Poroma Ecrino Plantar. Presentación de un caso

RESUMEN Los poromas ecrinos son tumores anexiales benignos que se originan de la porción intraepidérmica del conducto de la glándula sudorípara, representan aproximadamente el 10 % de todos los tumores de estas glándulas. La variante clásica de poroma se caracteriza por una neoformación de aspecto papular de color piel oeritematosa, con predilección por las palmas y plantas. Presentamos el caso de una paciente femenina de 53 años de edad, con antecedentes de diabetes mellitus tipo I que acude a consulta de dermatología del policlínico de suárea de salud, por presentar lesión en planta del pie izquierdo de 2 años de evolución, asintomática que comenzó como una bolita, notando que aumentaba de tamaño, acude primeramente a la consulta de podología y la envían a nuestra especialidad, donde es evaluada y se diagnóstica clínicamente un poroma ecrino. En el estudio histopatológico fue de gran valor en función de la orientación diagnóstica y se precisó la presencia de esta entidad. El caso presentado contribuye a visibilizar la necesaria revisión del tema teniendo en cuenta que representa un reto diagnóstico, por su gran variedad morfológica y se hacen necesarios los estudios histológicos.

ABSTRACT Eccrine poromas are benign adnexal tumors that originate from the intraepidermal portion of the sweat gland duct, representing approximately 10% of all tumors of these glands. The classic variant of poroma is characterized by a skin-colored or erythematous papular-looking neoformation, with a predilection for the palms and soles. We present the case of a 53-year-old female patient with a history of type I diabetes mellitus who attended the dermatology clinic of the polyclinic in her health area due to a 2-year history of an asymptomatic lesion on the sole of her left foot. It started as a small ball, noticing that it was increasing in size, she first went to the podiatry consultation and was sent to our specialty, where she was evaluated and an eccrine poroma was clinically diagnosed. In the histopathological study it was of great value depending on the diagnostic orientation and the presence of this entity was specified. The case presented contributes to make visible the necessary review of the subject, taking into account that it represents a diagnostic challenge, due to its great morphological variety and histological studies are necessary.

RESUMO Os poromas écrinos são tumores anexiais benignos que se originam da porção intraepidérmica do ducto das glândulas sudoríparas, representando aproximadamente 10% de todos os tumores dessas glândulas. A variante clássica do poroma é caracterizada por uma neoformação papular da cor da pele ou eritematosa, com predileção pelas palmas das mãos e plantas dos pés. Apresentamos o caso de uma paciente do sexo feminino, 53 anos, com histórico de diabetes mellitus tipo I, que compareceu ao ambulatório de dermatologia da policlínica de sua área de saúde devido a história de 2 anos de lesão assintomática em planta do pé esquerdo Começou por ser uma bolinha, notando que estava a aumentar de tamanho, foi primeiro à consulta de podologia e foi encaminhada para a nossa especialidade, onde foi avaliada e diagnosticado clinicamente um poroma écrino. No estudo histopatológico foi de grande valia dependendo da orientação diagnóstica e foi especificada a presença desta entidade. O caso apresentado contribui para tornar visível a necessária revisão do assunto, tendo em conta que representa um desafio diagnóstico, devido à sua grande variedade morfológica e são necessários estudos histológicos.

A two years study of histopathological spectrum of skin adnexal tumors in a tertiary care centre of Southern Assam, India

Background: Skin adnexal tumors (SAT) encompass a wide spectrum of benign and malignant tumors that differentiate toward one or more adnexal structures found in normal skin. Overall incidence of SATs is low yet they can be challenging to diagnose. Our study aims at analysis of histopathological spectrum of various SATs according to age, sex and anatomic locations along with histopathological features.Methods: It was a retrospective cross-sectional study conducted over a period of 2 years from June 2017 to May 2019. All cases were retrieved from department registries and analyzed.Results: Out of the total 4013 biopsies, 25 cases were diagnosed as SATs comprising 44% of tumors with eccrine sweat gland differentiation followed by tumors showing hair follicle differentiation (32%), sebaceous differentiation (16%) and apocrine gland differentiation (8%). The age ranged from 4 years to 68 years and male: female ratio was 1:1.5. Most of the tumors were benign (84%) while only 16% were malignant. Pilomatricoma (19%) was the most common benign tumor while sebaceous carcinoma (75%) was the most common malignant tumor.Conclusions: Skin adnexal tumors are relatively rare neoplasm. Malignant cases are less common than benign ones. Histopathology is quite essential for diagnostic point of view.

