1
|
Le NS, Janik S, Liu DT, Grasl S, Faisal M, Pammer J, Schickinger-Fischer B, Hamzavi JS, Seemann R, Erovic BM. Eccrine porocarcinoma of the head and neck: Meta-analysis of 120 cases. Head Neck 2020; 42:2644-2659. [PMID: 32314845 DOI: 10.1002/hed.26178] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/09/2020] [Accepted: 04/03/2020] [Indexed: 12/30/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Nguyen-Son Le
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - David T Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Muhammad Faisal
- Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria.,Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Johannes Pammer
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | | | - Jafar-Sasan Hamzavi
- Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
| | - Rudolf Seemann
- Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
| | - Boban M Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
| |
Collapse
|
2
|
Sekine S, Kiyono T, Ryo E, Ogawa R, Wakai S, Ichikawa H, Suzuki K, Arai S, Tsuta K, Ishida M, Sasajima Y, Goshima N, Yamazaki N, Mori T. Recurrent YAP1-MAML2 and YAP1-NUTM1 fusions in poroma and porocarcinoma. J Clin Invest 2019; 129:3827-3832. [PMID: 31145701 DOI: 10.1172/jci126185] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Poroma is a benign skin tumor exhibiting terminal sweat gland duct differentiation. The present study aimed to explore the potential role of gene fusions in the tumorigenesis of poromas. RNA sequencing and reverse transcription PCR identified highly recurrent YAP1-MAML2 and YAP1-NUTM1 fusions in poromas (92/104 lesions, 88.5%) and their rare malignant counterpart, porocarcinomas (7/11 lesions, 63.6%). A WWTR1-NUTM1 fusion was identified in a single lesion of poroma. Fluorescent in-situ hybridization confirmed genomic rearrangements involving these genetic loci. Immunohistochemical staining could readily identify the YAP1 fusion products as nuclear expression of the N-terminal portion of YAP1 with a lack of the C-terminal portion. YAP1 and WWTR1, also known as YAP and TAZ, respectively, encode paralogous transcriptional activators of TEAD, which are negatively regulated by the Hippo signaling pathway. The YAP1 and WWTR1 fusions strongly transactivated a TEAD reporter and promoted anchorage-independent growth, confirming their tumorigenic roles. Our results demonstrate the frequent presence of transforming YAP1 fusions in poromas and porocarcinomas and suggest YAP1/TEAD-dependent transcription as a candidate therapeutic target against porocarcinoma.
Collapse
Affiliation(s)
- Shigeki Sekine
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan.,Division of Molecular Pathology
| | - Tohru Kiyono
- Division of Carcinogenesis and Cancer Prevention.,Department of Cell Culture Technology, and
| | | | | | - Susumu Wakai
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Hitoshi Ichikawa
- Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | | | - Satoru Arai
- Department of Dermatology, St. Luke's International Hospital, Tokyo, Japan
| | - Koji Tsuta
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Mitsuaki Ishida
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Yuko Sasajima
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoki Goshima
- Molecular Profiling Research Center for Drug Discovery, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Taisuke Mori
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan.,Division of Molecular Pathology
| |
Collapse
|
3
|
Seo BF, Choi HJ, Jung SN. Eccrine porocarcinoma on the cheek. Arch Craniofac Surg 2019; 20:48-50. [PMID: 30739434 PMCID: PMC6411527 DOI: 10.7181/acfs.2018.02180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/30/2018] [Indexed: 11/23/2022] Open
Abstract
Eccrine porocarcinoma is a rare malignant tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It develops either spontaneously or from a long standing benign eccrine poroma. This entity usually affects older people and is commonly located on the lower extremities, the trunk, and the head. We report a case of eccrine porocarcinoma on the left cheek in an 85-year-old male. In our case, the tumor was treated with wide excision and postoperative adjuvant radiation therapy. The patient recovered well without local recurrence and distant metastasis during the 14-month follow-up period. Wide excision and postoperative adjuvant radiation therapy can be considered as a safe and effective treatment option in treating patients with eccrine porocarcinoma.
Collapse
Affiliation(s)
- Bommie Florence Seo
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Hyuk Joon Choi
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Sung-No Jung
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| |
Collapse
|
4
|
Nazemi A, Higgins S, Swift R, In G, Miller K, Wysong A. Eccrine Porocarcinoma: New Insights and a Systematic Review of the Literature. Dermatol Surg 2018; 44:1247-1261. [PMID: 29894433 DOI: 10.1097/dss.0000000000001566] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
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.
