Eccrine porocarcinoma

Treatment of eccrine porocarcinoma with Mohs micrographic surgery: a cases series and literature review

BACKGROUND

Eccrine porocarcinoma (EPC) is a rare malignant tumor of the eccrine sweat gland. It is a potentially fatal neoplasm that is locally aggressive and commonly recurs. Wide surgical excision has traditionally been the treatment of choice and is curative in approximately 70-80% of cases. The disease is metastatic to lymph nodes and distant sites in 20% and 10% of cases, respectively. Metastatic EPC has not shown any great response to adjuvant chemotherapy or radiation.

OBJECTIVE

The purpose of this study was to evaluate the efficacy of Mohs micrographic surgery (MMS) for EPC as an alternative to wide local excision.

METHODS

Five patients diagnosed with EPS between 2011 and 2014 at the University of Louisville and treated with MMS were studied. Recurrence-free periods subsequent to the treatment of EPC with MMS were measured.

RESULTS

The five patients with EPC treated by MMS remained recurrence-free for a mean of 11 months (range: 2-26 months).

CONCLUSIONS

Mohs micrographic surgery is a highly effective treatment for EPC. Given the high rate of recurrence, propensity for lymph node metastases, and the often ineffective options for treating advanced disease, MMS should be considered in the treatment of all cases of EPC.

Eccrine porocarcinoma: A case report and review of the literature

Eccrine porocarcinoma is a rare form of skin cancer that is often confused with other types of skin malignancy. The present paper highlights a typical case to remind plastic surgeons of the natural history, pathological findings and current literature on the management of this cancer.

Porocarcinoma: case report

Eccrine porocarcinoma is a rare, malignant neoplasm of eccrine sweat glands. It often occurs in elderly people, mean age of 67.5 years. The clinical features are variable and their localization is not related to sweat-gland concentration, occurring mainly on the feet and legs. Disease diagnosis and treatment should be as early as possible in order to avoid tumor aggressiveness that occurs in 20% of the cases. The authors present a case of extensive porocarcinoma on the thorax of a 71-year-old male patient.

Eccrine porocarcinoma of the lower extremity: a case report and review of literature

Eccrine porocarcinoma is a rare malignancy of the eccrine sweat gland. It is usually found frequently on the lower extremities, and it affects both sexes equally usually in the sixth to seventh decade. In our case, we present a 42-year-old male patient with a recurring exophytic tumor on the right lower extremity without local extension. The initial tumor was biopsied, excised and diagnosed as an eccrine poroma. The tumor then recurred 6 years later, was re-excised, reconstructed with a soleus muscle flap and diagnosed as an eccrine porocarcinoma.

Treatment of eccrine porocarcinoma with metastasis to the parotid gland using intensity-modulated radiation therapy: a case report

Introduction

Cutaneous eccrine porocarcinomas are uncommon malignant tumors of the sweat gland.

Case Presentation

A 76-year-old Caucasian man presented to our hospital with a left temporal mass. We describe a case of eccrine porocarcinoma with metastasis to the parotid gland with special emphasis on the role of surgical resection and adjuvant radiation therapy.

Conclusion

Besides surgical resection, little is known about the role of adjuvant therapy in managing eccrine porocarcinomas. Radiation therapy should be considered within a multidisciplinary approach in patients with primary or recurrent eccrine porocarcinomas.

Malignant eccrine poroma invading the parotid gland

Malignant eccrine poroma was first described by Pinkus and Mehregon in 1963. Because of the histologic characteristics of the tumor, these authors concluded that the tumor was likely of eccrine origin. Malignant eccrine poroma originates from the intraepidermal ductal portion of the eccrine gland. Like other tumors of skin adnexa, malignant eccrine poroma is a rare tumor. It mostly affects older persons. Clinical diagnosis is difficult, and lesions are often mistakenly identified as squamous cell carcinoma or pyogenic granuloma. We report a case of malignant eccrine poroma invading the parotid gland. A 65-year-old man presented with an ulcerated mass (2x3 cm) below the ear lobule of 3 months' duration. The mass was fixed to the skin and underlying parotid gland. The lesion was treated using a superficial parotidectomy approach including the overlying skin. Simultaneous neck dissection was performed. The diagnosis was malignant eccrine poroma invading the parotid gland.

Eccrine porocarcinoma arising in two African American patients: distinct presentations both treated with Mohs micrographic surgery

Abstract Background Eccrine porocarcinoma (EPC) is a rare, malignant adnexal tumor that has been reported only three times specifically in African American individuals. Diagnosis and treatment of EPC is important, given the 20% local recurrence and regional metastatic rates. However, no standard of care has been developed to guide effective treatment. Methods We report two distinct clinical presentations of EPC, both in African Americans, and discuss a review of the literature. Results The neoplasms were successfully removed from both patients by Mohs micrographic surgery. Conclusions These two cases illustrate that EPC can have a variety of presentations and can occur in African Americans. Although there is no standard of care for treating EPC, Mohs is becoming a common technique of removing these lesions.

