Case report: differential diagnosis between primary cutaneous apocrine adenocarcinoma versus extramammary or metastatic breast adenocarcinoma.

Cutaneous apocrine adenocarcinoma (CAA) is a rare adnexal neoplasm that histologically can mimic breast carcinoma metastatic to the skin or apocrine carcinoma arising in ectopic breast tissue. It can present with a wide range of clinical modalities and can often simulate many benign processes, which delays its diagnosis and hinders its prognosis. We describe a case of a 33-year-old man who had a short-evolution small nodule in the right axilla with local lymph node metastases. The immunohistochemical characterization was closer to that of breast adenocarcinoma than to an adnexal neoplasm. This was established as the main differential diagnosis. Diagnosis of cutaneous apocrine adenocarcinoma may be difficult and immunomarkers are not specific. The anatomical criteria and systemic investigation are mandatory to establish the correct diagnosis.

Chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia: reappraisal of epidemiological, clinical, and pathological features.

BACKGROUND: A characteristic cutaneous eruption related to the use of cytostatic chemotherapeutic drugs has been described in the literature. This condition appears to be characterized by an erythematous eruption, primarily affecting the intertriginous areas bilaterally, together with eccrine squamous syringometaplasia as the main histologic feature. OBJECTIVE: We sought to establish the epidemiologic, clinical, and histologic characteristics of this poorly defined chemotherapy drug-related eruption. METHODS: Retrospective data were collected from 21 consecutive patients with this clinical and histopathologic pattern who attended an oncology center between January 1999 and September 2009. Two skin biopsy specimens were obtained from all patients, with the first being taken within 24 hours of onset, and the second 72 to 96 hours after onset. RESULTS: The patients analyzed were predominantly female (72%), with a mean age of 52 years (range 10-69 years). The lesions presented clinically as bilateral erythematous plaques affecting both axillae (95%), groin (88%), and side aspects of the neck (48%). The main histologic feature in all cases was eccrine squamous syringometaplasia, characterized by the transformation of the eccrine cuboidal epithelium into two or more layers of squamous cells with intercellular bridges. The onset of the eruption appeared within 30 days (range 2-30 days) after the initiation of the cytostatic agent infusion. The lesions resolved with desquamation and postinflammatory hyperpigmentation. The same cutaneous pattern recurred in up to 50% of patients in whom the oncologist reintroduced the cytostatic treatment. LIMITATIONS: Small sample size was a limitation. CONCLUSIONS: We suggest the term "chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia" to describe this distinctive entity, which is primarily associated with pegylated liposomal doxorubicin infusions and chemotherapeutic regimens used in autologous bone-marrow transplantation.

Cirugía micrográfica de Mohs del canto interno del ojo. Estudio de casos y controles / Mohs' micrographic surgery of the medial canthus of the eye. A case-control study

Introducción: los carcinomas basocelulares (CB) localizados en zonas periorificiales y de fusión embrionaria se consideran de alto riesgo. Hemos observado que de estas localizaciones, el canto interno del ojo parece tener unas características que dan lugar a un manejo especialmente complicado de los CB. Material y métodos: se seleccionaron como casos 35 carcinomas basocelulares del canto interno del ojo (CBCIO) correspondientes a 30 pacientes y como controles 34 carcinomas basocelulares de la frente, mejillas y sien (CBOL) de 31 pacientes, todos ellos intervenidos con cirugía micrográfica de Mohs. Se evaluaron mediante estudio uni y multivariado las diferencias existentes en los siguientes datos: a) clínicos del paciente: edad y sexo; b) clínicos del tumor: tratamientos previos, tamaño tumoral, tiempo de evolución; c) histología del tumor: tipo, ulceración, estructuras infiltradas; d) cirugía: número de estadios, márgenes extirpados, defecto resultante y características de la reconstrucción, y e) seguimiento: existencia o no de recidiva. Resultados: los CBCIO tenían un menor tamaño tumoral, pero con infiltración más profunda, precisaban de un mayor número de estadios y de reconstrucciones más complejas durante el procedimiento quirúrgico y recurrieron con más frecuencia que los CBOL. Estas diferencias alcanzaron significación estadística. Conclusiones: los carcinomas basocelulares del canto interno del ojo merecen una especial consideración en cuanto a su tratamiento y se debería considerar la cirugía de Mohs como el tratamiento de elección, incluso para los casos aparentemente benignos (AU)