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.

Monday, December 7, 2009

Answer of Dermatopathology Case 6

Primary Cutaneous Apocrine Carcinoma

Visit: Cutaneous Apocrine Carcinoma
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Related article

Primary cutaneous cribriform apocrine carcinoma: a clinicopathologic andimmunohistochemical study of 26 cases of an under-recognized cutaneous adnexal neoplasm. J Am Acad Dermatol. 2009 Oct;61(4):644-51.
BACKGROUND: Cribriform carcinoma is the histopathologic variant of cutaneousapocrine carcinoma characterized by interconnected solid aggregations of neoplastic cells that are punctuated by small round spaces. OBJECTIVE: To describe the histopathologic and immunohistochemical characteristics of this under-recognized cutaneous adnexal neoplasm. METHODS: Twenty-six cases of primarycutaneous cribriform apocrine carcinoma were clinically, histopathologically, and immunohistochemically studied. RESULTS: Seven neoplasms arose in males and 19 in females. The median age of the patients was 47.8 years. The lower and upper limbswere the most frequent sites. Histopathologically, the neoplasms consisted ofwell-circumscribed dermal nodules composed of multiple, interconnected, solid aggregations of basophilic epithelial cells that were punctuated by small roundspaces. Immunohistochemically, the neoplastic cells expressed immunoreactivityfor MNF116, AE1/AE3, Cam 5.2, cytokeratin 7, carcinoembryonic antigen, andepithelial membrane antigen. LIMITATIONS: All specimens came from dermatopathology laboratories, and some inherent selection bias may exist. CONCLUSIONS: Primary cutaneous cribriform apocrine carcinoma is a distinctive but little-known variant of cutaneous apocrine carcinoma.

Axillary apocrine carcinoma with benign apocrine tumours: a case report involvinga pathological and immunohistochemical study and review of the literature. J Clin Pathol. 2005 Jul;58(7):757-61.
BACKGROUND: Apocrine carcinoma is rare and often occurs in the axilla. This is the second apocrine carcinoma arising in bilateral axillae with associated apocrine hyperplasia to be reported. AIMS/METHODS: Because benign apocrine tumours may be precursors of cancer, this case was investigatedimmunohistochemically and histologically, and a literature (English and Japanese) review undertaken of cases with coexistent malignant and benign apocrine tumours in the axilla to elucidate the relation between apocrine carcinoma and benign apocrine tumours. RESULTS: Only four cases of axillary apocrine carcinoma withbenign apocrine tumours were identified in the literature. In each case, benignapocrine hyperplasia was situated within and surrounding the adenocarcinomatousnests. Staining for epithelial membrane antigen revealed three patterns: (1) poorly differentiated tumour cells showing strong cytoplasmic staining; (2)combined luminal surface and cytoplasmic staining of glandular cells; and (3) a strongly positive lineal staining pattern at the luminal membrane surface,comprising one or two apocrine hyperplastic secretory cells. The basal lesions ofapocrine hyperplasia were strongly positive for alpha smooth muscle actin,whereas the periphery of adenomatous lesions showed weaker positive staining,even though the periphery of adenocarcinomatous lesions was negative.CONCLUSIONS: All five apocrine carcinomas with benign apocrine tumours occurred in elderly Japanese men who had bilateral benign apocrine tumours even ifaffected by unilateral axillary apocrine carcinoma. The immunohistochemical results support the notion that apocrine hyperplasia is a precursor of cancer andthat apocrine carcinoma, adenoma, and hyperplasia may be successive steps in the linear progression to carcinoma.