Malignant adnexal neoplasms

Malignant cutaneous adnexal neoplasms are one of the most challenging areas of dermatopathology. Tumors of the pilosebaceous apparatus can occur as single-lineage neoplasms or may manifest as complex proliferations with multilineal differentiation patterns including not only the germinative component of the hair bulb, the inner or outer root sheath epithelium and the sebaceous gland and duct, but also the sweat duct components that relate to the apocrine secretory apparatus which empties into the follicle near the follicular bulge. Eccrine and apocrine neoplasms present a bewildering array of morphologies, which often defy precise classification. The purpose of this review is to discuss in detail the malignant neoplasms of the cutaneous adnexae and their benign and prognostically indeterminate mimics.

Eccrine porocarcinoma of the eyelid treated with Mohs micrographic surgery

BACKGROUND

Eccrine porocarcinoma (EPC) is a rare malignant tumor of the eccrine sweat glands. The lesions are reported to occur most commonly on the lower extremity with variable prognosis.

OBJECTIVE

To discuss the clinical and histologic features and the prognosis of EPC.

METHODS

We report a 71-year-old man who presented with an asymptomatic lesion on his lower eyelid that had been present for 6 weeks.

RESULTS

The 4 x 4-mm lesion was removed in two stages using the Mohs micrographic surgery fresh-tissue technique. The histopathologic diagnosis was primary EPC.

CONCLUSION

EPCs most commonly occur on the lower extremity. This case is interesting because the lesion was located on the lower eyelid.

Widespread metastatic eccrine porocarcinoma

Eccrine porocarcinoma is a rare malignant sweat gland tumor arising from the acrosyringium. These lesions can show multiple epidermotropic metastases, however, systemic spread is rare. We describe the case of a 42-year-old African American man who presented in February 1998 with a lesion on the plantar surface of his right foot that was diagnosed as an eccrine porocarcinoma. Subsequently, during the next year, cutaneous metastases developed to his left shoulder and flank. Two years after his initial presentation, he was admitted with an esophageal mass and multiple gastric ulcers. Biopsy specimens of these lesions demonstrated metastatic eccrine porocarcinoma. Further evaluation revealed multiple metastases to lymph nodes, lungs, and brain. Histologic examination revealed nests of basaloid cells with eosinophilic cytoplasm and intracellular ductlike lumina lined by eosinophilic basement membranelike material. These ductular structures where highlighted by immunohistochemical stains for carcinoembryonic antigen, confirming their eccrine differentiation. There were mitotic figures and individual cell necrosis. Although rare, systemic metastases from an eccrine porocarcinoma must enter the differential diagnoses of a tumor mass in such patients.

Malignant eccrine poroma in an unusual location

Malignant eccrine poroma is a rare skin appendage tumour, originating from the intraepidermal and upper dermal eccrine ducts. The tumour either arises spontaneously or develops in a long-standing eccrine poroma, generally in elderly people over 60. Clinically, it tends to be a localized lesion, which manifests itself as a nodule or ulcerated tumour, favouring extremities. We report an 83-year-old female with an enlarging and bleeding tumour on her lumbosacral region. This lesion first appeared as a small pigmented papule and progressed to an erythematous patch with central papular portion and some peripheral pigmentation. Histopathology revealed malignant eccrine poroma. Also, immunohistochemically, diffuse and intense p53 staining was observed. Regular pigment pattern, brown globules and black dots were seen in dermoscopic examination. After performing a wide excision, 20 months of follow-up revealed no recurrence or metastasis of the tumour. This case represents an unusually located malignant eccrine poroma with some pigmentation.

Aberrant expression of p16 and RB protein in eccrine porocarcinoma

BACKGROUND

Eccrine porocarcinoma is a rare malignant tumor of the sweat gland and very little is known about its etiology and molecular basis.

METHODS

To investigate the expression of p16 and retinoblastoma (RB) protein and their relationship, an immunohistochemical method was performed on nine eccrine porocarcinomas and five eccrine poromas. Furthermore, one case of eccrine porocarcinoma was analyzed for p16 gene mutation.

RESULTS

A striking inverse correlation between p16 and RB expression was noted in all of the eccrine porocarcinomas and poromas. Strong immunoreactivity for p16 protein was observed in both nuclei and cytoplasm of the tumor cells in eight out of nine cases of eccrine porocarcinomas, while RB expression was negative in these cases. Conversely, one case of eccrine porocarcinoma did not show immunoreactivity for p16 protein, whereas RB protein was positive in the scattered nuclei. On the other hand, immunostaining of p16 was negative in all cases of five poromas, whereas RB-positive nuclei were sparse. No p16 gene mutation was detected in the investigated eccrine porocarcinoma case.

