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Cazzato G, Bellitti E, Trilli I, Colagrande A, Sgarro N, Scarcella VS, Lettini T, Ingravallo G, Piscitelli D, Resta L, Lospalluti L. Endocrine Mucin-Producing Sweat Gland Carcinoma: Case Presentation with a Comprehensive Review of the Literature. Dermatopathology (Basel) 2023; 10:266-280. [PMID: 37754277 PMCID: PMC10529628 DOI: 10.3390/dermatopathology10030035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
(1) Background: Endocrine Mucin-Producing Sweat Gland Carcinoma (EMPSGC) is a rare, low-grade, neuroendocrine-differentiated, cutaneous adnexal tumor, officially recognized by the World Health Organization (WHO) Skin Tumors Classification in 2018 as a separate entity and homologue of endocrine ductal carcinoma in situ (eDCIS)/solid papillary carcinoma of the breast. Although it is more frequent in the female sex, between 60 and 70 years old, in the peri-orbital region, EMPSGC has also been described in the male sex, in subjects under 60 and over 80, and in extra-eyelid localizations (cheek, temple, scalp), but also in extra-facial localizations (chest and scrotum). (2) Methods: We present the clinical case of a 71-year-old woman with an undated lesion of the scalp, which presented as a nodule, skin-colored, and 2.5 cm in maximum diameter. We also conduct a comprehensive literature review from 1997 to the end of 2022, consulting PubMed, Scopus, Web of Science (WoS), and Google Scholar using the following keywords: "Endocrine mucin-producing sweat gland carcinoma" and/or "EMPSGC" and/or "skin" and "cutaneous neoplasms". In addition, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 253 patients were recorded; 146 were females (57.7%) and 107 were males (42.2%). The vast majority of the lesions were in the eyelids (peri-ocular region), and only a minority of cases involved the cheeks, supra-auricular, retro-auricular, and occipital region, with very rare cases in the scalp, to which the present is also added. (4) Conclusions: The morphological and immunophenotypical features are essential both for the correct diagnosis and to be able to classify this lesion among the corresponding eDCIS/solid papillary carcinoma of the breast, with neuroendocrine differentiation. Recent papers have attempted to shed light on the molecular features of EMPSGC, and much remains to be conducted in the attempt to subtype the molecular profiles of these entities. Future studies with large case series, and especially with molecular biology techniques, will be needed to further add information about EMPSGC and its relationship in the PCMC spectrum.
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Affiliation(s)
- Gerardo Cazzato
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Emilio Bellitti
- Anatomic Pathology Unit, “A. Perrino” Hospital, 72100 Brindisi, Italy;
| | - Irma Trilli
- Odontomatostologic Clinic, Department of Innovative Technologies in Medicine and Dentistry, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy;
| | - Anna Colagrande
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Nicoletta Sgarro
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Vincenza Sara Scarcella
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Teresa Lettini
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Giuseppe Ingravallo
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Domenico Piscitelli
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Leonardo Resta
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (N.S.); (V.S.S.); (T.L.); (G.I.); (D.P.); (L.R.)
| | - Lucia Lospalluti
- Section of Dermatology, Azienda Ospedaliero-Universitaria Policlinico di Bari, 70121 Bari, Italy;
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Froehlich MH, Conti KR, Norris II, Allensworth JJ, Ufkes NA, Nguyen SA, Bruner ET, Cook J, Day TA. Endocrine Mucin-Producing Sweat Gland Carcinoma: A Systematic Review and Meta-Analysis. J DERMATOL TREAT 2021; 33:2182-2191. [PMID: 34057875 DOI: 10.1080/09546634.2021.1937479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Endocrine Mucin-Producing Sweat Gland Carcinoma is a rare, under-reported cutaneous adnexal tumor that is often misdiagnosed and has an unknown incidence of metastasis. OBJECTIVE To determine the incidence of metastasis and tumor recurrence, as well as diagnostic accuracy and current trends in treatment modality. METHODS A search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Tumor pathology and clinical data concerning demographics, presentation, diagnosis, treatment and follow-up were assessed. RESULTS A total of 36 publications with 110 cases were identified. Initial pathological diagnosis was incorrect in 45.5% of cases. One case of metastatic disease was reported. The incidence of locoregional recurrence was 10.6% over a mean follow-up period of 21.3 months. Of cases with known methods of resection, 34.6% were resected by excisional biopsy, 42.8% were resected by wide surgical excision, and 31.3% were cleared by Mohs micrographic surgery. LIMITATIONS The low reported incidence and level of evidence was suboptimal with only case reports and retrospective case studies being reported. CONCLUSION Reported cases of this pathology demonstrate poor diagnostic accuracy. High rates of misdiagnosis and inadequate definitive treatment suggest the need for more comprehensive work-up and management of lesions suspicious for this pathology.