Four years retrospective study of skin adnexal tumors: Histomorphology and special stain study

Background: Skin adnexal tumors (SATs) are uncommon and may cause diagnostic problems. Objective: The aim of this study is to determine the frequency of SATs with respect to their clinicopathological features over a period of 4 years. Materials and Methods: It was a retrospective, descriptive study. Formalin-fixed, paraffin-embedded sections were stained with hematoxylin and eosin for histopathological analysis and with special stains as Alcian blue/periodic acid–Schiff stain for confirmation. Results: A total number of cases that were diagnosed as SATs were 18; benign tumors were 17 (94.4%) and one malignant tumor (5.6%). Most tumors were of sweat gland origin (61.1%) followed by hair follicle origin (33.3%) then by sebaceous gland origin (5.6%). The age ranged from 3 to 51 years and male: female ratio was 1.57:1. The head-and-neck region was the most common location (44.4%). Hidradenoma (35.3%) was the most common benign tumor followed by pilomatrixoma (23.5%) and spiradenoma (17.6%) while sebaceous carcinoma was the only malignant tumor detected. Conclusion: The overall incidence of SATs was found to be very low. Benign SATs were more as compared with the malignant tumors. A careful histopathological assessment is essential for accurate diagnosis.

Quiste gigante de Naboth como diagnóstico diferencial de los tumores anexiales. Reporte de un caso / Giant Naboth cyst as a differential diagnosis of adnexal tumors. A case report

Resumen ANTECEDENTES: Los quistes de Naboth son tumoraciones benignas del cuello uterino, casi siempre son asintomáticos, por excepción son gigantes y de localización intraabdominal. CASO CLÍNICO: Paciente de 44 años, acudió a consulta debido a sangrado uterino anormal de 7 años de evolución, flujo transvaginal hialino abundante y continuo, sensación de pesantez pélvica, aumento del tamaño abdominal y dificultad para orinar. En la exploración física el abdomen se encontró blando, depresible, el útero no delimitado, con el anexo derecho aumentado de tamaño. La tomografía abdominopélvica reportó una lesión compleja en el anexo derecho. Debido a la sospecha diagnóstica de tumoración del anexo, dependiente del ovario, se solicitaron los marcadores tumorales Ca 125 que se reportaron con valores en límites normales; la citología cervicovaginal fue negativa para displasia. En la laparoscopia se encontró integridad de los anexos y útero macroscópicamente normal, con un quiste en la cara anterior, adherido al espacio paravesical. De la cistectomía con punción del quiste se obtuvo material mucinoso, se observó comunicación entre el quiste y el canal vaginal de aproximadamente 6 cm. Con base en esos hallazgos se decidió la histerectomía total por vía abdominal. El reporte histopatológico fue de: quiste complejo de Naboth, profundo hasta la pared en el segmento y parametrios, sin evidencia de malignidad. CONCLUSIONES: Los quistes gigantes de Naboth son sintomáticos, de origen compresivo y abundante descarga vaginal. Debe sospecharse entre las tumoraciones anexiales; el diagnóstico definitivo se establece por histopatología.

Abstract BACKGROUND: Naboth cysts are benign tumors of the uterine cervix, usually asymptomatic, exceptionally present as giant cysts and rarely intra-abdominal location. CLINICAL CASE: A 44-year-old female who came to present with abnormal 7-year-old uterine bleeding, a feeling of pelvic heaviness, an increase in abdominal size, difficulty in urination and the presence of abundant and continuous transvaginal hyaline flow. On physical examination, a depressible soft abdomen, an unmarked uterus, with an enlarged right appendix was found. Abdominopélvica computed axial tomography reported a complex lesion in the right annex. An annex tumor was suspected, mainly ovarian-dependent, so tumor markers Ca 125 were requested with values within normal ranges, cervicovaginal cytology was negative for dysplasia. Laparoscopy was performed finding the integrity of the annexes and macroscopically normal uterus with presence of cyst in the anterior face adhered to the paravesical space, cystectomy was performed with puncture of the cyst obtaining mucinous material, communication was observed between the cyst and the vaginal canal of approximately 6 cm, So it was decided to perform total hysterectomy via abdominal. The histopathological report: complex cyst of deep Naboth to wall in the segment and parametria without evidence of malignancy. CONCLUSIONS: Naboth´s giant cysts usually cause symptoms especially of compressive origin and abundant vaginal discharge, it should be suspected among the adnexal tumors, the definitive diagnosis is made by histopathology.

