Difference between revisions of "Dermatologic neoplasms"

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This article deals with '''dermatologic neoplasms'''.  It includes '''dermatologic cancer''', which can be deadly.  Collectively, dermatologic cancers are the most common form of cancer.
This article deals with '''dermatologic neoplasms''', also known as '''skin tumours'''.  It includes '''dermatologic cancer''', which can be deadly.  Collectively, dermatologic cancers are the most common form of cancer.


==Squamous cell carcinoma==
An introduction to dermatopathy is found in the ''[[dermatopathology]]'' article. Non-malignant disease is covered in the ''[[non-malignant skin disease]]'' article.
Precursor:<ref>TN07 D6.</ref>
*Actinic keratosis (solar keratosis).
**Clinical: yellow-brown scaly, patches, sandpaper sensation.
*Keratocathoma - see ''[[non-malignant skin disease]]''.
**Some don't believe this entity exists.
***These people sign this entity as ''low grade squamous cell carcinoma, keratoacanthoma type''.<ref>RS. 17 May 2010.</ref>


=The Big Three malignant=
==Basal cell carcinoma==
==Basal cell carcinoma==
===General===
{{Main|Basal cell carcinoma}}
*Very common.
 
*Sun exposed skin.
==Squamous cell carcinoma of the skin==
*Very rarely metastasizes - so rare... some don't think this is really a malignancy.
*Abbreviated ''skin SCC'', ''SCC of the skin'', and ''SCC of skin''.
{{Main|Squamous cell carcinoma of the skin}}
 
==Melanoma==
{{Main|Malignant melanoma}}
*Known as the great mimicker in pathology; it may look like many things.
 
=Less common malignant=
==Dermatofibrosarcoma protuberans==
*Abbreviated ''DFSP''.
{{Main|Dermatofibrosarcoma protuberans}}


===Clinical===
==Cutaneous B-cell lymphoma==
*Telangiectasias.
*Abbreviated CBCL.
*Raised pearly nodule.


====As part of a syndrome====
===General===
*Nevoid basal cell carcinoma syndrome (NBCCS), AKA ''Gorlin syndrome''.
*CBCL is less common than cutaneous T-cell lymphoma (CTCL).<ref>URL: [http://emedicine.medscape.com/article/1099540-overview http://emedicine.medscape.com/article/1099540-overview]. Accessed on: 24 August 2010.</ref>
*Bazex syndrome (X-linked).<ref>URL: [http://emedicine.medscape.com/article/1101146-diagnosis http://emedicine.medscape.com/article/1101146-diagnosis]. Accessed on: 6 May 2010.</ref>


===Microscopic===
===Microscopic===
Features:<ref>NEED REF.</ref>
Features:
*Artefactual separation of basal cell layer from underlying stroma.
*Dermal lymphoid infiltrate.
*Palisading hyperchromatic cells.
*"Grenz zone" - space between the epidermis and the dermal infiltrate - '''key feature'''.


Notes:
===IHC===
*There are various subtypes: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970110-3 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970110-3].
*B cell and T cell markers.  


DDx:
==Cutaneous T-cell lymphoma==
*Trichoepithelioma.
*Abbreviated CTCL.
{{Main|Cutaneous T-cell lymphoma}}


==Melanoma==
==Merkel cell carcinoma==
*[[AKA]] ''Malignant melanoma''.
{{Main|Merkel cell carcinoma}}
*Main DDx: [[melanocytic lesions]] - especially if pigmented.
*Known as the great mimicker in pathology; it may look like many things.


===Clinical===
==Eccrine carcinoma==
*''ABCD'' = asymmetric, borders (irregular), colour (black), diameter (large).
===General===
*Arises from the proximal sweat duct.


===Histology===
===Microscopic===
*Classic appearance of melanoma:  
Features:
**Loosely cohesive; mix of small nests of cells, single cells.
*Pleomorphic nuclei with nucleoli.
**Mixed of spindle and ovoid cell morphology.
*Duct-like structures - '''key feature'''.
**+/-Occasional large binucleated cells.
*Extends from dermis into epidermis (follows path of a benign sweat duct).
**Cytoplasm: brown pigment (melanin).
**Prominent (large) red nucleoli (like in ''serous carcinoma'' of the ovary).
**Marked nuclear pleomorphism - variation in cell size, shape & staining (like in ''serous carcinoma'' of the ovary).
**Nuclear pseudoinclusions (like in ''papillary thyroid carcinoma'').


