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Tinguria M. Primary Mucinous Carcinoma of Skin: A Rare Cutaneous Neoplasm. Clinicopathologic Features, Differential Diagnoses, and Review of Literature. Am J Dermatopathol 2024; 46:114-120. [PMID: 38055969 DOI: 10.1097/dad.0000000000002591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
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.
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Affiliation(s)
- Mukund Tinguria
- Department of Pathology and Laboratory Medicine, Brantford General Hospital, Brantford, Ontario, Canada
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2
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Freeman T, Russell AJ, Council ML. Primary Cutaneous Mucinous Carcinoma: A Review of the Literature. Dermatol Surg 2023; 49:1091-1095. [PMID: 37643246 DOI: 10.1097/dss.0000000000003921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Primary cutaneous mucinous carcinoma (PCMC) is an exceedingly rare, low-grade tumor that histologically resembles mucinous carcinoma from other primary sites, such as the breast, gastrointestinal tract, and lungs. OBJECTIVE The purpose of this article was to review the current literature on PCMC as it relates to epidemiology, clinical presentation, histopathology, immunohistochemistry, treatment, and prognosis. MATERIALS AND METHODS An extensive literature review was conducted using PubMed and Ovid MEDLINE to identify articles related to PCMC. RESULTS Several hundred cases have been reported in the medical literature, and surgical resection, whenever feasible, is the standard of care. CONCLUSION The diagnosis of primary cutaneous mucinous carcinoma is one of exclusion, requiring a metastatic work-up to rule out distant primary. Mohs micrographic surgery is a tissue sparing technique that allows complete margin control of these rare neoplasia.
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Affiliation(s)
- Timothy Freeman
- Washington University School of Medicine, St. Louis, Missouri
| | - Aaron J Russell
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - M Laurin Council
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Graham S, McDaniel M, Vangapandu S, Krishnamurthy S. Eyelid Papule: Answer. Am J Dermatopathol 2023; 45:854. [PMID: 37982468 DOI: 10.1097/dad.0000000000002533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Shaveonté Graham
- Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Mary McDaniel
- Department of Dermatology, Wright State University, Dayton, OH
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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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Ababtain RM, Alsharif HM, Alkatan HM, Arafah M, Al-Faky YH. Primary mucinous adenocarcinoma of the eyelid: A case with initial clinical misdiagnosis requiring surgical re-excision of the tumor. Int J Surg Case Rep 2021; 85:106185. [PMID: 34252644 PMCID: PMC8278420 DOI: 10.1016/j.ijscr.2021.106185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Primary mucinous adenocarcinoma (PMA) of the skin is a rare condition that is usually seen in elderly patients, most commonly involves the periorbital region as a slow growing mass. Histopathological and immunohistochemical (IHC) stains are of paramount importance for the diagnosis of these lesions, which are usually misdiagnosed either as benign or metastatic mucinous adenocarcinomas. Case presentation We herein report a rare presentation of PMA in a 70-year-old male patient who presented with an upper eyelid residual lesion after being incompletely excised elsewhere as an epidermal cyst and was successfully managed by complete surgical excision with frozen section control of the margins and no evidence of recurrence. Discussion PMA is a rare sweat gland malignancy that involves the eyelid in 41.9% in the head and neck area and is a disease of the elderly with median age of 60 years and variable reported racial and gender predilection. Diagnosis of PMA is challenging both clinically and histopathologically, which was the case in our patient's initial incomplete excision with the presumed diagnosis of a benign epidermal cyst. Proper final tissue diagnosis and surgical management in our patient ensured his favorable outcome. Conclusion Accurate diagnosis of PMA requires a high index of clinical suspicion and accurate histopathological diagnosis aided by proper IHC markers. Primary mucinous adenocarcinoma (PMA) is a rare cutaneous sweat gland malignancy. A 70-year-old male with eyelid PMA was misdiagnosed clinically elsewhere as an epidermal cyst. He underwent surgical re-excision of the tumor with frozen section control of margins. The diagnosis of PMA is challenging, and proper surgical complete excision is necessary.
