Basement membrane laminin and type IV collagen in various benign and malignant adnexal tumors of the skin: an immunohistochemical study.

Thirty benign and seven malignant adnexal tumors of the skin and one lymph node metastasis were stained for laminin and type IV collagen with rabbit antibodies against the human basement membrane (BM) proteins using the immunoperoxidase technique. Fifteen of the benign sweat gland, sebaceous gland, and hair follicle tumors showed a continuous and distinct BM around the tumor aggregates. The cylindromas and eccrine spiradenomas seemed to produce excessive amounts of BM material, part of which was seen as amorphic patches within the tumor cell clusters, whereas the trichofolliculomas, trichoepitheliomas, and pilomatrixomas showed an absence of BM from many areas. In syringomas, in addition to the tubular structures surrounded by a continuous BM, undifferentiated cell nests containing granular BM material were present. They probably represent primitive structures obtaining during early development into tubules. The seven malignant tumors and the only metastasis studied here all contained small, narrow strips of BM material extracellularly between the infiltrating tumor clusters. Only in two cases was faint staining for laminin found within the cells. The pepsin pretreatment of the formalin-fixed, paraffin-embedded samples had most probably degraded the intracytoplasmic BM material in most cases. The BM defects were found to be associated with malignancy and low differentiation of the adnexal skin tumors, as reported previously for other tumor types, but a partial loss of BM was also associated with high differentiation in some benign adnexal tumors.

Small cell sweat gland carcinoma in childhood.

Sweat gland carcinomas are rare skin tumors that typically occur in older patients. The spectrum of their clinical and pathologic features is broad, and many different types of sweat gland carcinomas have been described, ranging from fairly indolent to highly aggressive neoplasms. We present two cases of sweat gland carcinoma with a predominant small cell morphology. Both tumors occurred in children. One lesion developed in an 8-year-old girl as an asymptomatic papule on her left forearm, which ultimately was evaluated using biopsy because of rapid growth and change in color. The other lesion occurred on the hand of a 12-year-old boy. Both tumors were pandermal and extended into fat. They were composed of monotonous cuboidal cells with scant cytoplasm that formed tubules and grew in anastomosing cords and trabeculae. The tumor cells were immunoreactive for cytokeratins but not for cytokeratin 20. Ultrastructural analysis (available in one case only) showed that the tumor cells lacked neurosecretory granules. This variant of sweat gland carcinoma needs to be distinguished from other small cell neoplasms of the skin, especially Merkel cell carcinoma, its closest mimic.

Microglandular adenosis, apocrine adenosis, and tubular carcinoma of the breast. An immunohistochemical comparison.

Four cases of microglandular adenosis (MA), together with four cases of apocrine adenosis (AA) and 10 cases of tubular carcinoma (TC) of the breast were studied at the light and immunohistochemical level. One case of MA was studied with electron microscopy. MA is characterized by an absence of myoepithelial cells (ME), epithelial membrane antigen (EMA), and gross cystic disease fluid protein (GCDFP-15). The absence of EMA in MA makes it unique among benign glandular hyperplasias of the breast. AA contains myoepithelial cells and a distinct basal lamina. It is characterized by the presence of GCDFP-15, the specific apocrine marker, which is not present in MA. TC lacks both myoepithelial cells and a basal lamina. It is negative for GCDFP-15. Periductal and vascular elastosis are common and usually prominent, whereas they are not found in either MA and AA. Other stromal changes further distinguish the three lesions. These three distinct entities can be separated objectively and unequivocally and it is essential that this be done so as to prevent confusion.

Papillary eccrine adenoma. Immunohistochemical and ultrastructural analyses.

A case of papillary eccrine adenoma was analysed with immunohistochemical and ultrastructural methods regarding their direction of differentiation. It was found that the majority of the structures show either eccrine ductal or glandular differentiation. There were some segments, particularly in those exhibiting papillary growth, where cells similar to eccrine secretory (clear) cells or cells with characteristics of both ductal basal cells and glandular myoepithelial cells were present.

