Eccrine porocarcinoma

Eccrine porocarcinoma of the head and neck: Meta-analysis of 120 cases

BACKGROUND

The aim of the study is to analyze potential prognostic factors and to evaluate therapy strategies regarding clinical outcome in patients with eccrine porocarcinoma (EPC) of the head and neck.

METHODS

One hundred and sixteen EPC cases from ninety studies and four authors' EPC cases were included in the meta-analysis.

RESULTS

At an average follow up of 20.48 months, the 3-year overall survival and regional recurrence rate were 70.3% and 19.0%, respectively. Patients without surgical treatment had a significantly worse 3-year overall survival. Mohs microscopic surgery led to significantly less occurrence of regional recurrences compared to wide excision. An ulcerating lesion, high mitotic activity, and lymphovascular invasion were significant prognostic factors.

CONCLUSION

Surgical resection is the cornerstone in the therapy of EPC and represents the therapeutic modality that offers the best chance of disease-free survival. Due to the high probability of recurrence, close follow-ups are strongly recommended.

Eccrine Porocarcinoma: New Insights and a Systematic Review of the Literature

BACKGROUND

Eccrine porocarcinoma (EPC) is a rare cutaneous neoplasm with high potential for morbidity and mortality. Due to its rarity, there is a paucity of data profiling diagnosis, work-up, and management.

OBJECTIVE

To consolidate reported information on demographics, diagnostics, clinical behavior, treatment modalities, and patient outcomes in EPC to provide a reference tool to optimize diagnosis and management.

METHODS

A comprehensive PubMed search was performed from 1963 to November 2017 using PRISMA guidelines. This yielded 155 articles detailing 206 cases of porocarcinoma.

RESULTS

Eccrine porocarcinoma most often presents in elderly patients on the head and neck or lower limbs. Metastatic disease at presentation is not uncommon (22%). Primary tumor location is significantly correlated with presence of metastasis (p = .038). The most common treatment is excision followed by Mohs micrographic surgery (MMS), although the outcomes after MMS were superior to those after surgical excision.

CONCLUSION

This systematic review of individual patient data reveals that all patients should have a histological diagnosis with imaging considered for high-risk cases. Primary tumor location should also be considered in diagnostic and therapeutic decision-making. Although wide local excision (WLE) is currently the first-line treatment, MMS is becoming increasingly used, with evidence indicating improved outcomes as compared to those seen with WLE.

Eosinophilic variant of eccrine porocarcinoma of the scalp: Case report and review of the literature

Porocarcinoma is a rare malignant neoplasm of the acrosyringium with metastatic potential that most commonly presents on the acral skin in older adults (mean age = 72 years). We present the case of a 43-year-old woman who developed a rapidly growing de novo porocarcinoma on the scalp with an unusual oncocytic appearance. The tumor consisted of benign eccrine poroma that arose from the epidermis and broad pushing borders with minimal cytological atypia but ample eosinophilic cytoplasm with numerous mitotic figures. Although some tumors may appear deceptively bland, the histologic recognition of pushing/infiltrative borders and mitotic figures are helpful to make the appropriate diagnosis of carcinoma. This lesion was treated with Mohs micrographic surgery and the patient remained free of recurrence after more than 2 years. It is important to recognize the eosinophilic variants of eccrine porocarcinoma because it can histologically mimic a squamous cell carcinoma.

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.

Primary eccrine porocarcinoma of the finger with transit forearm and axillary metastasis

Sweat gland tumors of the upper extremity are uncommon. Eccrine porocarcinoma is a rare skin malignant lesion representing 0.005% to 0.01% of all cutaneous tumors, which most commonly presents in patients more than 60 years of age. Approximately 250 cases of eccrine porocarcinoma have been reported since this disease was first described in 1963. However, only 2 cases occurring specifically on the finger (including the current case) have been documented in the literature to date. On the basis of the rarity of eccrine porocarcinoma of the finger, we report an eccrine porocarcinoma that presented as an ulcerated lesion of the left ring finger with metastasis to the forearm and axilla in an 80-year-old man. The etiology, diagnosis, treatment, and prognosis of this disease are discussed, with a brief review of the literature.

