DERMATOPATHOLOGY CASES: Self-Assessment Cases: Editor - Dr Sampurna Roy MD

Digital Images of interesting cases that will include the full spectrum of Dermatopathology, presented in the form of quiz.

The answer of the cases include related links and recent abstracts of articles.

Sunday, December 6, 2009

Answer of Dermatopathology Case 4

Eccrine Porocarcinoma

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Eccrine porocarcinoma of the auricle: a case report. Kaohsiung J Med Sci. 2009 Jul;25(7):401-4.
Eccrine porocarcinoma (EP) is a rare skin malignant lesion representing0.005-0.01% of all cutaneous tumors. It is a tumor that most commonly present in elderly people aged over 60 years. Approximately 250 cases of EP have been reported since this disease was first described in 1963. However, only three cases occurring specifically on the ear (including the current case) have beendocumented in the literature to date. Based on the rarity of EP of the ear, we present this 78-year-old man with EP on the right ear lobule, which was diagnosedaccidentally during the management of other unrelated problems. The etiology,diagnosis, treatment and prognosis of this disease are discussed, with a brief review of the literature in this report.

Fine-needle aspiration cytology of metastatic eccrine porocarcinoma.Diagn Cytopathol. 2009 Oct;37(10):755-8.
Eccrine porocarcinoma (EP), although rare, is widely recognized as the mostcommon malignant sweat gland tumor. EP typically grows slowly and usually iscured by surgical excision with clear margins. An elevated mortality rate, however, is observed when regional lymph nodes are involved. We herein describecytohistologic findings in a case of metastatic EP. An 86-year-old man with ahistory of EP of the left lateral ankle and squamous cell carcinoma in situ (Bowen's disease) of the penis presented with enlarged left inguinal lymph nodes. A superficial fine-needle aspiration (FNA) was performed and demonstrated a hypercellular sample with discohesive clusters and/or individual tumor cells. The tumor cells were round or oval with most of the cells showing dense, refractilecytoplasm. Intracytoplasmic vacuoles were readily appreciated in some of thecells. Nuclear enlargement, high N/C ratio, nuclear hyperchromasia, bi- and multinucleation, and prominent nucleoli were seen. A diagnosis of metastaticeccrine porocarcinoma was rendered. Enlarged retroperitoneal lymph nodes weredetected and CT-guided left retroperitoneal core biopsy was performed 1 weeklater. The biopsy revealed features consistent with metastatic eccrine porocarcinoma.

Eccrine porocarcinoma.Dermatol Ther. 2008 Nov-Dec;21(6):433-8.
Eccrine porocarcinoma (EPC) is a rare cutaneous neoplasm that grows slowly over along period of time but often experiences an accelerated growth phase. This malignant tumor may arise denovo or evolve from a pre-existing benign eccrineporoma. Histologic evaluation demonstrates anaplastic cells involving theepidermis and infiltrating the dermis. Metastasis to regional lymph nodesdistally occurs in a significant number of cases. Treatment modalities haveincluded standard excision, Mohs micrographic surgery (MMS), chemotherapy, and radiation therapy. Recently sentinel lymph node biopsy has begun to beinvestigated as a staging tool. The literature on EPC is reviewed with attention paid to which of the various therapeutic options offers a clear advantage overthe others. MMS affords the greatest likelihood of clear margins and cure inabsence of regional and distant metastases.