Collapse
Affiliation(s)
| | | | | | | | | | - Ashley Wysong
- Otolaryngology-Head and Neck Surgery, Keck Medicine of USC, Los Angeles, California
| |
Collapse
|
5
|
Affiliation(s)
- M S Walsh
- Department of Surgery, Whipps Cross Hospital, Leytonstone
| |
Collapse
|
6
|
Horwich MD, Finch J, Ibrahimi O, Dadras SS. Eosinophilic variant of eccrine porocarcinoma of the scalp: Case report and review of the literature. Int J Womens Dermatol 2017; 3:157-160. [PMID: 28831427 PMCID: PMC5555270 DOI: 10.1016/j.ijwd.2017.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/13/2017] [Accepted: 06/13/2017] [Indexed: 11/25/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- M D Horwich
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - J Finch
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - O Ibrahimi
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - S S Dadras
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT.,Departments of Pathology and Genetics/Genomic Sciences, Farmington, CT
| |
Collapse
|
7
|
Abstract
BACKGROUND Eccrine porocarcinoma (EPC) is a rare malignant adnexal neoplasm with reported metastatic potential and undefined optimal treatment. OBJECTIVE This study reviews the clinical characteristics and outcomes of patients with EPC treated with Mohs micrographic surgery (MMS). MATERIALS AND METHODS The authors performed a retrospective chart review of patients with EPC treated by MMS at the Mayo Clinic from 1995 to 2013, recording patient demographics, tumor characteristics, MMS stages to clearance, follow-up, recurrence, metastasis, and mortality. RESULTS A total of 9 patients underwent MMS for EPC in 19 years. The average age was 64.2 years, with 6 males and 3 females. All patients were Caucasian. The head and lower extremity were the most common locations (44% each), with 1 on the forearm. Of the 9 tumors, 8 were located on the right side of the body. The mean preoperative tumor size and postoperative defect were 2.9 and 7.8 cm, respectively, when 2 outliers were excluded. An average of 1.3 MMS stages was required for clearance. The mean postoperative follow-up was 3.3 years (range: 1-60 months). No tumors treated with MMS recurred, metastasized, or led to disease-related mortality. CONCLUSION Mohs micrographic surgery seems to be a useful treatment modality for EPC. This is one of the largest single-center series of EPC treated with MMS.
Collapse
|
8
|
Abstract
Poroma is a benign adnexal neoplasm of the terminal sweat gland duct. Although poromas have traditionally been thought to originate from the eccrine sweat gland, there have been cases of apocrine etiology as well. Eccrine and apocrine poromas typically present as erythematous or flesh-colored nodules on the palms and soles. As these features overlap with a multitude of differential diagnoses, it is imperative to have a firm understanding of the characteristics that make the diagnosis of poroma. In addition, the malignant counterpart to the poroma, the eccrine porocarcinoma, manifests in a similar nonspecific fashion. Case studies and literature reviews have contributed immensely to our present knowledge of poroma and porocarcinoma. Given the rarity of these neoplasms, however, there remains a relative paucity of information on atypical presentations and rates of malignant transformation. In this article, the epidemiology, clinical presentation, diagnosis, and management of poroma and porocarcinoma will be reviewed. This systematic approach may serve as a guide in navigating the diagnostic dilemma of these rare cutaneous lesions.
Collapse
|
9
|
Lloyd MS, El-Muttardi N, Robson A. Eccrine porocarcinoma: A case report and review of the literature. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2013; 11:153-6. [PMID: 24115860 DOI: 10.1177/229255030301100304] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
Collapse
Affiliation(s)
- Mark Sheldon Lloyd
- Department of Plastic Surgery and St John's Institute of Dermatology, St Thomas' Hospital, London, United Kingdom
| | | | | |
Collapse
|
10
|
Abstract
Nonmelanoma skin cancer (NMSC) is the most common form of malignancy in humans. The incidence of NMSC continues to increase despite increased awareness and sun-protective measures. If neglected or mismanaged, NMSC can cause significant morbidity and even death. The most common forms of NMSC on the head and neck include basal cell carcinoma, squamous cell carcinoma, sebaceous carcinoma, eccrine porocarcinoma, Merkel cell carcinoma, atypical fibroxanthoma, and microcystic adnexal carcinoma. Surgery is the mainstay of treatment (standard excision, Mohs micrographic surgery, curettage); however, other modalities exist, including radiation, topical immunomodulators, photodynamic therapy, and new systemic medications.