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Affiliation(s)
| | - Heba M Alsharif
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Pathology & Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Maha Arafah
- Department of Pathology & Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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6
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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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7
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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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9
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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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11
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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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12
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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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Held L, Ruetten A, Kutzner H, Palmedo G, John R, Mentzel T. Endocrine mucin-producing sweat gland carcinoma: Clinicopathologic, immunohistochemical, and molecular analysis of 11 cases with emphasis on MYB immunoexpression. J Cutan Pathol 2018; 45:674-680. [PMID: 29882219 DOI: 10.1111/cup.13290] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/20/2018] [Accepted: 06/01/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare low-grade primary cutaneous sweat gland carcinoma with predilection for the periorbital skin in elderly female patients. METHODS We describe 11 cases of EMPSGC using a broad panel of immunohistochemical markers including BerEP4, cytokeratin 7, CAM 5.2, synaptophysin, chromogranin, cytokeratin 20, Ki67, progesterone receptor, and estrogen receptor. Calponin (1A4) and p63 were used to detect surrounding myoepithelial cells. We also examined staining with a relatively new marker, MYB. Previous studies of MYB on EMPSGC remain limited. As mucin-rich basal cell carcinoma (BCC) represents a main differential diagnosis and primary cutaneous mucinous carcinoma (PCMC) could appear synchronous with EMPSGC, these lesions were also stained for MYB. RESULTS We found strong and homogenous nuclear MYB-expression in 10 EMPSGC cases stained for MYB. MYB staining was not performed in one case. Furthermore, PCMC and mucin-rich BCCs did not express MYB. CONCLUSION The strong nuclear MYB-positivity in EMPSGC could be useful as a new surrogate marker, especially in mucin-poor EMPSGC cases. Additionally, the staining of PCMC revealed absent MYB-expression leading to the conclusion that EMPSGC might not represent a precursor lesion for primary cutaneous mucinous carcinoma.
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Affiliation(s)
- Laura Held
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | - Arno Ruetten
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | - Heinz Kutzner
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | | | - Rahel John
- Department of Pathology, Advocate Lutheran General Hospital, Park Ridge, Illinois
| | - Thomas Mentzel
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
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14
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Pure mucinous (colloid) adenocarcinoma of the conjunctiva. J Cutan Pathol 2017; 45:78-83. [DOI: 10.1111/cup.13060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 11/26/2022]
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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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Ross AG, Chan AA, Mihm MC, Yu JY. Endocrine Mucin-Producing Sweat Gland Carcinoma: An Uncommon Presentation. Semin Ophthalmol 2016; 32:511-513. [DOI: 10.3109/08820538.2015.1115085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ahmara G. Ross
- University of Pennsylvania, Scheie Eye Institute, Philadelphia, PA, USA
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Collinson AC, Sun MT, James C, Huilgol SC, Selva D. Endocrine mucin-producing sweat gland carcinoma of the eyelid. Int Ophthalmol 2015; 35:883-6. [DOI: 10.1007/s10792-015-0127-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/12/2015] [Indexed: 10/23/2022]
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Fernandez-Flores A, Cassarino DS. Endocrine mucin-producing sweat gland carcinoma: a study of three cases and CK8, CK18 and CD5/6 immunoexpression. J Cutan Pathol 2015; 42:578-86. [PMID: 25925290 DOI: 10.1111/cup.12512] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 01/26/2015] [Accepted: 02/02/2015] [Indexed: 12/31/2022]
Abstract
Endocrine mucin-producing sweat gland carcinoma is a cutaneous adnexal tumor that is rarely reported in the literature. We identified only 29 previously reported cases. All these cases share some clinical morphologic and immunohistochemical features. Among the immunohistochemical markers, cytokeratins 5/6, 8 and 18 (CK5/6, CK8 and CK18) had not been previously studied in this tumor. Although studies with cytokeratin Cam5.2 exist, we know at present that this marker does not correspond to antibodies CK8/18, but rather to CK7 and CK8. We studied three examples of endocrine mucin-producing sweat gland carcinoma with 18 immunostains. Our cases showed an immunoprofile CK8+, CK18+, CK5/6- (or only focally positive), CK7+, GCDFP-15+ (2 cases), estrogen receptor+, progesterone receptor+, HER2-, neuron-specific enolase + (2 cases), anti-synaptophysin+, chromogranin A +, CD56 variable (1 case +, 1 case-), CD57-, anti-human D2-40- (two cases), p63- or focally positive, smooth muscle actin + with variable pattern of expression and smooth muscle myosin heavy chain expressed in a peripheral discontinuous layer in some nodules, but absent in most.