CONCLUSIONS

These results indicate that detectable p16 protein and loss of RB protein are common occurrences in eccrine porocarcinoma lesions. Moreover, overexpression of p16 protein may be an additional, simple and useful diagnostic marker for eccrine porocarcinoma on routine laboratory screening.

Eccrine porocarcinoma (malignant eccrine poroma): a clinicopathologic study of 69 cases

The clinicopathologic characteristics of 69 cases of eccrine porocarcinoma (EP) have been studied. Seven cases of purely in situ disease are included. Forty patients were female, 29 male with ages ranging from 29 to 91 years (mean 73 years). The lower extremity represented the single most common site (44%). Other common sites were the trunk (15 cases, 24%) and head (11 cases, 18%). The histologic diagnosis of EP was predicated on the basis of an irregular tumor at least partly formed of characteristic poromatous basaloid epithelial cells displaying ductal differentiation, and significant cytologic atypia. Forty-seven tumors (68%) contained mature well-formed eccrine ducts having an eosinophilic luminal cuticle, with the remaining tumors containing small ill-formed ducts and/or intracytoplasmic lumina. All ducts were discernible via light microscopy and in 49 cases were highlighted with DPAS stain and/or CEA/EMA immunocytochemistry. A variant with a broad pushing tumor margin and marked nuclear pleomorphism showed some resemblance to proliferative bowenoid dysplasia. In 11 cases (18%) the tumors appeared to arise in continuity with a benign preexistent poroma. A variety of histologic patterns were displayed including clear, squamous, and spindle cell differentiation, mucus cell metaplasia, and colonization by melanocytes. Lymphovascular invasion was present in 9 cases (15%). Three cases showed pagetoid extension of malignant cells (epidermotropism) and appeared to be multifocal. Follow-up was available in 54 patients (78%) with 9 (17%) experiencing local recurrence, 10 developing lymph node metastases (19%), and 6 (11%) experiencing distant metastases or death. Mitoses, the presence of lymphovascular invasion, and tumor depth >7 mm were associated with a poorer prognosis. Dividing tumors into those with a "pushing" or "infiltrating" advancing margin was also predictive of outcome with the latter having an increased risk of local recurrence. This report, the largest series of EP to date, suggests that the incidence of aggressive behavior is less than popularly believed. Furthermore, EP can display a wide variety of histologic patterns that may lead to diagnostic error in the unwary. The large number of cases in this series enables a reliable evaluation of prognostic parameters. A more aggressive clinical course may be indicated by more than 14 mitoses per high power field (hazard ratio [HR] for death 17.0, 95% confidence interval [CI] 2.71-107), lymphovascular invasion by tumor (HR 4.41, CI 1.13-17.2), and depth >7 mm (HR 5.49, CI 1.0-30.3). Thus, mitoses, lymphovascular invasion, and tumor depth should be evaluated in these tumors. We also suggest that tumors presenting an "infiltrative" advancing margin are particularly prone to local recurrence and require wide excision with close attention to the surgical margins by the reporting pathologist.

Intracranial extension of an eccrine porocarcinoma. Case report and review of the literature

Eccrine porocarcinoma is a rare malignant tumor of the true sweat gland. It commonly presents in the lower extremities with lymphatic metastasis. The authors describe the clinical presentation, radiographic evidence, operative discoveries, and pathological findings in a patient with an eccrine porocarcinoma involving the soft tissue of the occiput, which had eroded through the cranium. A review of the literature failed to reveal any other such case. The discussion includes the epidemiology, pathogenesis, treatment, and outcome of eccrine porocarcinomas. The six reported cases of scalp eccrine tumors are reviewed.

Eccrine porocarcinoma

Eccrine porocarcinoma is a malignant tumor of eccrine sweat glands. It is a very rare, slow growing tumor and clinically resembles other skin cancers. We report a case and review its clinical and pathological features. These tumors have a propensity for local recurrence, and wide excision with negative margins is recommended.

Metastasizing eccrine porocarcinoma: report of a case and review of the literature

Eccrine porocarcinoma is a rare malignant tumor arising from the intraepidermal ductal portion of the eccrine sweat gland (acrosyringium). It usually affects older persons and is located most commonly on the lower extremities. We describe a 55-year-old man with an aggressive metastasizing eccrine porocarcinoma diagnosed 10 years after the primary lesion. The metastatic lesions were located in the public area and scrotum and were associated with progressive lymphedema. Several biopsy specimens revealed numerous tumor cells in the dermis and especially in the lumina of lymph and blood vessels. Immunohistochemical studies showed staining with cytokeratin KL1, epithelial membrane antigen, Ca 15-3, and Ca 19-9. Vimentin, S-100 protein, neuron specific enolase, and carcino-embryonic antigen were negative. Treatment with carbon dioxide laser failed. The use of interferon alfa-2a for 9 months stopped progression of the tumor.