ABSTRACT
This paper describes a case of a 71-year-old female who initially went to a dermatologist to assess a scalp skin tumor, which performed an incisional biopsy. Anatomopathological and immunohistochemical study revealed a preliminary diagnosis of breast carcinoma metastasis. Although the patient had no medical history of breast cancer, due to this result, she was referred to a mastologist, who investigated her breast nodules for the possible primary focus of the carcinoma. Despite an active investigation through imaging tests, biopsies, and mammotomy, without finding any possible primary focus on the breasts. Finally, the lesion on the scalp was entirely removed by a plastic surgeon. New anatomopathological and immunohistochemical exams confirmed the diagnosis of breast carcinoma metastasis. Given these results, the authors discuss the difficulty in diagnosing differentiation from a primary or metastatic neoplasm of the scalp, with the resources currently available, until the conclusion that it was a primary carcinoma of the sweat gland.
Este artigo descreve o caso de uma mulher de 71 anos que inicialmente foi ao dermatologista para avaliação de tumor de pele no couro cabeludo, e que realizou biópsia incisional desta lesão. O estudo anatomopatológico e imuno-histoquímico revelou um diagnóstico preliminar de metástase de carcinoma de mama. Embora a paciente não tivesse história clínica de câncer de mama, devido a esse resultado, foi encaminhada à mastologista, que investigou seus nódulos mamários para localizar o possível foco primário do carcinoma. Apesar de uma investigação ativa por meio de exames de imagem, biópsias e mamotomia, não foi encontrado nenhum possível foco primário nas mamas. Por fim, a lesão no couro cabeludo também foi totalmente removida por um cirurgião plástico. Novos exames anatomopatológicos e imuno-histoquímicos confirmaram o diagnóstico de metástase de carcinoma de mama. Diante desses resultados, os autores discutem a dificuldade em diagnosticar a diferenciação de uma neoplasia primária ou metastática do couro cabeludo, com os recursos disponíveis atualmente, até a conclusão de que se tratava de um carcinoma primário da glândula sudorípara.
Subject(s)
Skin Neoplasms , Sweat Glands , Breast NeoplasmsABSTRACT
@#Introduction: Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a recently described adnexal tumour with a predilection for the face particularly the eye-lids. Considered to be a precursor lesion of mucinous adenocarcinoma, it may represent part of a morphological spectrum. We described a case of this entity, which we believe is the first case to be reported in Malaysia. Case report: A 59-year-old Chinese male presented with a slow-growing cystic lesion over the left lower lateral canthal region. The lesion became progressively larger and nodular within the last 6 months. Histologically, the lesion is a well-circumscribed intradermal tumour with pushing borders extending into the subcutaneous tissue. The tumour cells were arranged in lobules of solid, papillary and cribriform architecture. The cells displayed uniform, medium-sized, round to oval nuclei with stippled chromatin pattern and ample eosinophilic granular cytoplasm. Intracellular mucin (as highlighted by mucicarmine stain) was observed in areas with focal extracellular mucin seen. Mitotic figures were not particularly impressive. By immunohistochemistry study, the tumour cells expressed ER, PR, CK7, GCDFP-15, mammaglobin and EMA diffusely. Chromogranin A and synaptophysin highlighted a significant number of tumour cells. Discussion: The morphology and immunohistochemical profile similarities between EMPSGC and solid papillary carcinoma of the breast (SPCOTB) makes the former considered as the cutaneous analogue of the latter. In fact, one should rule out the possibility of metastatic SPCOTB before considering the diagnosis of EMPSGC.
ABSTRACT
A 60-year-old male presented with a 6-month-old history of a left upper lid mass. The mass was excised, and histopathological evaluation showed a well-circumscribed, multinodular, intradermal tumor consisting of round-to-oval cells with round nuclei and mucin filled cysts. On immunohistochemical analysis, the tumor cells stained positively for cytokeratin (CK)-7, CK-8, estrogen receptor (ER), progesterone receptor (PR), mucicarmine, synaptophysin, gross cystic disease fluid protein-15 (GCDFP-15), and neuron-specific enolase (NSE). A diagnosis of endocrine mucin-producing sweat gland carcinoma (EMPSGC) of the eyelid was made and at 6-month follow-up, no recurrence was noted. In this communication, we discuss the pathology and treatment options of EMPSGC of the eyelid. Although an uncommon entity, EMPSGC may be considered as a differential when encountered with a suspicious, potentially malignant eyelid mass.
ABSTRACT
A 79-year-old male presented with left ocular pain. Evisceration and silicone ball implantation were performed after a diagnosis of phthisis. He returned six weeks later because of left facial erythematous swelling, tenderness, mild fever, chills and cough. His condition was diagnosed as orbital cellulitis. Despite two weeks of empirical antibiotic therapy, the symptoms worsened. A subsequent orbital computed tomography scan revealed enhanced soft tissue infiltrations in his left orbit and eyelid. Biopsy showed a diffusely infiltrating tumor of signet ring cell cytology. A systemic evaluation revealed multiple bone metastases. Based on this evidence, the patient was diagnosed with a very rare case of histiocytoid variant eccrine sweat gland carcinoma with multiple bone metastases.
Subject(s)
Aged , Humans , Male , Carcinoma/diagnosis , Eccrine Glands , Histiocytes/pathology , Orbital Neoplasms/diagnosis , Positron-Emission Tomography , Sweat Gland Neoplasms/diagnosis , Tomography, X-Ray ComputedABSTRACT
A primary skin adenoid cystic carcinoma first described by Boggio in 1975, is one of the rarest type of eccrine sweat gland carcinoma. Histologically, a tumor with typical morphologic features closely resembles adenoid cystic carcinoma was found in other tissues but in the skin must be distinguished from aggressive basal cell carcinoma. The natural history of this tumor is not yet fully determined but suggests a long indolent and progressive course. We report a case of a 77-year-old male with a small skin nodule in the abdomen.