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Affiliation(s)
| | - David S Cassarino
- Department of Pathology, Southern California Kaiser Permanente, Los Angeles Medical Center (LAMC), Los Angeles, CA, USA
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Shon W, Salomão DR. WT1 expression in endocrine mucin-producing sweat gland carcinoma: a study of 13 cases. Int J Dermatol 2015; 53:1228-34. [PMID: 25219513 DOI: 10.1111/ijd.12470] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Endocrine mucin-producing sweat gland carcinoma (EMPSGC), a low-grade sweat gland carcinoma with a predilection for the eyelids, often shows areas of benign eccrine cysts, atypical intracystic proliferation and associated mucinous carcinoma, suggesting tumor progression. Wilms tumor 1 (WT1) protein, a transcription factor, is overexpressed in many tumors and plays a role in oncogenesis. METHODS A computer-based search for tumors diagnosed between 1989 and 2009 was conducted. Clinical data were obtained from pathology reports and patient records. Biopsies were reviewed for histologic features. Immunostaining was performed for WT1, chromogranin, synaptophysin, estrogen receptor (ER), epithelial membrane antigen (EMA), polyclonal carcinoembryonic antigen (P-CEA), cytokeratin 7 (CK7), cytokeratin 20 (CK20) and MIB-1. RESULTS Eight women and five men (mean age: 61.2 years; range: 40-77 years) presented with slow-growing eyelid nodules. Cases of EMPSGC were characterized by the presence of dermal nodules with various growth patterns. Adjacent eccrine cysts were present in five patients, atypical epithelial proliferation within the cyst wall in four patients, and an associated mucinous carcinoma in one patient. All tumors were positive for WT1, CK7, ER, P-CEA and EMA and negative for CK20. Tumors were positive for synaptophysin in 12 cases and chromogranin in nine cases. The MIB-1 proliferation index was low in most cases. No WT1 staining was observed in the overlying epidermis, adnexal structures or areas of benign eccrine cyst. WT1 expression was observed in areas of atypical epithelial proliferation, and the neoplastic cells. CONCLUSIONS The present study shows WT1 expression in the neoplastic epithelial cells of EMPSGC, areas of atypical intraductal proliferations, and mucinous carcinoma. The absence of WT1 expression in areas of benign eccrine cyst and cutaneous sweat glands suggests WT1 upregulation plays a role in tumor cell proliferation and progression of EMPSGC.