Notes:
Notes:
*Can look almost like anything.
*May resemble [[Extramammary Paget's disease]]/[[Paget's disease of the breast]].
**Like it is said that [[sarcoidosis]] is in every internal medicine DDx... melanoma is every pathologic DDx.
*Melanomas with:
**An epitheloid cell morphology may mimic adenocarcinoma.
**A spindle cell morphology may mimic spindle cell carcinoma (squamous cell carcinoma) or a sarcoma.


===Stains===
==Kaposi sarcoma==
*''Fontana-Masson stain'', stains melanin.<ref>URL: [http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exfontana.htm http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exfontana.htm]. Accessed on: 5 May 2010.</ref>
:See ''[[Kaposi sarcoma]]''.
**May be useful to differentiate melanin from other brown stuff (e.g. lipofuscin, hemosiderin).
 
==Sebaceous carcinoma==
{{Main|Sebaceous carcinoma}}
 
==Microcystic adnexal carcinoma==
{{Main|Microcystic adnexal carcinoma}}
 
==Trichilemmal carcinoma==
{{Main|Trichilemmal carcinoma}}


===Electron microscopy===
==Lymphomatoid papulosis==
*Melanosomes.
===General===
*Rare.
*Benign behaviour.


Image(s):
===Microscopic===
*[http://www.nature.com/nrm/journal/v8/n10/fig_tab/nrm2258_F1.html Melanosomes (nature.com)].
Features:
*Dermal lymphocytosis.
**No epidermal lymphocytes.
*Focal nuclear atypia.


===[[IHC]]===
DDx:
Standard panel:
*[[CTCL]].
*S-100 +ve.
*Cutaneous [[ALCL]].
*HMB-45 +ve.
*Melan A (MART-1) +ve.


Notes:
===IHC===
*The standard panel above is positive in other lesions also, e.g. ''cellular blue nevus''.
*CD30 +ve.<ref>URL: [http://path.upmc.edu/cases/case513/dx.html http://path.upmc.edu/cases/case513/dx.html]. Accessed on: 25 January 2012.</ref>


==Dermatofibrosarcoma protuberans==
=Rare malignant=
==Basosquamous carcinoma==
:Should '''not''' be confused with ''basaloid [[squamous cell carcinoma]]'' ([[AKA]] ''squamous cell carcinoma, basaloid variant'').
===General===
===General===
*Abbreviated ''DFSP''.
*Very rare.
*Dermal location.
**Largest case series, as of 2000, 35 cases.<ref name=pmid10717618>{{Cite journal  | last1 = Martin | first1 = RC. | last2 = Edwards | first2 = MJ. | last3 = Cawte | first3 = TG. | last4 = Sewell | first4 = CL. | last5 = McMasters | first5 = KM. | title = Basosquamous carcinoma: analysis of prognostic factors influencing recurrence. | journal = Cancer | volume = 88 | issue = 6 | pages = 1365-9 | month = Mar | year = 2000 | doi =  | PMID = 10717618 }}
*Destroys adnexal structures.
</ref>
*May be considered an aggressive variant of [[basal cell carcinoma]].<ref name=pmid10717618/>
*Aggressive behaviour.<ref name=pmid12859383>{{Cite journal  | last1 = Bowman | first1 = PH. | last2 = Ratz | first2 = JL. | last3 = Knoepp | first3 = TG. | last4 = Barnes | first4 = CJ. | last5 = Finley | first5 = EM. | title = Basosquamous carcinoma. | journal = Dermatol Surg | volume = 29 | issue = 8 | pages = 830-2; discussion 833 | month = Aug | year = 2003 | doi =  | PMID = 12859383 }}.</ref>


Treatment
===Microscopic===
*Wide excision.
Features:
*Has features of both [[basal cell carcinoma]] and [[squamous cell carcinoma of the skin|squamous cell carcinoma]].<ref name=pmid12859383/>
**BCC component usually predominant.<ref name=Ref_Derm397>{{Ref Derm|397}}</ref>


===Histology===
Note:
*Spindle cell morphology.
*''Busam'' notes that there is disagreement about what defines this tumour;<ref name=Ref_Derm372>{{Ref Derm|372}}</ref> however, he goes on the describe it as a ''[[collision tumour]]''.<ref name=Ref_Derm397>{{Ref Derm|397}}</ref>
*Contains adipose tissue within the tumour -- ''key feature''.


===IHC===
DDx:
Panel:<ref>AP. May 2009.</ref>
*Basaloid [[squamous cell carcinoma]].
*CD34 +ve.
*[[Basal cell carcinoma]] with squamous differentiation.
**Usually negative in dermatofibroma.<ref name=pmid7694515>PMID 7694515.</ref><ref name=pmid9129699>PMID 9129699.</ref>
*Factor XIIIa -ve.
**Usually positive in dermatofibroma.<ref name=pmid7694515>PMID 7694515.</ref><ref name=pmid9129699>PMID 9129699.</ref>
*S100 -ve (screen for melanoma).
*caldesmin -ve (screen for muscle differentiation).
*beta-catenin ???.
*MIB-1 (proliferation marker) -- should not be confused with ''MIB1'' a gene that regulates [[apoptosis]].