Collapse
Affiliation(s)
- Lauren E Dubas
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | | |
Collapse
|
11
|
WEN SY. Case report of eccrine porocarcinoma in situ associated with eccrine poroma on the forehead. J Dermatol 2011; 39:649-51. [DOI: 10.1111/j.1346-8138.2011.01447.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Yu L, Olsen S, Lowe L, Michael C, Jing X. Fine-needle aspiration cytology of metastatic eccrine porocarcinoma. Diagn Cytopathol 2009; 37:755-8. [DOI: 10.1002/dc.21099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
13
|
|
14
|
Gerber PA, Schulte KW, Ruzicka T, Bruch-Gerharz D. Eccrine porocarcinoma of the head: an important differential diagnosis in the elderly patient. Dermatology 2008; 216:229-33. [PMID: 18182815 DOI: 10.1159/000112931] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 08/21/2007] [Indexed: 11/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Peter Arne Gerber
- Department of Dermatology, University Hospital, Duesseldorf, Germany
| | | | | | | |
Collapse
|
15
|
Goh SGN, Dayrit JF, Calonje E. Sarcomatoid eccrine porocarcinoma: report of two cases and a review of the literature. J Cutan Pathol 2007; 34:55-60. [PMID: 17214856 DOI: 10.1111/j.1600-0560.2006.00556.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Eccrine porocarcinoma is an uncommon sweat gland malignancy. To the best of our knowledge, there has been no report in the English literature of porocarcinoma with predominantly undifferentiated sarcomatous change. We present two cases of sarcomatoid eccrine porocarcinoma associated with a benign poroma. Case 1 pertained to an 82-year-old woman with an ulcerated chest wall tumor, and Case 2 was that of a 74-year-old woman who presented with an ulcerated plaque in the lower leg. Case 1 showed an unusual pseudo-angiosarcomatous morphology with spindle cells dissecting through collagen bundles and forming vascular like channels. Case 2 revealed high-grade malignant spindle cells with focal evidence of ductal differentiation. In both the cases, benign poromatous elements were histologically evident. Immunohistochemistry performed showed pancytokeratin positivity in spindle cells of both lesions. Epithelial membrane antigen and carcino-embryonic antigen positivity in the malignant ductal elements and focal smooth muscle actin staining of the spindle cells were demonstrated in Case 2. A brief review of relevant literature is presented.
Collapse
|
16
|
Martinelli PT, Cohen PR, Schulze KE, Tschen JA, Nelson BR. Mohs micrographic surgery for tubular apocrine adenoma. Int J Dermatol 2006; 45:1377-8. [PMID: 17076735 DOI: 10.1111/j.1365-4632.2006.02842.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
17
|
Mahlberg MJ, McGinnis KS, Draft KS, Fakharzadeh SS. Multiple eccrine poromas in the setting of total body irradiation and immunosuppression. J Am Acad Dermatol 2006; 55:S46-9. [PMID: 16843124 DOI: 10.1016/j.jaad.2006.02.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 02/21/2006] [Accepted: 02/23/2006] [Indexed: 01/11/2023]
Abstract
Eccrine poromas are benign, adnexal tumors that most often occur as a solitary lesion on the palm or sole. The occurrence of multiple eccrine poromas is extremely rare. In this report, we describe the development of several eccrine poromas in an acral distribution in a 42-year-old man. Before the appearance of these tumors, the patient had received total body irradiation and allogeneic bone marrow transplantation for treatment of acute lymphocytic leukemia. As a complication of the bone marrow transplant, the patient developed chronic graft-versus-host disease, which was treated with immunosuppressive therapy. We discuss this patient and review the available literature regarding multiple eccrine poromas.
Collapse
Affiliation(s)
- Matthew J Mahlberg
- Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, USA
| | | | | | | |
Collapse
|
18
|
Valverde K, Senger C, Ngan BY, Chan HS. Eccrine porocarcinoma in a child that evolved rapidly from an eccrine poroma. MEDICAL AND PEDIATRIC ONCOLOGY 2001; 37:412-4. [PMID: 11568910 DOI: 10.1002/mpo.1221] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- K Valverde
- Division of Hematology and Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | | | | | | |
Collapse
|
19
|
Robson A, Greene J, Ansari N, Kim B, Seed PT, McKee PH, Calonje E. Eccrine porocarcinoma (malignant eccrine poroma): a clinicopathologic study of 69 cases. Am J Surg Pathol 2001; 25:710-20. [PMID: 11395548 DOI: 10.1097/00000478-200106000-00002] [Citation(s) in RCA: 273] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
Collapse
Affiliation(s)
- A Robson
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, UK
| | | | | | | | | | | | | |
Collapse
|
20
|
Nagore E, Díaz F, Sánchez-Motilla JM, Prats A, García-Castell J, Aliaga A. A poroid neoplasia arising close to a seborrheic keratosis and a trichoepithelioma. J Dermatol 1999; 26:253-7. [PMID: 10343473 DOI: 10.1111/j.1346-8138.1999.tb03467.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 69-year-old woman had a well-defined, slightly raised, brownish, keratotic plaque with an eccentric group of roughly circular, bluish, dome nodules on her right scapular area. Histological study revealed the presence of an eccrine poroma demonstrating features of eccrine poroma, hidroacanthoma simplex, and dermal duct tumor and arising in a lesion of seborrheic keratosis and a trichoepithelioma. In the eccrine poroma region, an area with malignant changes was evident. The findings in this case support the view of eccrine poroma as a spectrum of histological variants and the possibility of malignant transformation from a eccrine poroma towards porocarcinoma. The association with seborrheic keratosis is most probably coincidental, and the trichoepithelioma was probably due to induction of the tumoral stroma on adjacent follicular epithelia.