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Affiliation(s)
- Michael H Froehlich
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Keith R Conti
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ivy I Norris
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jordan J Allensworth
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicole A Ufkes
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Evelyn T Bruner
- Department of Pathology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joel Cook
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A Day
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Au RTM, Bundele MM. Endocrine mucin-producing sweat gland carcinoma and associated primary cutaneous mucinous carcinoma: Review of the literature. J Cutan Pathol 2021; 48:1156-1165. [PMID: 33590507 DOI: 10.1111/cup.13983] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare, low-grade, cutaneous adnexal carcinoma with neuroendocrine differentiation. It is considered to be a precursor of invasive neuroendocrine type primary cutaneous mucinous carcinoma (PCMC). OBJECTIVE To review clinicopathological literature summary of EMPSGC and associated neuroendocrine PCMC from all reported cases and compare its behavior vs non-neuroendocrine PCMC data reported in the literature. METHODS A review of English literature of all EMPSGC cases with and without associated PCMC was carried out. RESULTS EMPSGC was associated with invasive neuroendocrine type PCMC in 35.7% of cases. We found the recurrence rate of PCMC associated with EMPSGC of about 12.3%, which is much less than the 30% recurrence rate reported for the non-neuroendocrine subtype of PCMC. The non-neuroendocrine subtype of PCMC shows a 4% and 11% rate of distant and lymph node metastasis, respectively, vs EMPSGC-associated neuroendocrine type of PCMC, which is very indolent and only one recent case of locoregional metastasis out of 190 EMPSGC cases has been reported so far. LIMITATION Limitation of our study includes data derivation from case reports and case series in the literature. CONCLUSION The prognostic benefits for this cohort of patients may be considered in their overall management.
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Affiliation(s)
| | - Manish M Bundele
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
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Shah DS, Homer NA, Epstein A, Durairaj VD. Simultaneous presentation of orbital mantle cell lymphoma and endocrine mucin-producing sweat gland carcinoma. Orbit 2021; 41:509-513. [PMID: 33657963 DOI: 10.1080/01676830.2021.1894583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mantle cell lymphoma is a rare malignancy to present in the orbit, comprising only 1-5% adnexal lymphomas. Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is an equally uncommon adnexal tumor of sweat gland origin that may present on the eyelid. Herein we present a case of a 77-year old man with no previous cancer history who presented with painless progressive left globe proptosis and an enlarging left upper lid margin lesion, ultimately determined upon biopsy to be simultaneous orbital mantle cell lymphoma with systemic involvement and isolated eyelid EMPSGC. The pathogenesis, clinical manifestation, and management for each rare disease entity are reviewed and concept of collision tumors is discussed.