===DDx - histologic===
=Intermediate=
*Dermatofibroma - has entrapment of collagen bundles at the edge of the lesion.
==Atypical fibroxanthoma==
*Abbreviated ''AFX''.
{{Main|Atypical fibroxanthoma}}


=Benign=
==Syringoma==
{{Main|Syringoma}}


==Cutaneous T cell lymphoma==
==Chondroid syringoma==
*Abbreviated CTCL.
*Used to be called ''mixed tumour of skin''.<ref name=pmid19693940>{{Cite journal  | last1 = Kumar | first1 = B. | title = Chondroid syringoma diagnosed by fine needle aspiration cytology. | journal = Diagn Cytopathol | volume = 38 | issue = 1 | pages = 38-40 | month = Jan | year = 2010 | doi = 10.1002/dc.21159 | PMID = 19693940 }}</ref>


===General===
===General===
*''Mycosis fungoides'' - is a subtype (???).
*Mixed apocrine & eccrine tumour of skin, usually in the head & neck<ref name=pmid19693940/>, especially nose and cheek.<ref name=pmid19633639/>
*CTCL is more common than cutaneous B-cell lymphoma (CBCL).<ref>URL: [http://emedicine.medscape.com/article/1099540-overview http://emedicine.medscape.com/article/1099540-overview]. Accessed on: 24 August 2010.</ref><ref>URL: [http://emedicine.medscape.com/article/1098342-overview http://emedicine.medscape.com/article/1098342-overview]. Accessed on: 24 August 2010.</ref>
*May be in major and minor salivary glands.<ref name=pmid19633639>{{Cite journal  | last1 = Rauso | first1 = R. | last2 = Santagata | first2 = M. | last3 = Tartaro | first3 = G. | last4 = Filipi | first4 = M. | last5 = Colella | first5 = G. | title = Chondroid syringoma: a rare tumor of orofacial region. | journal = Minerva Stomatol | volume = 58 | issue = 7-8 | pages = 383-8 | month =  | year =  | doi =  | PMID = 19633639 }}</ref>


===Microscopic===
===Microscopic===
*Atypical lymphocytes:
Features:
**Have folded "cerebriform" nuclei; ''Sezary-Lutzner cells''.<ref>Klatt. AOP. P.385.</ref>
*Mix tumour with:<ref name=pmid19693940/>
*Grouping:
*#Epithelial component:
**Nests in the epidermis - known as "Pautrier microabscesses".
*#*Nests of cells with:
**Single lymphocytes in epidermis; "lymphocyte exocytosis".<ref>URL: [http://www.mdconsult.com/das/book/body/199872830-2/0/1709/I4-u1.0-B978-0-443-06694-8..50117-2--f2.fig http://www.mdconsult.com/das/book/body/199872830-2/0/1709/I4-u1.0-B978-0-443-06694-8..50117-2--f2.fig]. Accessed on: 6 May 2010.</ref>
*#**Moderate dull eosinophilic cytoplasm.
**Short linear arrays of lymphocytes along the basal layer of the epidermis; "epidermotropism".<ref>Klatt. AOP. P.385.</ref>
*#**Round/ovoid nuclei with nucleoli.
*#Mesenchymal component - '''key feature''':
*#*[[Chondromyxoid stroma]].
 
Images:
*[https://www.dermnetnz.org/topics/apocrine-mixed-tumour-pathology Chondroid syringoma  (DermnetNZ)].
 
==Dermal cylindroma==
{{Main|Dermal cylindroma}}


Images:
==Keratoacanthoma==
*[http://www.jci.org/articles/view/24826/figure/2 CTCL (jci.org)].
{{Main|Keratoacanthoma}}
*[http://www.mdconsult.com/das/book/body/199872830-2/0/1709/I4-u1.0-B978-0-443-06694-8..50117-2--f2.fig CTCL (mdconsult.com)].


==Merkel cell carcinoma==
==Sebaceous adenoma==
===General===
===General===
Features:<ref name=pmid20418670>{{Cite journal  | last1 = Calder | first1 = KB. | last2 = Smoller | first2 = BR. | title = New insights into merkel cell carcinoma. | journal = Adv Anat Pathol | volume = 17 | issue = 3 | pages = 155-61 | month = May | year = 2010 | doi = 10.1097/PAP.0b013e3181d97836 | PMID = 20418670 }}</ref>
*Seen in [[Muir-Torre syndrome]] - a variant of [[Lynch syndrome]] (hereditary non-polyposis colon cancer).
*Rare.
 