Eccrine porocarcinoma of the head: an important differential diagnosis in the elderly patient

BACKGROUND

Eccrine porocarcinoma is a rare malignant tumor of the sweat gland, characterized by a broad spectrum of clinicopathologic presentations. Surprisingly, unlike its benign counterpart eccrine poroma, eccrine porocarcinoma is seldom found in areas with a high density of eccrine sweat glands, like the palms or soles. Instead, eccrine porocarcinoma frequently occurs on the lower extremities, trunk and abdomen, but also on the head, resembling various other skin tumors, as illustrated in the patients described herein.

OBSERVATIONS

We report 5 cases of eccrine porocarcinoma of the head. All patients were initially diagnosed as having epidermal or melanocytic skin tumors. Only after histopathologic examination were they classified as eccrine porocarcinoma, showing features of epithelial tumors with abortive ductal differentiation. Characteristic clinical, histopathologic and immunohistochemical findings of eccrine porocarcinomas are illustrated.

CONCLUSION

Eccrine porocarcinomas are potentially fatal adnexal malignancies, in which extensive metastatic dissemination may occur. Porocarcinomas are commonly overlooked, or misinterpreted as squamous or basal cell carcinomas as well as other common malignant and even benign skin tumors. Knowledge of the clinical pattern and histologic findings, therefore, is crucial for an early therapeutic intervention, which can reduce the risk of tumor recurrence and serious complications.

Eccrine poroma: a differential diagnosis in chronic foot lesions

Eccrine poroma is a benign tumor which arises from the intraepidermal portion of the eccrine sweat glands. It usually occurs as a solitary lesion in the extremity, with the foot and sole as a common site. It may present as a foot mass, ulcerative lesion, bleeding lesion, or suspected melanoma. The clinical diagnosis is often delayed or inaccurate. Three cases of eccrine poroma on the foot are presented. The clinical and histological features, problem in diagnosis, chance of recurrence, and potential transformation to eccrine porocarcinoma are discussed. It is emphasized that eccrine poroma should be considered in the differential diagnosis of chronic foot lesions. Complete excision prevents recurrence, excludes dysplastic change, and prevents future malignant change.

Sentinel lymph node analysis in patients with sweat gland carcinoma

BACKGROUND

Sentinel lymph node mapping and biopsy (SLNB) has become a standard staging procedure for patients with cutaneous neoplasms of known metastatic potential. In the current study, the authors explored the use of SLNB in patients with primary sweat gland carcinomas (SGCs).

METHODS

Six patients with SGC underwent SLNB. The tumors and lymph nodes were examined using routine hematoxylin and eosin (H&E) stained sections and by immunohistochemistry using antibodies against epithelial membrane antigen and cytokeratins.

RESULTS

Metastases were detected in the SLNs of four of the six patients with SGC. One patient with a primary tumor of the neck was found to have bilateral positive SLNs. Tumor deposits were detected by H&E stained sections alone in all but two SLNs, in which the metastatic cells were recognized only with the aid of immunohistochemical stains. Positive non-SLNs were found in two patients after complete regional lymph node dissection was performed.

CONCLUSIONS

The high frequency of positive SLNs in this small series suggests that SLNB is a useful staging tool for patients with SGC. As in SLNBs of other tumors, immunohistochemistry appears to facilitate the recognition of small microscopic metastases.

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.

Malignant eccrine poroma of the hand: a case report

Carcinoma of sweat glands is a very rare neoplasm that is difficult to diagnose clinically and histologically. This report presents a case of malignant eccrine poroma of the hand which is a distinct histologic subtype of sweat gland carcinoma with a high local recurrence rate. A distal radial artery based forearm flap was used to provide soft tissue coverage.