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Affiliation(s)
- Darsh S Shah
- Department of Ophthalmology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Natalie A Homer
- Department of Ophthalmology, UC Davis, Sacramento, California, USA
| | | | - Vikram D Durairaj
- Department of Ophthalmology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.,TOC Eye and Face, Austin, Texas, USA
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An Update on Endocrine Mucin-producing Sweat Gland Carcinoma: Clinicopathologic Study of 63 Cases and Comparative Analysis. Am J Surg Pathol 2020; 44:1005-1016. [PMID: 32452870 DOI: 10.1097/pas.0000000000001462] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare, low-grade adnexal neoplasm with predilection for the periorbital skin of older women. Histologically and immunophenotypically, EMPSGC is analogous to another neoplasm with neuroendocrine differentiation, solid papillary carcinoma of the breast. Both lesions are spatially associated with neuroendocrine mucinous adenocarcinomas of the skin and breast, respectively. EMPSGC is ostensibly a precursor of neuroendocrine-type mucinous sweat gland adenocarcinoma (MSC), a lesion of uncertain prognosis. Non-neuroendocrine MSC has been deemed locally aggressive with metastatic potential, and previous works speculated that EMPSGC-associated (neuroendocrine-type) MSC had similar recurrence and metastatic potential with implications for patient follow-up. Only 96 cases of EMPSGC have been reported (12 cases in the largest case series). Herein, we present 63 cases diagnosed as "EMPSGC" in comparison with aggregated results from known published EMPSGC cases. We aim to clarify the clinicopathologic features and prognostic significance of the neuroendocrine differentiation of EMPSGC and its associated adenocarcinoma and to determine the nosological relevance of EMPSGC association in the spectrum of MSC histopathogenesis. Results established an overall female predominance (66.7%) and average presenting age of 64 years. EMPSGC lesions were associated with adjacent MSC in 33.3% of cases. The recurrence rate for neuroendocrine-type MSC was ~21%, less than the reported 30% for non-neuroendocrine MSC. There were no cases of metastasis. EMPSGC and neuroendocrine-type MSC are distinct entities with more indolent behavior than previously reported, supporting a favorable prognosis for patients.
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Nasser H, Siddiqui S. Endocrine Mucin-Producing Sweat Gland Carcinoma: Two New Eyelid Cases and Review of the Literature. Int J Surg Pathol 2020; 28:653-657. [PMID: 32188317 DOI: 10.1177/1066896920913940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare low-grade sweat gland carcinoma. It is clinically often mistaken for basal cell carcinoma and presents a low rate of local recurrence. In this article, we present 2 new cases of EMPSGC arising in a similar location (left lower eyelid) and review the literature on this topic. One patient is a 72-year-old male with complete excision and no evidence of recurrence after 17 months of surveillance. The second patient is a 77-year-old female with incomplete initial excision and local recurrence after 38 months. p63 immunostain was negative in both cases. EMPSGC should be suspected in elderly patients with lesions of eyelids. Histologically, it should be considered and worked up if the lesion is separated from the overlying epidermis and presents a mucinous component. Complete excision is advised to avoid local recurrences.
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Affiliation(s)
- Haitham Nasser
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Sami Siddiqui
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
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7
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Chen YC, Wang SH, Chang YJ. Endocrine mucin-producing sweat gland carcinoma: Report of two cases. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Navrazhina K, Petukhova T, Wildman HF, Magro CM, Minkis K. Endocrine mucin-producing sweat gland carcinoma of the scalp treated with Mohs micrographic surgery. JAAD Case Rep 2018; 4:887-889. [PMID: 30306119 PMCID: PMC6172448 DOI: 10.1016/j.jdcr.2018.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kristina Navrazhina
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Tatyana Petukhova
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Horatio F Wildman
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Cynthia M Magro
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Kira Minkis
- Department of Dermatology, Weill Cornell Medical College, New York, New York
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9
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Qin H, Moore RF, Ho CY, Eshleman J, Eberhart CG, Cuda J. Endocrine mucin-producing sweat gland carcinoma: A study of 11 cases with molecular analysis. J Cutan Pathol 2018; 45:681-687. [PMID: 29943394 DOI: 10.1111/cup.13308] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/15/2018] [Accepted: 06/21/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare, low-grade adnexal neoplasm that most commonly involves the eyelid. Analogous to solid papillary carcinoma of the breast, it probably represents a precursor lesion to mucinous carcinoma. Here, we describe 11 cases of EMPSGC with molecular analysis. METHODS We performed a retrospective search of the Johns Hopkins Medical Institute pathology database and identified 11 cases of EMPSGC. Immunohistochemistry was performed for chromogranin, synaptophysin, neuron specific enolase, estrogen receptor (ER), epithelial membrane antigen (EMA), cytokeratin 7 (CK7), and cytokeratin 20 (CK20). Array comparative genomic hybridization (aCGH) and BRAFV600E pyrosequencing were performed on two and three cases, respectively. RESULTS We observed a strong female predilection (73% females, 8/11 cases) with an average age of 66 years (range, 56-83 years). EMPSGCs were associated with adjacent benign sweat gland cysts (3/11), atypical intraductal proliferation (1/11), and mucinous carcinoma (1/11). Immunohistochemically, all tumors expressed at least one neuroendocrine marker, ER, EMA, and CK7, and were negative for CK20. aCGH demonstrated a 6p11.2 to 6q16.1 deletion (1/2 cases). All cases were negative for BRAFV600E mutation (3/3 cases). CONCLUSION This series provides further histopathologic support that EMPSGC represents a multistage progression to mucinous carcinoma. Additional studies are needed to understand its molecular mechanisms.