*Aggressive course/poor prognosis.
Notes:
*Neuroendocrine-like.<ref name=pmid19395876>{{Cite journal  | last1 = Pulitzer | first1 = MP. | last2 = Amin | first2 = BD. | last3 = Busam | first3 = KJ. | title = Merkel cell carcinoma: review. | journal = Adv Anat Pathol | volume = 16 | issue = 3 | pages = 135-44 | month = May | year = 2009 | doi = 10.1097/PAP.0b013e3181a12f5a | PMID = 19395876 }}
*Sebaceous lesions (from benign to malignant): [[sebaceous hyperplasia]], sebaceous adenoma, sebaceoma, [[sebaceous carcinoma]].
</ref>
 
===Microscopic===
Features:
*Abnormal sebaceous glands (pale fluffy cytoplasm):
**Increased basal epithelium.
**Multiple dilated glands - opening to the surface.
 
====Images====
<gallery>
Image:Sebaceous_adenoma_-_low_mag.jpg | Sebaceous adenoma - low mag. (WC/Nephron)
Image:Sebaceous_adenoma_-_high_mag.jpg | Sebaceous adenoma - high mag. (WC/Nephron)
</gallery>
www:
*[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=587283984 Sebaceous adenoma (jhmi.edu)].
 
==Trichilemmoma==
*May be spelled ''tricholemmoma''.
{{Main|Trichilemmoma}}
 
==Poroma==
{{Main|Poroma}}
 
==Nodular hidradenoma==
*[[AKA]] ''eccrine acrospiroma''.<ref name=pmid18319032>{{Cite journal  | last1 = Punia | first1 = RP. | last2 = Garg | first2 = S. | last3 = Bal | first3 = A. | last4 = Mohan | first4 = H. | title = Pigmented nodular hidradenoma masquerading as nodular malignant melanoma. | journal = Dermatol Online J | volume = 14 | issue = 1 | pages = 15 | month = | year = 2008 | doi = | PMID = 18319032 |URL = http://dermatology.cdlib.org/141/case_presentations/hidradenoma/punia.html }}</ref>
{{Main|Nodular hidradenoma}}
 
==Trichoblastoma==
{{Main|Trichoblastoma}}
 
==Trichofolliculoma==
{{Main|Trichofolliculoma}}


Etiology:
==Apocrine carcinoma of the skin==
*Polyomavirus (?).<ref name=pmid20418670/>
===General===
*Immunocompromised/immunosuppressed (e.g. organ transplant recipients).
*Rare.<ref name=pmid7678545>{{Cite journal  | last1 = Paties | first1 = C. | last2 = Taccagni | first2 = GL. | last3 = Papotti | first3 = M. | last4 = Valente | first4 = G. | last5 = Zangrandi | first5 = A. | last6 = Aloi | first6 = F. | title = Apocrine carcinoma of the skin. A clinicopathologic, immunocytochemical, and ultrastructural study. | journal = Cancer | volume = 71 | issue = 2 | pages = 375-81 | month = Jan | year = 1993 | doi =  | PMID = 7678545 }}</ref>
*Usually very good prognosis.<ref name=pmid7678545/>


===Microscopic===
===Microscopic===
Features:<ref name=Ref_WMSP491>{{Ref WMSP|491}}</ref>
Features:<ref name=pmid7678545/>
*Nests or sheets or trabeculae.
*Nests.
*Scant cytoplasm.
*Apocrine snouts - "decapitation secretion"
*Nuclear moulding.
 
*Multiple small nucleoli.
DDx:
*Usually mitotically active.
*[[Paget disease of the breast]]/[[Extramammary Paget disease]].


Image:
====Images====
*[http://www.ispub.com/ispub/ijd/volume_5_number_2_8/concurrent_merkel_cell_carcinoma_and_bowen_s_disease_of_the_thigh/bowen-fig3.jpg Merkel cell carcinoma (ispub.com)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Merkelcellcarcinoma_Tag.jpg Merkel cell carcinoma - nested pattern (WC)].
Image:Apocrine_carcinoma_-_intermed_mag.jpg | Apocrine carcinoma - intermed. mag. (WC/Nephron)
Image:Apocrine_carcinoma_-_high_mag.jpg | Apocrine carcinoma - high mag. (WC/Nephron)
</gallery>
===Stains===
Features:<ref name=pmid7678545/>
*PAS +ve.
*PASD +ve.