Malignant eccrine spiradenoma with carcinomatous and sarcomatous elements.

A case of a 60 year old man with malignant eccrine spiradenoma involving the perineum is described. Areas of typical eccrine spiradenoma were admixed with carcinomatous and sarcomatous elements. Immunohistochemical and ultrastructural analysis revealed no evidence of epithelial differentiation in the sarcomatous areas. The tumour qualified for the designation carcinosarcoma arising in eccrine spiradenoma. The clinical course was aggressive with rapid development of nodal and pulmonary metastases.

Apocrine cystadenoma. An ultrastructural study.

An apocrine cystadenoma was examined with the electron microscope. Two types of cells were identified: secretory cells and basal (myoepithelial) cells. The secretory cells showed abundant granules that had the features of lipid droplets. The lumen of the cyst contained fragments of cytoplasm that appeared to be detached from the apical portions of the secretory cells. This feature suggests an apocrine type of secretory mechanism involving decapitation of the apical parts of the cells. A merocrine type of secretion was also seen. The basal myoepithelial cells showed abundant cytoplasmic filaments, most of which appeared to be tonofilaments. These cells had fewer myofilaments than those seen in normal apocrine gland cells. Annulate lamellae were not seen in this case.

Ultrastructure of eccrine cystadenoma. A case report.

A case of eccrine cystadenoma was studied by electron microscopy. The tumor showed two types of cells, luminal and basal cells. The cells lacked the characteristics of the secretory segment of the sweat glands. The features of the luminal cells are similar to those of the intradermal portion of the eccrine sweat duct. In some areas, the lesion showed features characteristic of apocrine gland structure. Nuclear bodies were very frequent. The ultrastructural findings of eccrine cystadenoma support an origin from the ductal portion of eccrine sweat glands.

Sweat gland tumor with glandular and spindle cell features.

We studied a sweat gland tumor by light and electron microscopy that displayed both well-differentiated glandular areas and an anaplastic spindle cell component suggestive of neuroendocrine differentiation. The Merkel cell or a primitive pleuropotential cell is considered to be the most likely cell of origin for this tumor.

Dermal duct tumor: a histochemical and electron microscopic study.

The histochemical and electron microscopic findings in seven cases of dermal duct tumor are described. All seven of the patients were elderly, and five were women. The tumors were small flesh-colored or red papules located most often on the head and neck region. Intense phosphorylase and moderate respiratory enzymes characterized the histochemical reaction of the tumors. The following three types of tumor cells were recognized ultrastructurally: clear, dark, and luminal. The tumor was principally composed of clear cell proliferation around a regular ductal lumen. In addition, melanocytes, Langerhans' cells, and lymphocytes were occasionally seen within the tumor masses. An intact basal lamina and few hemidesmosomes with no detectable actin-like microfilaments were the features of the tumor-stroma interface. Our study results showed that the dermal duct tumor is a benign tumor with eccrine dermal ductal differentiation.

Primary mucinous sweat gland carcinoma of the eyelid simulating metastatic carcinoma.

A 78-year-old man suffered an unusual variant of sweat gland carcinoma of the eyelid. This disorder is seldom recognized, and is frequently confused with inflammation, benign neoplasms, and metastatic carcinomas. On the basis of clinicopathologic and ultrastructural features found by both light and electron microscopy, we diagnosed sweat gland carcinoma of the eyelid. We considered the possibility of metastasis from a primary carcinoma elsewhere in the patient.

Eccrine porocarcinoma: a case report with light microscopy and ultrastructure.

A case of eccrine porocarcinoma in a 63-yr-old man is reported. There was a 10 yr history of an abdominal skin lesion which recurred after cautery and metastasized to skin and abdominal lymph nodes. Histologically, the primary tumour was composed of small squamoid cells with ductal lumina. There was intraepidermal nesting spread and an invasive dermal component. Formation of intracytoplasmic lumina in cells with squamoid features, best seen on electron microscopy, pointed towards poral differentiation and was a useful diagnostic feature which persisted in the less well differentiated metastases. The role of hidroacanthoma simplex as a possible preinvasive precursor lesion is discussed. The differential diagnosis from other skin tumours is described. The literature is reviewed. Despite their sometimes innocuous histological appearance, eccrine porocarcinomas are aggressive lesions which require wide local excision of the primary site and consideration of regional lymph node dissection.