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Affiliation(s)
- Huamin Qin
- Department of Pathology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Department of Pathology, Ophthalmology and Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Robert F Moore
- Department of Pathology, Ophthalmology and Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Cheng-Ying Ho
- Department of Pathology, University of Maryland, Baltimore, Maryland
| | - James Eshleman
- Department of Pathology, Ophthalmology and Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Charles G Eberhart
- Department of Pathology, Ophthalmology and Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Jonathan Cuda
- Department of Dermatology, Dermatopathology and Oral Pathology, Johns Hopkins University, Baltimore, Maryland
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Endocrine Mucin–Producing Sweat Gland Carcinoma Treated With Mohs Micrographic Surgery. Dermatol Surg 2017; 43:1498-1500. [DOI: 10.1097/dss.0000000000001138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Hasegawa-Murakami Y, Kono M, Yokota K, Inaba H, Fukumoto T, Akiyama M. Dermoscopic features of endocrine mucin-producing sweat gland carcinoma. J Dermatol 2017; 45:353-356. [PMID: 29178396 DOI: 10.1111/1346-8138.14146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022]
Abstract
Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is very rare, with only 61 cases reported to date. EMPSGC is considered to be a low-grade carcinoma of sweat gland origin. Dermoscopic findings of EMPSGC have not been previously reported. We report the first case of a man with EMPSGC, featuring dermoscopic findings. Dermoscopic examinations of the present EMPSGC lesion revealed tumor cell proliferation that appeared as pink ovoid nests and elongated epidermis that resembled a whitish-pink network. Another characteristic finding of the present lesion was the large red/blue globules in pink ovoid nests in the tumor. Those reflected lacunae containing secretory fluid with red blood cells. We think that the large red/blue globules in pink ovoid nests in our case could be a characteristic dermoscopic finding specific to EMPSGC. We dermatologists encounter many "pink nodules" at out-patient clinics. The present dermoscopic findings may be useful for the differential diagnosis of EMPSGC.
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Affiliation(s)
| | - Michihiro Kono
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Yokota
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroko Inaba
- Devision of Dermatology, Tokoname City Hospital, Tokoname, Japan
| | | | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Endocrine Mucin-Producing Sweat Gland Carcinoma, a Histological Challenge. Case Rep Pathol 2017; 2017:6343709. [PMID: 28299221 PMCID: PMC5337370 DOI: 10.1155/2017/6343709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/29/2017] [Indexed: 11/22/2022] Open
Abstract
Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare adnexal tumor of the skin with low-grade cytological features and neuroendocrine differentiation. It has a predilection for the skin of the eyelid, but has also been reported in the face and rarely extra-facial locations. The tumor is seen more frequently in women and on average affects the elderly. It is histologically and immunohistochemically analogous to solid papillary carcinoma of the breast/endocrine ductal carcinoma in situ with a nodular, solid, papillary, and/or cribriforming architecture, neuroendocrine differentiation, and mucin production. Since it was first described by Flieder et al. in 1997, less than 60 cases have been reported in literature. We describe the morphological and immunohistochemical features of another case with a review of the common histological differential diagnoses and emphasize the salient features that help distinguish this rare neoplasm.
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