===IHC===
===IHC===
*CK7 -ve, CK20 +ve
*[[GCDFP-15]] (gross cystic disease fluid protein-15) +ve.<ref name=pmid7678545/>


==Eccrine carcinoma==
==Dermatomyofibroma==
:Should ''not'' be confused with [[dermatofibroma]].
*Abbreviated ''DMF''.
===General===
===General===
*Arises from the proximal sweat duct.
*Uncommon.


===Microscopic===
===Microscopic===
Features:
Features:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*Pleomorphic nuclei with nucleoli.
*Poorly formed fasicles parallel to the skin surface, usu. restricted to the superficial dermis.
*Duct-like structures - '''key feature'''.
*Moderate cellular density - less cellular than [[DFSP]].
*Extends from dermis into epidermis (follows path of a benign sweat duct).
*Eosinophilic cytoplasm.
 
Image: [http://commons.wikimedia.org/wiki/File:Eccrine_carcinoma_intermed_mag.jpg Eccrine carcinoma - intermed. mag. (WC)].
DDx:
*[[DFSP]].
*[[Dermatofibroma]].
 
Images:
*[http://www.dermpedia.org/node/8822 DMF - low mag. (dermpedia.org)].
*[http://www.dermpedia.org/node/8824 DMF - high mag. (dermpedia.org)].
 
===IHC===
Features:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*CD10 +ve.
*Vimentin +ve.
 
Others:<ref name=Ref_Derm504>{{Ref Derm|504}}</ref>
*CD34 -ve.
*Factor XIIIa -ve.
*S-100 -ve.


==Eccrine poroma==
==Papillary eccrine adenoma==
*Abbreviated ''[[PEA]]''.
===General===
===General===
*Benign tumour arising from the distal sweat duct.
*Uncommon.
*Erythematous - gross.
*Benign.<ref name=pmid857729>{{Cite journal  | last1 = Rulon | first1 = DB. | last2 = Helwig | first2 = EB. | title = Papillary eccrine adenoma. | journal = Arch Dermatol | volume = 113 | issue = 5 | pages = 596-8 | month = May | year = 1977 | doi =  | PMID = 857729 }}</ref>
 
Treatment:
*Excision.<ref>URL: [http://archderm.jamanetwork.com/article.aspx?articleid=541159 http://archderm.jamanetwork.com/article.aspx?articleid=541159]. Accessed on: 10 December 2012.</ref>
===Gross===
*Central location.
 
Note:
*The ''digital papillary adenoma'' is considered malignant; the AFIP says these are best classified as ''adenocarcinomas'', i.e. ''[[digital papillary adenocarcinoma]]''.<ref name=pmid10843279>{{Cite journal  | last1 = Duke | first1 = WH. | last2 = Sherrod | first2 = TT. | last3 = Lupton | first3 = GP. | title = Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited). | journal = Am J Surg Pathol | volume = 24 | issue = 6 | pages = 775-84 | month = Jun | year = 2000 | doi =  | PMID = 10843279 }}</ref>


===Microscopic===
===Microscopic===
Features:<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70190-5 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70190-5]. Accessed on: 2 July 2010.</ref>
Features:<ref name=pmid17642667>{{Cite journal  | last1 = Laxmisha | first1 = C. | last2 = Thappa | first2 = DM. | last3 = Jayanthi | first3 = S. | title = Papillary eccrine adenoma. | journal = Indian J Dermatol Venereol Leprol | volume = 70 | issue = 6 | pages = 370-2 | month =  | year =  | doi =  | PMID = 17642667 | URL = http://www.ijdvl.com/article.asp?issn=0378-6323;year=2004;volume=70;issue=6;spage=370;epage=372;aulast=Laxmisha }}</ref><ref name=pmid9793207/>
*Broad sheets of basaloid cells containing ductal structures - '''key feature'''.
*Well-circumscribed lesions consisting of multiple cystic spaces lined by a bilayered epithelium with:
*Biphasic stroma:
**Papillary projections into the lumen.
*#Edematous stroma.
**Amorphous eosinophilic material in the cystic spaces.
*#Sclerotic stroma.
**Surrounded by a fibrous stroma.<ref name=pmid9508346>{{Cite journal  | last1 = Mizuoka | first1 = H. | last2 = Senzaki | first2 = H. | last3 = Shikata | first3 = N. | last4 = Uemura | first4 = Y. | last5 = Tsubura | first5 = A. | title = Papillary eccrine adenoma: immunohistochemical study and literature review. | journal = J Cutan Pathol | volume = 25 | issue = 1 | pages = 59-64 | month = Jan | year = 1998 | doi =  | PMID = 9508346 }}</ref>
*Moderate nuclear pleomorphism.
 
*+/-Occasional mitoses.
Note:
*May appear to have more than two cell layers.
 