A histopathological study of sebaceous neoplasms and related lesions at a tertiary care centre

Background: Sebaceous lesions have intrigued pathologists and dermatologist alike causing a great deal of diagnostic confusion. Tumors and tumor like conditions of the sebaceous glands include sebaceous hyperplasia, Nevus sebaceus of Jadassohn, sebaceous adenoma, sebaceoma and sebaceous carcinoma.Methods: A three-year study of all lesions with sebaceous differentiation was carried out in the histopathology section of a tertiary care hospital to study the spectrum of lesions showing sebaceous differentiation. Patient records were noted, and paraffin embedded sections stained with haematoxylin and eosin were examined for histopathological diagnosis. Clinical correlation was done in all the cases.Results: The spectrum of lesions encountered included sebaceous carcinoma, Nevus sebaceous, sebaceous hyperplasia, sebaceous adenoma among others. Eyelid was the most common site followed by scalp. Clinicopathological correlation was found to be poor in these lesions with clinical examination failing to correctly identify most of the cases.Conclusions: Sebaceous neoplasms were seen to be rarer in our population as compared to other adnexal tumors. Histopathology, in the presence of typical features, is the mainstay of diagnosis with immunohistochemistry aiding in certain doubtful cases.

Clinicopathological study of skin tumours

Background: Skin cancers are relatively uncommon malignancies worldwide, but the incidence of skin cancers has progressively increased over the last few decades. The distinction between benign and malignant neoplasm are more difficult to define when they appear in skin than when found elsewhere and histopathological examination is frequently required to establish a definitive diagnosis. Diagnosis of any skin tumours can be done by correlating clinical features and histological features. The aim and objective were to study age-sex wise distribution, clinical presentation and histopathological spectrum of various skin tumours.Methods: This is a retrospective study of three years conducted in the Department of Pathology, Government Medical College, Aurangabad, India from December 2015 to December 2018. Specimens received from Department of Dermatology were fixed in formalin and after adequately processing the sections were stained routinely with H and E stain and properly evaluated for histopathological examination. This study includes tumors of epidermis along with melanogenic tumors and skin appendageal tumors. The data collected was tabulated, analysed and compared to other similar studies.Results: The study consists of 130 cases. The ratio of male to female was 1.24:1. Head and neck region (48.46%) was the most common site observed where skin lesions were present followed by extremities (37.69%). Most of the malignant tumours were presented with non-healing ulcers (30.76%) and Noduloulcerative lesions (20.33%). Out of 130 cases, 83 (63.84%) were benign whereas 47 (36.15%) were malignant tumour. According to WHO classification, keratinocytic tumour 55 (42.30%) was the most common tumour type in the present study. Skin adnexal tumours and melanocytic tumours were observed in 54 (41.53%) and 21 (16.15%) respectively.Conclusions: The skin is a complex organ. Because of complexity of skin, a wide range of diseases can develop from the skin. The majority of benign neoplasms are from skin adnexal group whereas most common malignant neoplasm were from keratinocytic group. Skin adnexal tumors can occur anywhere in the body, however head and neck region constitute the most common site. Skin adnexal tumours are clinically often misdiagnosed, so histopathological examination remains gold standard for their correct diagnosis and for their differentiation between benign and malignant neoplasm.