Stereographic analysis of syringomas.

To investigate biological characteristics of syringomas, three-dimensional (3-D) architectures of epithelial tumor nests and luminal structures of syringomas, hair follicles, and epidermal basement membrane in skin lesions were reconstructed using a computer stereographic analysis. Each lesion was composed of many spherical- to ovoid-shaped tumor nests, which interconnected with each other by narrow tumor strands, showing features of ginger roots or budding fungi. Small discrete tumor nests were often present in the peripheral areas of the lesions. Tumor nests developed around hair follicles and beneath epidermis, but they were never connected with hair follicles or epidermal basement membrane, although occasionally such structures were slightly bent by a pressure from the developing tumor nests. There was no relationship between tumor nests and normal sweat glands. Many tumor nests formed luminal structures; however, some small tumor nests did not. Most of the luminal structures were disconnectedly present. These findings suggest that in each lesion syringoma may occur in a single focus in the upper dermis without a relationship to the surrounding normal epithelial tissues, develop and partly swell forming lumina, and then the peripheral parts of the tumor may become discrete. The ratio of [lumen volume/tumor nest volume] measured by computer stereometry was 0.275 +/- 0.037 (n = 5); this indicates a constant ability to form luminal structures by syringoma cells.

Malignant eccrine spiradenoma. Case report and review of the literature.

Malignant eccrine spiradenoma is an exceedingly rare tumor. A case of a 72-year-old women with this highly aggressive malignancy arising from a long-standing lower leg lesion is reported. Management during the course of disease included surgery, radiation therapy (RT), hyperthermic limb perfusion chemotherapy, and chemotherapy. The patient died of her disease, with widespread metastatic disease 20 months after the diagnosis. A review of the literature is presented, and treatment considerations are summarized.

Recurrent malignant chondroid syringoma of the foot: a case report and review of the literature.

Malignant chondroid syringoma, or mixed tumor of the skin, salivary gland type, is an uncommon neoplasm believed to originate in sweat glands. This neoplasm occurs mostly in women and is typically seen in the extremities and torso. A case of recurrent malignant chondroid syringoma of the right foot in a man aged 34 years is described with a review of pertinent literature. The surgically excised neoplasm was evaluated by routine histology, immunohistochemistry, and transmission electron microscopy. The malignant chondroid syringoma showed microscopic dermal satellite tumor nodules. Immunohistochemical staining was positive for keratin and S100 and negative for actin and p53. Ki-67 showed <10% positive staining. Ultrastructurally, the neoplasm was composed of epithelial cells with tonofilaments, cell junctions, and electron-dense amorphous keratin-like substance in the intercellular spaces. No evidence of myoepithelial differentiation was noted. Given the tumoral size, acral location, and histologic findings, the neoplasm was classified as a malignant chondroid syringoma. After reviewing the literature, it became apparent that wide surgical excision, adjuvant radiation therapy as well as patient education are critical in facilitating long-term survival.

Bone marrow relapse in primary mucinous carcinoma of skin.

Primary mucinous carcinoma of skin is a rare adnexal tumor arising from the eccrine sweat gland. The tumors grow slowly and have low rates of local recurrence and rare chances of distant metastasis. The authors report a 70-year-old man with primary mucinous skin carcinoma who had a relapse in bone marrow 19 months after initial treatment.

Hyaline cell-rich chondroid syringoma: case report and review of the literature.