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.

Porocarcinoma of the heel. A case report with unusual histologic features

BACKGROUND

Eccrine porocarcinoma is an uncommon neoplasm of the intraepidermal sweat gland duct.

METHODS

A case of porocarcinoma of the right heel in a male age 51 years is described with a review of pertinent literature. The surgically excised neoplasm was evaluated by routine histology and transmission electron microscopy.

RESULTS

The porocarcinoma showed extensive nuclear pleomorphisms with frequent, multinucleated tumor giant cells, focal epidermotrophic spread within the epidermis, a peripheral, eccrine syringofibroadenoma-like growth pattern, and an origin in a contiguous eccrine poroma. Ultrastructurally, the squamous tumor cells contained rare intracytoplasmic lumens.

CONCLUSIONS

The extensive nuclear pleomorphism with frequent tumor giant cells was an unusual feature of the porocarcinoma. Its epidermotrophic spread within the epidermis and its origin in a contiguous eccrine poroma supported the diagnosis of porocarcinoma. The eccrine syringofibroadenoma-like growth pattern in the periphery of the tumor was a unique and previously undescribed feature of the porocarcinoma. The presence of intracytoplasmic lumens in squamous tumor cells mimicked embryonic development of the intraepidermal sweat gland duct.

Eccrine porocarcinoma

Eccrine porocarcinoma, a malignancy of the eccrine sweat glands, is extremely rare. Our report and a review of the literature (70 cases) emphasize the features of this tumor. Age at time of treatment ranged from 19 to 94 years (mean 67 years). Duration of the lesion ranged from two months to 50 years; 31 (44%) had the lesion present > or = 5 years. Forty-four patients (62%) had tumors located on the extremities, 13 (19%) on the head and neck region and 12 (17%) on the trunk. All patients whose race is known were white. Primary treatment should consist of wide local excision and regional lymphadenectomy, if clinically indicated. Although there is a significant risk of cutaneous, regional lymph node, or visceral metastases, the value of elective or therapeutic regional lymphadenectomy is unknown, as is the role of adjunctive therapy.

Eccrine porocarcinoma of the face

Eccrine porocarcinoma is a rare tumor of the skin. We report a case on the chin that was successfully treated with Mohs surgery. In our review of the world's literature 105 cases were compiled. The tumor most often occurs in the elderly and affects men more frequently than women. It may develop from a preexisting benign poroma and may also appear as a verrucous or nodular, ulcerative growth. Approximately 50% of the tumors occur on the lower extremities; the leg is the most common site. Microscopically the tumor demonstrates both intraepidermal and dermal invasion and is capable of forming satellite lesions and in-transit metastases when lymphatic vessels are invaded. The local recurrence and regional metastatic rates are both approximately 20%. Distant metastasis occurs in 12% of cases. The mortality rate is more than 65% when regional nodes are involved.

The role of radiotherapy in the treatment of malignant sweat gland neoplasms

Malignant sweat gland neoplasms are rare tumors. Historically, the principal mode of treatment has been local surgical excision. Eight published studies show that greater than 50% of patients develop either local tumor recurrence after surgery or regional lymph node metastases. Most patients have evidence of locoregional failure before distant metastases are detected. Three patients were recently referred to the University of Arizona Cancer Center for consideration of irradiation after resection of such tumors. In two patients, the tumor was located on the scalp and, in one patient, on the alar surface of the nose. Their ages ranged from 19 to 60 years. All underwent surgical resection followed by high-dose irradiation of the surgical bed (approximately 70 Gy) and regional lymphatic chains (approximately 50 Gy). Two patients remain disease-free at 27 and 35 months, respectively, after completion of treatment; the third died of rapidly progressive systemic metastases. A review of the literature is provided focusing on treatment success and predominant patterns of recurrence. Finally, a rational approach for evaluation of patients that might benefit from local irradiation is presented.