A Spectrum Of Skin Adnexal Tumors

Background: Troublesome tumors (Skin adnexal tumors (SAT)) pose a major diagnostic difficulties because of their wide spectrum and variants, their rarity, differentiation along two or more adnexal lines and their complicated nomenclature to both the surgeon and the pathologist. Histopathology is the gold standard of diagnosis with immunohistochemistry playing a limited role.Materials and methods: A Prospective study of skin adnexal tumors (n =25) diagnosed on histopathological examination over a period of 2 years (June 2015 to May 2017). All slides were stained with H & E.Results: Majority of the patients are in the third and fourth decade. Females outnumbered the males.Twenty-two tumors are benign and 3 are malignant. Most common skin adnexal tumors are Hair follicle origin tumors comprising of 15cases (60%). In that most common benign tumor is Trichoepithelioma. Head and neck region is the commonest site involved.Conclusion: Skin adnexal tumors are relatively rare. Benign adnexal tumors are more common than the malignant lesions. Histopathology is essential to confirm the diagnosis.

Eccrine Skin Adnexal Tumors: An Institutional Based Clinicopathological Study

Background: Histopathology is the gold standard of diagnosiswith a limited role of Immunohistochemistry. The present studywas Conducted to study the Eccrine skin Adnexal tumors withreference to their Anatomical location, age, sex of theindividuals affected to determine their incidence and correlatethem with other simulating studies.Material & Method: A total of 106 specimens of skin Adnexaltumors were received in the department of pathology fromdepartment of Dermatology, surgery and other specialties fromJune 2002 to May 2012. Histopathological Examination wasdone on routine Hematoxylin and Eosin stained tissuesections. Special stains like PAS and recticulin was donewhere required.Results: There were 21 males and 25 female patientsconstituting a ratio of 0.84 :1. The age range of these tumorswas 31-40 years with a mean age range of 43.73 years. In thepresent study 46/106 (43.39%) cases of SAT’s were of eccrinedifferentiation. Eccrine Acrospiroma was the most CommonBenign Skin adnexal tumor of Eccrine differentiationconstituting 25 out of 46 cases (54.34%) and Eccrine poromawas the least common benign Eccrine SAT. Out of 6 cases ofMalignant Eccrine skin Adnexal tumors 3/46 were of malignanteccrine acrospiroma and eccrine ductal carcinomarespectively.Conclusion: We concluded that the pattern and biologicalbehaviour of the tumors cannot be determined until thebiopsies are submitted for HPE so histopathology is mandatoryfor diagnosis SAT and to know their potential biologicalbehaviour for further management.

A giant trichoblastic carcinoma

Trichoblastic carcinoma usually occurs as a malignant transformation of the trichoblastoma, but is very rare. A 25-year-old man was admitted with trichoblastoma in the nuchal area with frequent recurrences since birth. The preoperative neck magnetic resonance image revealed lobulated soft tissue lesions involving superficial fascia and infiltrating into both proximal trapezius muscles. In our department, wide excision and reconstruction with a free anterolateral thigh flap were performed. Histological examination revealed skin adnexal carcinoma, originating from the hair follicles, consistent with trichoblastic carcinoma. There was no palpable mass 5 years postoperatively, and there was no recurrence on follow-up positron emission tomography-computed tomography. Trichoblastic carcinomas are rare and difficult to diagnose, but histopathological findings include atypical basaloid keratinocytes with crowded, hyperchromatic nuclei, and increased mitotic activity. The presence of hypercellular stroma is a criterion for distinguishing trichoblastic carcinoma from basal cell carcinoma. A rare giant trichoblastic carcinoma was reported, which was the biggest one in the literature.

Comparación de tres índices ecográficos para evaluación del riesgo de malignidad de los tumores anexiales / Comparison of three ultrasound index in evaluating the risk of malignancy of adnexal tumors

