Primary mucinous adenocarcinoma of the scalp: A case report and literature review

Primary Mucinous Carcinoma of Skin: A Rare Cutaneous Neoplasm. Clinicopathologic Features, Differential Diagnoses, and Review of Literature

ABSTRACT

Primary mucinous carcinoma of the skin (PMCS) is a rare malignant neoplasm of sweat gland origin, with an incidence of 0.07 per million. Histologically, it may be difficult to differentiate it from metastatic mucinous carcinomas of the skin. A case of PMCS is reported here in a 59-year-old woman who presented with a lesion on the right lower eyelid. Histological examination revealed features of mucinous adenocarcinoma. The main differential diagnosis was metastatic mucinous adenocarcinoma; however, the lack of colorectal and lung markers and the presence of focal in situ components were consistent with the diagnosis of PMCS. PMCS and breast mucinous carcinoma share immunohistochemical markers, such as GCDFP-15 and mammaglobin; however, focal in situ component with the presence of myoepithelial cells in the tumor ruled out metastatic mucinous carcinoma of breast origin. The subsequent mammograms did not reveal any breast lesions. Colonoscopy did not show any evidence of colonic malignancy, and imaging studies (CT scan) did not show any evidence of neoplasm in the body. These findings were in keeping with a diagnosis of PMCS. The present case emphasizes the importance of clinicopathological correlation, histopathology, and immunohistochemistry in the accurate diagnosis of PMCS and summarizes the literature on these rare cutaneous neoplasms.

Primary cutaneous mucinous carcinoma of the scalp masquerading as a benign dermatological mass - A case report

INTRODUCTION AND IMPORTANCE

Primary cutaneous mucinous carcinoma (PCMC) is a rare low-grade malignant neoplasm derived from the sweat glands. Local recurrence of PCMC occurs frequently, but these lesions rarely metastasize. Due to the absence of classical demographic and clinical characteristics, PCMCs masquerade as sebaceous cyst, lipoma, pilomatrixoma, chalazion, or squamous cell carcinoma. This misdiagnosis frequently leads to incomplete surgical excision which necessitates further surgical therapy for a curative intent.

CASE PRESENTATION

We present a case of PCMC in a 45-year-old woman which presented as a slow- growing and symptomless nodule in the scalp. After clinical evaluation, the patient had a typical surgical excision for a benign-looking lesion. Histological evaluation of the specimen confirmed a localized PCMC in the scalp with involved surgical margins.

CLINICAL DISCUSSION

A thorough oncological assessment by PET-CT scan and radionuclide scintigraphy was performed. Later, a wide local excision using a gamma probe for intra-operative radionuclide localization of the tumor area and sentinel lymph nodes was done.

CONCLUSION

The patient did not have any regional or distant metastases and remained stable at the time of reporting this case.

A Case of Eccrine Mucinous Carcinoma Involving Scalp

The report presents a case of a 67-year-old female with a long-standing lump on the scalp. After its excision the histopathology revealed consistency with eccrine mucinous carcinoma. These neoplasms are quite rare with only around 100 cases reported since 1951. The report concludes the importance of encouraging follow-up of cutaneous lesions among patients as well as ongoing research to better identify and manage the tumor.

Primary Mucinous Adenocarcinoma of the Upper Eyelid in an African American Female: A Rare Clinical Entity. A Case Report and Literature Review

Primary mucinous adenocarcinoma (PMA) of the eyelid is a rare eccrine gland cancer with an incidence of 0.07 per million person-years. We report a case of a 62-year-old African American female who presented with a tender lesion over her left upper eyelid which was gradually progressive over four years. It was initially presumed to be benign but histopathology after excision was suggestive of a mucinous colloid carcinoma with positive margins. She underwent repeat excision with wide margins and reconstruction and immunohistochemical studies were suggestive of PMA. Workup for metastatic disease and rare possibility of underlying occult malignancy was negative. PMA is uncommon, more so in the African American population and in females. Given the uncommon occurrence of this tumor and similarities in histopathology to colon and breast cancers, underlying occult malignancies need to be ruled out prior to confirming the diagnosis of PMA. The most effective treatment modalities are Mohs micrographic surgery or excision with frozen section control of margins with regular follow up over a prolonged period of time. However, there are no large clinical studies with regard to treatment and follow up. More literature on this tumor would therefore be beneficial to clinicians.

Primary mucinous adenocarcinoma of the eyelid: A case report and literature review

Primary mucinous adenocarcinoma (PMA) of the eyelid is an exceptionally rare clinical entity. Often, it mimics with benign lesions on clinical examination and with metastatic mucinous adenocarcinoma on histological examinations. We report a case of PMA in a 60-year-old male patient who came with a slow-growing, painless swelling near the lower lid of the left eye. Excisional biopsy from the mass revealed a mucinous adenocarcinoma. To differentiate it from a metastatic mucinous adenocarcinoma, a wide range of immunohistochemistry panel was run. The tumor cells showed strong positivity for cytokeratin7, cytokeratin5/6, p63, estrogen receptor, progesterone receptor and negativity for cytokeratin20. Moreover, extensive metastatic work-up did not show any primary malignancy elsewhere, hence a final diagnosis of PMA was made. We report a rare case of PMA from the Madinah region of Saudi Arabia.

