers, toes and adjacent skin of palms and soles. Clinical presentation: Presents as a solitary, painless, cystic nodule, usually less than 2cm in diameter. Gross features: Tumour has been described as being tan-gray to white-pink and rubbery. Microscopic features: A poorly circumscribed lesion which involves dermis and subcutis ; Consists of both solid and cystic components ; Tubulo-alveolar and ductal structures with areas of papillary projections protruding into cystic lumina ; Cribriform pattern may be present ; Glandular structures contain eosinophilic material ; Solid area is characterized by back-to-back glands lined by cuboidal or low columnar epithelium ; Backround stroma displays thin fibrous septa to areas of dense hyalinized collagen ; Mitotic figures are noted ; Cytologic atypia is usually not striking.
Some cases show poor glandular differentiation, poorly defined
borders, clear cut infiltrative properties, focal necrosis and
cytological evidence of malignancy.
There may be invasion of soft tissues, blood vessels and underlying
bones. Recognition of these tumors is important because of a potential risk of local recurrence ( 40 - 50% of patients) and distant metastases (14% of patients), usually involving lymph nodes and/or lungs. Aggressive surgical treatment consisting of wide local excision with clear margins and close surveillance for signs of recurrence or metastasis are indicated for this rare sweat gland neoplasm. Differential diagnosis: May be misdiagnosed particularly for a metastasis of papillary adenocarcinoma originating in the colon, thyroid, or breast. Clinicopathological correlation is essential to rule out a possible risk of metastatic carcinoma of the skin. Papillary eccrine adenoma: The ductal structures are larger and more dilated than those in the papillary eccrine adenoma |
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Abstracts: Aggressive digital papillary adenocarcinoma: a case report. Pathologica. 2003;95(6):447-51. Metastatic aggressive digital papillary adenocarcinoma. Cutis. 2003;72(2): 145-7. Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited).Am J Surg Pathol. 2000;24(6): 775-84. Aggressive digital papillary adenocarcinoma of the foot: the clinicopathologic features of two cases. J Foot Ankle Surg. 2000;39(6):402-5. Aggressive digital papillary adenocarcinoma.J Am Acad Dermatol.1990;23 (2 Pt 2):331-4. Carcinomas of sweat glands. Pathology Annual 22 (Pt 1), 1987; 88-124 . Sweat gland carcinomas: a comprehensive review. Sem Diag Pathol.1987; 4:38-74,
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Tumours of the Hair Follicle Hair Germ Differentiation: Desmoplastic Trichoepithelioma
Cutaneous lymphadenoma
Tumour of Follicular Infundibulum Outer root
sheath differentiation: Proliferating Trichilemmal Cyst (Pilar Tumour)
Matrical differentiation: |
| Lichen planus-like lesions |