Resumen Objetivo: Determinar y comparar el rendimiento diagnóstico de las Reglas Ecográficas Simples (RES), Índice Morfológico Ecográfico (IME) e Índice de Riesgo de Malignidad de Jacobs (IRM) en el diagnóstico de benignidad o malignidad de un tumor anexial. Material y método: Estudio retrospectivo, transversal y analítico efectuado en el Hospital Militar de Especialidades de la Mujer y Neonatología de la Ciudad de México. Se incluyeron pacientes con diagnóstico ecográfico de tumor anexial intervenidas quirúrgicamente. Se estudió el rendimiento diagnóstico de los índices comparado con el diagnóstico histopatológico mediante tablas de contingencia. Resultados: Se analizaron 141 pacientes y 166 tumores; 22 casos fueron bilaterales. De la muestra analizada, 79 eran pacientes premenopáusicas y 62 posmenopáusicas. Los casos de neoplasia maligna fueron 43 (26%) y benigna 123 (74%). El Índice Morfológico Ecográfico tuvo sensibilidad de 98.8%, especificidad de 33.3%, valor predictivo positivo de 33.9% y valor predictivo negativo de 97.6%. Las Reglas Ecográficas Simples reportaron una sensibilidad de 97.2%, especificidad de 71.1%, valor predictivo positivo de 55.6% y valor predictivo positivo de 98.6%; y el Índice de Riesgo de Malignidad de Jacobs una sensibilidad de 72.7%, especificidad de 79.3%, valor predictivo positivo de 55.8% y valor predictivo positivo de 89.4%. Conclusiones: Las Reglas Ecográficas Simples son un modelo prequirúrgico que en 82% de los casos permitieron clasificar los tumores anexiales en benignos o malignos. Los casos indeterminados deben ser reevaluados por un ecografista experto. El método es reproducible por evaluadores de mediana experiencia y susceptible de aplicarse en instituciones hospitalarias de segundo y tercer nivel de atención.

Abstract Objective: To determine and compare the diagnostic performance of the Simple Ultrasound-Based Rules (SUR), Sonographic Morphology Index (SMI) and the Jacob´s Risk Malignancy Index (RMI) in the diagnosis of benignity or malignancy to an adnexal tumor. Materials and methods: Retrospective, cross-sectional and analytical study at the at the Hospital Militar de Especialidades de la Mujer y Neonatología of Mexico City. Patients with ultrasound diagnosis of adnexal tumor who underwent surgery were included. The diagnostic performance of the indices compared to histopathological diagnosis was studied using contingency tables. Results: 141 women and 166 tumors were included for analysis, 22 cases were bilateral. Of the sample analyzed, 79 were premenopausal and 62 postmenopausal. Cases of malignant neoplasm were 43 (25.9%) and benign 123 (74.1%). The SMI had a sensitivity of 98.8%, specificity of 33.3%, positive predictive value (PPV) of 33.9%, and negative predictive value (NPV) of 97.6%. SUR showed a sensitivity of 97.2%, specificity of 71.1%, PPV of 55.6% and NPV of 98.6%; And RMI had a sensitivity of 72.7%, specificity of 79.3%, PPV of 55.8% and NPV of 89.4%. Conclusions: The simple ultrasonographic rules are a presurgical model that in 82% of the cases allowed to classify the adnexal tumors in benign or malignant. Indeterminate cases should be reevaluated by an expert sonographer. The method is reproducible by evaluators of medium experience and susceptible of being applied in hospital institutions of the second and third level of care.

Cystic panfolliculoma of the scalp: Report of a very rare case and brief review.

Panfolliculoma is an exceeding rare follicular benign neoplasm with differentiation toward both upper and lower segments of the hair follicle. In this report, we present a case of cystic panfolliculoma in the occipital region of the scalp of a 19-year-old female. We describe the histopathological and immunohistochemical features of the tumor and briefl y discuss the differential diagnoses of this rare entity.

Neoplasias anexiales de la piel: Revisión histopatológica de 8 años de experiencia / Skin´s adnexal tumors: Histopathologic reviewof eight years of experience