DDx:
*[[Digital papillary adenocarcinoma]] - location important.
*[[Tubular apocrine adenoma]] (tubulopapillary hidradenoma<ref name=pmid1566975>{{Cite journal  | last1 = Fox | first1 = SB. | last2 = Cotton | first2 = DW. | title = Tubular apocrine adenoma and papillary eccrine adenoma. Entities or unity? | journal = Am J Dermatopathol | volume = 14 | issue = 2 | pages = 149-54 | month = Apr | year = 1992 | doi =  | PMID = 1566975 }}</ref>) - a related tumour.<ref name=pmid8238787>{{Cite journal  | last1 = Ishiko | first1 = A. | last2 = Shimizu | first2 = H. | last3 = Inamoto | first3 = N. | last4 = Nakmura | first4 = K. | title = Is tubular apocrine adenoma a distinct clinical entity? | journal = Am J Dermatopathol | volume = 15 | issue = 5 | pages = 482-7 | month = Oct | year = 1993 | doi =  | PMID = 8238787 }}</ref>
 
Image:
*[http://www.ijdvl.com/viewimage.asp?img=ijdvl_2004_70_6_370_13482_2.jpg PEA - crappy image (ijdvl.com)].<ref name=pmid17642667/>
 
===IHC===
Outer layer of epithelium:<ref name=pmid9508346/>
*SMA-alpha +ve.  
*Keratin 14 +ve.
Inner layer of epithelium:<ref name=pmid9508346/>
*Keratin 8 +ve.
 
Other stains:<ref name=pmid9793207>{{Cite journal  | last1 = Guccion | first1 = JG. | last2 = Patterson | first2 = RH. | last3 = Nayar | first3 = R. | last4 = Saini | first4 = NB. | title = Papillary eccrine adenoma: an ultrastructural and immunohistochemical study. | journal = Ultrastruct Pathol | volume = 22 | issue = 3 | pages = 263-9 | month =  | year =  | doi =  | PMID = 9793207 }}</ref>
*Vimentin +ve.
*CEA +ve.
*[[EMA]] +ve.
*S-100 +ve.
 
===Sign out===
<pre>
SKIN LESION, LEFT PARIETAL SCALP, BIOPSY:
- PAPILLARY ECCRINE ADENOMA.
</pre>


Notes:
====Micro====
*Area above gland appears crusted.
The sections show a well-circumscribed multi-locular superficial dermal lesion with a bilayered epithelium and intracystic papillary projections. The cystic spaces contain amorphous eosinophilic material. The cystic component is surrounded by a dense fibrous stroma with a mixed inflammatory infiltrate, consisting primary of plasma cells and lymphocytes.


==Kaposi sarcoma==
There is no significant nuclear atypia and no mitotic activity is appreciated. The overlying epidermis matures appropriately. A granular layer is present.
:See ''[[Kaposi sarcoma]]''.


==See also==
=See also=
*[[Dermatopathology]].
*[[Dermatopathology]].
*[[Cytopathology]].
*[[Cytopathology]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Dermatopathology]]
[[Category:Dermatopathology]]

Latest revision as of 14:10, 8 October 2024

This article deals with dermatologic neoplasms, also known as skin tumours. It includes dermatologic cancer, which can be deadly. Collectively, dermatologic cancers are the most common form of cancer.

An introduction to dermatopathy is found in the dermatopathology article. Non-malignant disease is covered in the non-malignant skin disease article.

The Big Three malignant

Basal cell carcinoma

Main article: Basal cell carcinoma

Squamous cell carcinoma of the skin

  • Abbreviated skin SCC, SCC of the skin, and SCC of skin.
Main article: Squamous cell carcinoma of the skin

Melanoma

Main article: Malignant melanoma
  • Known as the great mimicker in pathology; it may look like many things.

Less common malignant

Dermatofibrosarcoma protuberans

  • Abbreviated DFSP.
Main article: Dermatofibrosarcoma protuberans

Cutaneous B-cell lymphoma

  • Abbreviated CBCL.

General

  • CBCL is less common than cutaneous T-cell lymphoma (CTCL).[1]

Microscopic

Features:

  • Dermal lymphoid infiltrate.
  • "Grenz zone" - space between the epidermis and the dermal infiltrate - key feature.

IHC

  • B cell and T cell markers.

Cutaneous T-cell lymphoma

  • Abbreviated CTCL.
Main article: Cutaneous T-cell lymphoma

Merkel cell carcinoma

Main article: Merkel cell carcinoma

Eccrine carcinoma

General

  • Arises from the proximal sweat duct.