Hyaline cell-rich chondroid syringoma (HCRCS) is a rare benign cutaneous neoplasm composed of cells with eosinophilic hyaline cytoplasm and plasmacytoid features, the origin of which remains elusive. To the best of our knowledge, only eight cases of this entity have been reported so far, and none of them was submitted to a large panel of myoepithelial markers. We report on a case of a previously healthy 29-year-old male patient who presented with a slowly enlarging flesh-colored nodule on the palmar aspect of the tenar region of his left hand, measuring 2 cm in maximum diameter. The nodule was "shelled-out" and submitted to light microscopy, immunohistochemistry, and ultrastructural examination. Histopathologic analysis disclosed a lobulated neoplasm composed of hyaline cells with plasmacytoid features showing ovoid nuclei, with occasional invaginations, finely granular chromatin, and discrete nucleoli; the cytoplasm was deeply eosinophilic with occasional dot-shaped paranuclear hyaline inclusions. On immunohistochemical evaluation, hyaline cells were strongly and diffusely positive for S-100 protein, vimentin, pan (CAM 5.2) and high molecular weight (34betaE12) cytokeratins; these cells were focally positive for GFAP, maspin, neuron-specific enolase, and cytokeratin 14. Alpha-smooth muscle actin, epithelial membrane antigen, carcinoembryonic antigen, collagen IV, Gp100 (HMB-45), and p63 were negative in neoplastic hyaline cells. Ultrastructural analysis disclosed cells with ovoid nuclei showing occasional invaginations and nuclear pockets; the cytoplasm was rich in meshworks of non-bundling intermediate filaments and a variable amount of rough endoplasmic reticulum cisternae. Based on our findings and those previously reported, hyaline cells of HCRCS might posses an aberrant myoepithelial differentiation. Most importantly, pathologists need to be aware of the histologic and immunohistochemical features of HCRCS to avoid a misdiagnosis of highly malignant neoplams, such as malignant melanoma and extra-skeletal myxoid chondrosarcoma.

Malignant eccrine tumor--a case report and a classification of tumors of eccrine sweat apparatus.

A case of malignant eccrine tumor and its histological findings were reported. In this case, we considered basal cell carcinoma or malignant melanoma clinically; however, the histological features matched those of malignant eccrine tumor. It has been said that it is very difficult to determine the origin of tumors of sweat apparatus; to contribute to this ongoing dialogue, the classification of tumors of eccrine sweat apparatus was also discussed.

Fine-needle aspiration of nodular hidradenoma: a case report.

A case of nodular hidradenoma presenting on the forearm of a 36 year old woman is reported. The diagnosis was made on fine-needle aspiration biopsy (FNAB). The cytologic features of the lesion are described. This is the first case to be diagnosed cytologically.

Fine needle aspiration cytology of chondroid syringoma and syringocystadenoma papilliferum. A report of two cases.

Fine needle aspiration cytology of one case each of chondroid syringoma and syringocystadenoma papilliferum with histopathologic confirmation are reported. The aspirate of chondroid syringoma was characterized by the presence of two distinct components, a mesenchymal element with a chondroid appearance and an epithelial component. The chondroid element predominated in the smears. The aspirate from syringocystadenoma papilliferum showed papillalike clusters and dyshesive, monomorphic epithelial cells in a background of inflammatory cells. The clinical diagnosis and differential cytodiagnoses are discussed.

Poroid hidradenoma. Report of a case with cytologic findings on fine needle aspiration.

BACKGROUND: Fine needle aspiration cytology (FNAC) can be used for establishing a diagnosis of cutaneous lesions, especially in cases with cyst formation. Poroid hidradenoma is eccrine neoplasm with both solid and cystic components. CASE: A 77-year-old female presented with a slightly elevated nodule in the skin on her left elbow. The tumor was well demarcated, 2.7 x 2.4 cm and soft, and overlying skin was slightly reddish. FNAC revealed two types of cell: one had abundant cytoplasm in which small to large, occasionally multinucleated nuclei with small but distinct nucleoli were evident. Chromatin was finely granular, and nuclear membrane was thin and almost smooth. Another type of cell had scanty cytoplasm and a round to oval nucleus with small but prominent nucleoli. Histologic diagnosis was poroid hidradenoma. CONCLUSION: FNAC can be useful for diagnosing intradermal cystic lesions before surgical resection.