Overlooked adenocarcinoma of the scalp

An apocrine adenocarcinoma of the scalp is a rare diagnosis in internal medicine. The article reviews the pathophysiology of the diagnosis and new, nonsurgical treatment options including radiation therapy and topical chemotherapy treatments.

Expression of hormone receptors, adipophilin, and GCDFP-15 in mucinous carcinoma of the skin

BACKGROUND

Primary cutaneous mucinous carcinoma (PCMC) is a rare epithelial tumor with unclear histogenesis.

METHODS

We evaluated the immunohistochemical expression of the estrogen receptor (ER), progesterone receptor (PR), and androgen receptor (AR) in six cases of PCMC. The immunoreactivity of adipophilin and gross cystic disease fluid protein (GCDFP)-15 was investigated to determine the origin of the tumor.

RESULTS

The study included five males and one female aged 50 to 69 years who presented with a cutaneous mass in the face. Immunoreactivity for ER, PR, and AR was observed in all cases, and all cases were negative for adipophilin but positive for GCDFP-15.

CONCLUSIONS

This report is the first to show AR expression in PCMC. All of followed cases manifested indolent clinical course, and the prognostic significance of hormone receptors in PCMC remains unclear. The negative immunoreactivity of PCMC for adipophilin and positivity for GCDFP-15 suggests a more likely relationship to apocrine than to sebaceous glands.

Mucinous Adenocarcinoma of the Scalp: Primary Cutaneous Neoplasm Versus Underlying Metastatic Disease

Primary cutaneous mucinous carcinoma (PCMC) is a rare mucin-producing malignancy derived from epithelial glandular structures. The literature regarding this topic is mostly in the form of case reports and case series. PCMC tends to present in the elderly with predilection for the head and neck and on initial assessment it can be easily mistaken for a simple inclusion cyst. Although PCMC is often indolent in nature, in rare instances it can metastasize and should remain a differential diagnosis in a selected population. The significance in identifying PCMC is reliably differentiating it from metastatic mucinous adenocarcinoma. We present a review of literature and case of PCMC on the scalp of a 67-year-old female.

Primary Mucinous Adenocarcinoma of Skin: Myoepithelial Cells are a Clue to its Diagnosis

Primary mucinous adenocarcinoma is a rare adnexal neoplasm of eccrine gland. Fewer than 200 cases are reported in literature. Clinically, it can be mistaken as a benign lesion. The primary challenge in these lesions is to differentiate these rare primary lesions from more frequent mucinous secondary deposits. Morphologically, they are similar to metastatic deposits of mucinous carcinoma from other viscera such as breast, lung, or gastrointestinal tract. Use of ancillary techniques and a thorough metastatic work up are mandatory to differentiate these lesions from metastases. We report a case of primary mucinous carcinoma of nasojugal region in a 51-year-old female. It was diagnosed on fine-needle aspiration cytology, and later, the lesion was excised and diagnosis confirmed on histopathological examination and immunohistochemistry.

Primary mucinous eccrine carcinoma of the buccal space: A case report and review of the literature

IMPORTANCE

Mucinous eccrine carcinoma is a rare entity that most commonly affects the head and neck. Due to its low frequency of occurrence, review of its etiology, histopathology, and treatment strategies is beneficial to all clinicians who may encounter similar appearing masses.

OBSERVATION

An 84-year-old male presented with a blue mass on the left cheek. This mass started as a small bump and grew significantly over one year. His primary care physician monitored its growth and ultimately referred to an otolaryngologist. Imaging findings revealed a multi-lobular solid and cystic left buccal lesion. FNA was suggestive of low grade mucoepidermoid carcinoma.

INTERVENTION

Patient underwent surgical excision with primary closure of the defect. Frozen section was consistent with low grade salivary malignancy. Final pathology revealed primary mucinous eccrine carcinoma of the skin.

CONCLUSIONS AND RELEVANCE

Mucinous eccrine carcinoma is a rare entity commonly seen in the head and neck region. Mucinous deposits to the skin from primaries elsewhere in the body are much more common than primary lesions of the skin. Histology is a key component of the diagnosis but full oncologic workup is required. Treatment typically includes wide local excision with possible adjuvant chemotherapy or radiation for high risk features.

Unusual skin mass (primary cutaneous mucinous carcinoma)

Primary mucinous carcinoma of the skin is a rare malignant tumour of sweat gland origin. Diagnostic concerns include its deceptively benign appearance in some cases and the difficulty in differentiating it from secondary mucinous carcinoma of skin metastasising from a primary source elsewhere. A case of a 75-year-old man is reported who presented with a slowly growing painless mass near the lateral canthus of the right eye for about 2 years. Clinically, a diagnosis of basal cell carcinoma was made whereas histopathology revealed mucinous carcinoma of the skin. The primary source of the tumour could not be found on detailed physical examination and laboratory investigations. Immunohistochemistry, performed later, was consistent with primary cutaneous mucinous carcinoma.