Collapse
Affiliation(s)
- E Nagore
- Department of Dermatology, Hospital General Universitario, Valencia, Spain
| | | | | | | | | | | |
Collapse
|
21
|
Ritter AM, Graham RS, Amaker B, Broaddus WC, Young HF. Intracranial extension of an eccrine porocarcinoma. Case report and review of the literature. J Neurosurg 1999; 90:138-40. [PMID: 10413167 DOI: 10.3171/jns.1999.90.1.0138] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
Collapse
Affiliation(s)
- A M Ritter
- Division of Neurosurgery, Medical College of Virginia, Richmond 23298, USA
| | | | | | | | | |
Collapse
|
22
|
MacSWEEN RUTHM, STEVENS ALAN, MILLARD LESLIEG. Stump the Experts. Dermatol Surg 1997. [DOI: 10.1111/j.1524-4725.1997.tb00765.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Huet P, Dandurand M, Pignodel C, Guillot B. Metastasizing eccrine porocarcinoma: report of a case and review of the literature. J Am Acad Dermatol 1996; 35:860-4. [PMID: 8912607 DOI: 10.1016/s0190-9622(96)90105-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
Collapse
Affiliation(s)
- P Huet
- Department of Dermatology, University Hospital of Caremeau, Nîmes, France
| | | | | | | |
Collapse
|
24
|
Abstract
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.
Collapse
Affiliation(s)
- T A Goedde
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263
| | | | | | | | | |
Collapse
|
25
|
Yamamoto O, Haratake J, Yokoyama S, Imayama S, Asahi M. A histopathological and ultrastructural study of eccrine porocarcinoma with special reference to its subtypes. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1992; 420:395-401. [PMID: 1317619 DOI: 10.1007/bf01600510] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Five cases of eccrine porocarcinoma were studied by light and electron microscopy. Histopathologically, these could be classified into two types; the common and the giant cell type. The common type was characterized by almost uniform medium-sized cuboidal tumour cells and a formation of well-developed intracytoplasmic lumina. A broad diversity of histopathological and ultrastructural features was seen in these tumours. The tumours of the giant cell type consisted of mononuclear polygonal cells and bizarre giant cells. This type was considered to be an undifferentiated form of porocarcinoma.
Collapse
Affiliation(s)
- O Yamamoto
- Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | | | | | |
Collapse
|
26
|
Abstract
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.
Collapse
Affiliation(s)
- S N Snow
- Department of Medicine, University of Wisconsin-Madison 53705
| | | |
Collapse
|
27
|
Abstract
Three cases of epidermotropic eccrine porocarcinoma are summarized and compared with reported cases. All patients had a long-standing tumor on a lower extremity that rapidly metastasized to the skin and proximal lymph nodes. The histologic picture was consistent with an intraepidermal eccrine sweat gland carcinoma.
Collapse
Affiliation(s)
- N G Landa
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
28
|
Nakamura S, Imai T, Nakayama K, Goto M, Nishihara K, Hoshi K. Malignant eccrine tumor--a case report and a classification of tumors of eccrine sweat apparatus. J Dermatol 1990; 17:500-5. [PMID: 2229655 DOI: 10.1111/j.1346-8138.1990.tb01683.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A case of malignant eccrine tumor and its histological findings were reported. In this case, we considered basal cell carcinoma or malignant melanoma clinically; however, the histological features matched those of malignant eccrine tumor. It has been said that it is very difficult to determine the origin of tumors of sweat apparatus; to contribute to this ongoing dialogue, the classification of tumors of eccrine sweat apparatus was also discussed.
Collapse
Affiliation(s)
- S Nakamura
- Department of Dermatology, First Hospital of Nippon Medical School, Tokyo, Japan
| | | | | | | | | | | |
Collapse
|