Antecedentes: los tumores anexiales cutáneos representan un grupo heterogéneo de entidades de baja frecuencia de presentación, que puede plantear ciertas dificultades diagnósticas para el patólogo general. Métodos: se realizó un estudio retrospectivo observacional, revisándose informes cuyo diagnóstico correspondía a tumores anexiales, realizados en la institución entre los años 2000 y 2007. Se utilizó la clasificación de tumores anexiales de la WHO del consenso del año 2003 en Lyon. De dichos informes, se registraron características como género y edad, localización, histopatología, márgenes y multicentricidad, entre otras. Resultados: fueron recolectados 200 informes correspondientes a 178 pacientes, encontrándose en 13 de ellos más de un tumor. El 50% era de sexo masculino. El 47% correspondía a tumores foliculares, el 42% a tumores ecrinos y apócrinos y el 11% a tumores sebáceos. El más frecuente de los tumores foliculares fue el pilomatrixoma (67%); entre los ecrinos y apócrinos, el siringoma (24%) y de los sebáceos se destacó el carcinoma (63%). El 84,5% correspondía a tumores benignos, el 12% a malignos y el 3,5% a tumores de potencial incierto. Entre los tumores ecrinos y apócrinos, se registró un predominio del sexo femenino y en los restantes del sexo masculino. Los tumores foliculares se presentaron a edades más tempranas y los sebáceos, a edades mayores. Todos ellos se localizaron principalmente en la región cefálica. Conclusión: nuestros resultados demostraron concordancia con la literatura consultada y confirmaron la heterogeneidad de dichos tumores en su presentación como biopsias cutáneas, a pesar de su baja frecuencia.

Introduction: skin´s adnexal tumors represent a heterogeneous group of lesions of low frequency of presentation, which can cause certain diagnostic difficulties for the general pathologist. Materials and methods: a retrospective study was carried out. The reports about adnexal tumors performed in the institution between the years 2000 and 2007 were revised. The Who classification of adnexal tumors from the consensus of 2003 in Lyon was used. The gender, age, localization, histopathology, margins and other characteristics of the biopsies were revised. Results: 200 reports were revised corresponding to 178 patients. 13 of them presented more than one tumor. 50% were men. Among all the reports, 47% corresponded to follicular tumors, 42% to apocrine and eccrine tumors and 11% to sebaceous tumors. Between the follicular ones, the pilomatricomas were the most common (67%), among apocrine and eccrine ones, were the syringomas (24%) and the sebaceous carcinomas (63%) were the principal diagnostic as regard sebaceous tumors. 84.5% were benign, 12% were malignant and 3.5% were of uncertain biological potential. There was a female predominance between the apocrine and eccrine tumors. The sebaceous and follicular tumors were more common in men. The follicular ones were diagnosed in earliest ages, in contraposition with the sebaceous ones, diagnosed in advanced ages. All of these tumors were more frequent in cephalic region. Conclusions: our results showed concordance with the literature and confirmed the heterogeneity of these tumors in their presentation as skin biopsies, in despite of their low frequency.

Efficacy of Frozen Section Biopsy in the Diagnosis of Adnexal Neoplasms / 대한산부인과학회잡지

Recently, the possibility of inappropriate management of undiagnosed early cancers increased with spreading laparoscopic approach of adnexal tumors. The pathologic diagnosis of frozen section biopsy(FBx) guide the surgeon to perform the appropriate surgical procedure of adnexal tumors. This study was conducted to verify preliminarily the criteria for the laparoscopic management and determine the accuracy and efficacy of conditioned FBx according to the criteria. The inclusive criteria of FBx results in this study was designed by means of the preoperative transvaginal sonography(morphologic score >or=10) or tumor marker level of serum(CA-125 level>or=35 U/ml in postmenopause and >or=65 U/ml in postmenopause) or suspected gross findings of the malignancy during operation. On the other hand, cases which were convinced as dermoid cysts, endometriomas and advanced(>or=IIIb) ovarian cancers on the basis of gross findings were excluded in this study. Two hundred seventy-six operations of adnexal tumors were performed between January 1995 and June 1996 and 74 results of FBx were picked up in this study. The overall rate of conditioned FBx was 26.8%(74/276). The applied criterion in this study had the sensitivity of 0.97, specificity of 0.78, negative predictive value of 0.99, positive predictive value of 0.36. The accuracy of frozen sectional biopsy were 87.8% in the histopathologic diagnosis and 97.3% in the clinicopathologic diagnosis. The sensitivity, specificity, negative predictive value and positive predictive value for ovarian cancers(borderline+malignant) were 1 in all. It was thought that frozen sectional biopsy was a appropriate guide for the decision of methods during operation of adnexal tumors and that the criteria in this study could be used as a guideline for frozen section biopsy in the laparoscopic surgery of adnexal tumors.