Microscopic

Features:

  • Pleomorphic nuclei with nucleoli.
  • Duct-like structures - key feature.
  • Extends from dermis into epidermis (follows path of a benign sweat duct).

Notes:

Kaposi sarcoma

See Kaposi sarcoma.

Sebaceous carcinoma

Main article: Sebaceous carcinoma

Microcystic adnexal carcinoma

Main article: Microcystic adnexal carcinoma

Trichilemmal carcinoma

Main article: Trichilemmal carcinoma

Lymphomatoid papulosis

General

  • Rare.
  • Benign behaviour.

Microscopic

Features:

  • Dermal lymphocytosis.
    • No epidermal lymphocytes.
  • Focal nuclear atypia.

DDx:

IHC

Rare malignant

Basosquamous carcinoma

Should not be confused with basaloid squamous cell carcinoma (AKA squamous cell carcinoma, basaloid variant).

General

  • Very rare.
    • Largest case series, as of 2000, 35 cases.[3]
  • May be considered an aggressive variant of basal cell carcinoma.[3]
  • Aggressive behaviour.[4]

Microscopic

Features:

Note:

  • Busam notes that there is disagreement about what defines this tumour;[6] however, he goes on the describe it as a collision tumour.[5]

DDx:

Intermediate

Atypical fibroxanthoma

  • Abbreviated AFX.
Main article: Atypical fibroxanthoma

Benign

Syringoma

Main article: Syringoma

Chondroid syringoma

  • Used to be called mixed tumour of skin.[7]

General

  • Mixed apocrine & eccrine tumour of skin, usually in the head & neck[7], especially nose and cheek.[8]
  • May be in major and minor salivary glands.[8]

Microscopic

Features:

  • Mix tumour with:[7]
    1. Epithelial component:
      • Nests of cells with:
        • Moderate dull eosinophilic cytoplasm.
        • Round/ovoid nuclei with nucleoli.
    2. Mesenchymal component - key feature:

Images:

Dermal cylindroma

Main article: Dermal cylindroma

Keratoacanthoma

Main article: Keratoacanthoma

Sebaceous adenoma

General

Notes:

Microscopic

Features:

  • Abnormal sebaceous glands (pale fluffy cytoplasm):
    • Increased basal epithelium.
    • Multiple dilated glands - opening to the surface.

Images

  • Sebaceous adenoma - low mag. (WC/Nephron)

  • Sebaceous adenoma - high mag. (WC/Nephron)

www:

Trichilemmoma

  • May be spelled tricholemmoma.
Main article: Trichilemmoma

Poroma

Main article: Poroma

Nodular hidradenoma

Main article: Nodular hidradenoma

Trichoblastoma

Main article: Trichoblastoma

Trichofolliculoma

Main article: Trichofolliculoma

Apocrine carcinoma of the skin

General

  • Rare.[10]
  • Usually very good prognosis.[10]

Microscopic

Features:[10]

  • Nests.
  • Apocrine snouts - "decapitation secretion"

DDx:

Images

  • Apocrine carcinoma - intermed. mag. (WC/Nephron)

  • Apocrine carcinoma - high mag. (WC/Nephron)

Stains

Features:[10]

  • PAS +ve.
  • PASD +ve.

IHC

Dermatomyofibroma

Should not be confused with dermatofibroma.
  • Abbreviated DMF.

General

  • Uncommon.

Microscopic

Features:[11]

  • Poorly formed fasicles parallel to the skin surface, usu. restricted to the superficial dermis.
  • Moderate cellular density - less cellular than DFSP.
  • Eosinophilic cytoplasm.

DDx:

Images:

IHC

Features:[11]

  • CD10 +ve.
  • Vimentin +ve.

Others:[11]

  • CD34 -ve.
  • Factor XIIIa -ve.
  • S-100 -ve.

Papillary eccrine adenoma

  • Abbreviated PEA.

General

  • Uncommon.
  • Benign.[12]

Treatment:

Gross

  • Central location.

Note:

Microscopic

Features:[15][16]

  • Well-circumscribed lesions consisting of multiple cystic spaces lined by a bilayered epithelium with:
    • Papillary projections into the lumen.
    • Amorphous eosinophilic material in the cystic spaces.
    • Surrounded by a fibrous stroma.[17]

Note:

  • May appear to have more than two cell layers.

DDx:

Image:

IHC

Outer layer of epithelium:[17]

  • SMA-alpha +ve.
  • Keratin 14 +ve.

Inner layer of epithelium:[17]

  • Keratin 8 +ve.

Other stains:[16]

  • Vimentin +ve.
  • CEA +ve.
  • EMA +ve.
  • S-100 +ve.

