Apocrine cystadenoma: A long-standing apocrine hidrocystoma with an adenomatous proliferation.

BACKGROUND: Apocrine cystadenoma is a rare, benign adenomatous cystic neoplasm, the pathogenesis of which is not fully understood. We sought to characterize the clinical, dermatoscopic, and histopathologic features of apocrine cystadenoma and its relationship to hidrocystoma. METHODS: We retrospectively analyzed cases of apocrine cystadenoma and hidrocystoma retrieved from the dermatopathology laboratory information system. RESULTS: Of the 350 cases apocrine cystic lesions, 13 cases of apocrine cystadenomas met the inclusion criteria. The age ranged from 20 to 84 years with an average of 64 years. They were long-standing (duration 3-15 years), slow-growing, large tumors usually found on the scalp. Dermatoscopy accentuated translucent light to dark blue color and prominent vessels that were present more at the periphery. All lesions were multilocular with columnar to cuboidal lining and decapitation secretion. A large portion of the lesion consisted of a simple nonproliferative epithelial lining, identical to that observed in apocrine hidrocystomas, while the proliferative adenomatous component made up a smaller portion with two patterns: (1) tubular proliferation, which either protruded into the cystic cavity or expanded outward peripherally, or (2) papillary projections, which were multiple layers thick with fibrovascular core, sometimes accompanied by tubular proliferation. Immunohistochemical stains showed strong staining for p40 and a sparse number of cells stained for Ki-67 and p53. CONCLUSIONS: The long duration of the lesion and the large areas of simple apocrine epithelial lining suggest that apocrine cystadenomas arise from long-standing apocrine hidrocystomas. However, the retrospective nature of the study from a single institution is a limitation.

Contiguous verrucous proliferations in syringocystadenoma papilliferum: A retrospective analysis with additional evaluation via mutation-specific BRAFV600E immunohistochemistry.

BACKGROUND: Syringocystadenoma papilliferum (SCAP) is an uncommon cutaneous adnexal proliferation. There have been several reports describing collision lesions of SCAP and verruca, although little is known about the frequency of this association. Molecular testing has revealed the BRAFV600E mutation in a large proportion of SCAP cases, although its expression pattern has not been previously evaluated. METHODS: In this retrospective analysis, we explored the potential histopathological association between verruca and SCAP. We also evaluated mutation-specific BRAFV600E expression in these lesions by immunohistochemistry. Cases of SCAP diagnosed over a 7-year period were closely reviewed for the presence of contiguous verrucous proliferations. Additional sections were cut and stained using the BRAFV600E-specific clone VE1 antibody. RESULTS: Contiguous verrucous proliferations were identified in 9 out of 12 identified cases. Furthermore, expression of the BRAFV600E mutation was identified in 7 out of 12 cases. Interestingly, in SCAP associated with endophytic verrucous proliferations (n = 4), expression of BRAFV600E was found in both the glandular and the contiguous hyperplastic squamous epithelium. CONCLUSION: Overall, these findings suggest that contiguous verrucous proliferations in SCAP are common. Both components of the neoplasm may express the BRAFV600E mutation, which is suggestive of a common origin.

Dermatology consultations in a tertiary care hospital: A retrospective study of 243 cases.

BACKGROUND: The practice of dermatology remains mainly outpatient, although dermatologic consultations often have a large impact on inpatient care. OBJECTIVE: To analyze the reasons for dermatologic consultation and the impact of dermatologic evaluation at a major teaching hospital. METHODS: Retrospective chart review of 243 consecutive dermatologic consultations from primary ward teams between July 2012, and August 2013. RESULTS: Sixty-seven percent of the dermatologic consults were requested by the internal medicine, intensive care units, and hematology/oncology departments. Common skin conditions accounted for a large majority of consultations including: infectious (24.0%), drug-related (22.3%), and inflammatory skin conditions (21.0%). Most consultations required only one visit for resolution (60.9%). The primary team submitted a correct dermatologic diagnosis in 48.9% of cases. Dermatology consultation resulted in a change in or addition to treatment in 72.4% of patients. LIMITATIONS: Our analysis was limited by the data capture of the consulting physicians and the reliability of the patient historian. CONCLUSIONS: Our results revealed that common dermatoses account for a majority of dermatologic consultations. Modern ward teams continue to struggle with promptly recognizing and appropriately managing common skin conditions. Further training of ward physicians on common dermatologic conditions will improve recognition and treatment of skin conditions in hospitalized patients.