Sign out

SKIN LESION, LEFT PARIETAL SCALP, BIOPSY:
- PAPILLARY ECCRINE ADENOMA.

Micro

The sections show a well-circumscribed multi-locular superficial dermal lesion with a bilayered epithelium and intracystic papillary projections. The cystic spaces contain amorphous eosinophilic material. The cystic component is surrounded by a dense fibrous stroma with a mixed inflammatory infiltrate, consisting primary of plasma cells and lymphocytes.

There is no significant nuclear atypia and no mitotic activity is appreciated. The overlying epidermis matures appropriately. A granular layer is present.

See also

References

  1. ↑ URL: http://emedicine.medscape.com/article/1099540-overview. Accessed on: 24 August 2010.
  2. ↑ URL: http://path.upmc.edu/cases/case513/dx.html. Accessed on: 25 January 2012.
  3. ↑ 3.0 3.1 Martin, RC.; Edwards, MJ.; Cawte, TG.; Sewell, CL.; McMasters, KM. (Mar 2000). "Basosquamous carcinoma: analysis of prognostic factors influencing recurrence.". Cancer 88 (6): 1365-9. PMID 10717618.
  4. ↑ 4.0 4.1 Bowman, PH.; Ratz, JL.; Knoepp, TG.; Barnes, CJ.; Finley, EM. (Aug 2003). "Basosquamous carcinoma.". Dermatol Surg 29 (8): 830-2; discussion 833. PMID 12859383..
  5. ↑ 5.0 5.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 397. ISBN 978-0443066542.
  6. ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 372. ISBN 978-0443066542.
  7. ↑ 7.0 7.1 7.2 Kumar, B. (Jan 2010). "Chondroid syringoma diagnosed by fine needle aspiration cytology.". Diagn Cytopathol 38 (1): 38-40. doi:10.1002/dc.21159. PMID 19693940.
  8. ↑ 8.0 8.1 Rauso, R.; Santagata, M.; Tartaro, G.; Filipi, M.; Colella, G.. "Chondroid syringoma: a rare tumor of orofacial region.". Minerva Stomatol 58 (7-8): 383-8. PMID 19633639.
  9. ↑ Punia, RP.; Garg, S.; Bal, A.; Mohan, H. (2008). "Pigmented nodular hidradenoma masquerading as nodular malignant melanoma.". Dermatol Online J 14 (1): 15. PMID 18319032.
  10. ↑ 10.0 10.1 10.2 10.3 10.4 Paties, C.; Taccagni, GL.; Papotti, M.; Valente, G.; Zangrandi, A.; Aloi, F. (Jan 1993). "Apocrine carcinoma of the skin. A clinicopathologic, immunocytochemical, and ultrastructural study.". Cancer 71 (2): 375-81. PMID 7678545.
  11. ↑ 11.0 11.1 11.2 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 504. ISBN 978-0443066542.
  12. ↑ Rulon, DB.; Helwig, EB. (May 1977). "Papillary eccrine adenoma.". Arch Dermatol 113 (5): 596-8. PMID 857729.
  13. ↑ URL: http://archderm.jamanetwork.com/article.aspx?articleid=541159. Accessed on: 10 December 2012.
  14. ↑ Duke, WH.; Sherrod, TT.; Lupton, GP. (Jun 2000). "Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited).". Am J Surg Pathol 24 (6): 775-84. PMID 10843279.
  15. ↑ 15.0 15.1 Laxmisha, C.; Thappa, DM.; Jayanthi, S.. "Papillary eccrine adenoma.". Indian J Dermatol Venereol Leprol 70 (6): 370-2. PMID 17642667.
  16. ↑ 16.0 16.1 Guccion, JG.; Patterson, RH.; Nayar, R.; Saini, NB.. "Papillary eccrine adenoma: an ultrastructural and immunohistochemical study.". Ultrastruct Pathol 22 (3): 263-9. PMID 9793207.
  17. ↑ 17.0 17.1 17.2 Mizuoka, H.; Senzaki, H.; Shikata, N.; Uemura, Y.; Tsubura, A. (Jan 1998). "Papillary eccrine adenoma: immunohistochemical study and literature review.". J Cutan Pathol 25 (1): 59-64. PMID 9508346.
  18. ↑ Fox, SB.; Cotton, DW. (Apr 1992). "Tubular apocrine adenoma and papillary eccrine adenoma. Entities or unity?". Am J Dermatopathol 14 (2): 149-54. PMID 1566975.
  19. ↑ Ishiko, A.; Shimizu, H.; Inamoto, N.; Nakmura, K. (Oct 1993). "Is tubular apocrine adenoma a distinct clinical entity?". Am J Dermatopathol 15 (5): 482-7. PMID 8238787.
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