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Affiliation(s)
- Wonwoo Shon
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
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Rütten A, Mentzel T, Requena L. Endokrines muzinproduzierendes Schweißdrüsenkarzinom. DER PATHOLOGE 2014; 35:462-6. [DOI: 10.1007/s00292-014-1936-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Tsai JH, Hsiao TL, Chen YY, Hsiao CH, Liau JY. Endocrine mucin-producing sweat gland carcinoma occurring on extra-facial site: a case report. J Cutan Pathol 2014; 41:544-7. [DOI: 10.1111/cup.12314] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/16/2013] [Accepted: 01/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jia-Huei Tsai
- Department of Pathology; National Taiwan University Hospital; Taipei Taiwan
- Graduate Institute of Pathology, College of Medicine; National Taiwan University; Taipei Taiwan
| | - Tzu-Lin Hsiao
- Department of Dermatology; National Taiwan University Hospital; Taipei Taiwan
| | - Yi-Ying Chen
- Department of Dermatology; National Taiwan University Hospital; Taipei Taiwan
| | | | - Jau-Yu Liau
- Department of Pathology; National Taiwan University Hospital; Taipei Taiwan
- Graduate Institute of Pathology, College of Medicine; National Taiwan University; Taipei Taiwan
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Mucin-producing sweat gland carcinoma of the eyelid: diagnostic and prognostic considerations. Am J Ophthalmol 2013; 155:585-592.e2. [PMID: 23218693 DOI: 10.1016/j.ajo.2012.09.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 09/19/2012] [Accepted: 09/20/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the clinical and pathologic characteristics of mucin-producing sweat gland carcinoma of the eyelid and to determine whether neuroendocrine differentiation is of prognostic significance. DESIGN Retrospective interventional case series. METHODS Search of the New York Eye and Ear Infirmary pathology database between 1990 and 2011 identified 16 patients with mucin-producing sweat gland carcinoma. Clinical, histopathologic, and immunohistochemical analyses were performed on all identified cases. RESULTS The patients presented with vascularized, focally cystic, nonulcerated eyelid margin lesions. Histopathologic evaluation showed that 4 lesions (25%) had a cystic, papillary, and solid growth pattern with an in situ component, 7 (44%) were pure invasive mucinous carcinomas, and 5 (31%) demonstrated both growth patterns. Immunohistochemical analysis of 15 tumors showed that pure cystic/papillary lesions had a significantly greater percentage of synaptophysin-immunoreactive cells (P = .036). There was no significant difference in the number of neuroendocrine markers expressed or in the intensity of immunostaining among the 3 different growth patterns. Re-excision for margin clearance was performed in 8 of 13 cases (61.5%). Two of 13 lesions recurred (15%); 1 of these was an in situ tumor with cystic morphology and neuroendocrine differentiation and the other was pure invasive mucinous carcinoma. None of the lesions metastasized. CONCLUSIONS Mucin-producing sweat gland carcinoma pathologically represents a continuum, from an in situ lesion to a classic, invasive mucinous carcinoma. Immunohistochemical evidence of neuroendocrine differentiation can be observed in all lesions and does not appear to have a prognostic significance, arguing against the utility of immunohistochemical subtyping of mucinous sweat gland carcinomas.
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Mucinous eccrine carcinoma: a rare case of recurrence with lacrimal gland extension. Ophthalmic Plast Reconstr Surg 2012; 28:e109-10. [PMID: 22327636 DOI: 10.1097/iop.0b013e31823c80ba] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mucinous eccrine carcinoma (MEC) is a rare skin cancer of sweat gland origin with a high rate of recurrence. The most common sites are head and neck, with 40% of cancers found on the eyelid. The clinical appearance and differential diagnosis of MEC are highly varied, but histologically it is similar to metastatic carcinomas, specifically breast and colon. A diagnosis of primary MEC always warrants a full systemic workup to ensure that no other malignancy is present. This cancer is known for frequent recurrences, but rarely metastasizes to distant organs. MEC is resistant to both chemotherapy and radiation; surgical excision remains the treatment of choice in most cases. The authors report a unique case of extension of MEC to the lacrimal gland with a brief review of histologic characteristics of this tumor.
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Endocrine mucin producing sweat gland carcinoma: a clinicopathological analysis of three cases. Pathology 2012; 44:568-71. [DOI: 10.1097/pat.0b013e32835833d8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Inozume T, Kawasaki T, Harada K, Tanaka K, Kawamura T, Shibagaki N, Katoh R, Shimada S. A case of endocrine mucin-producing sweat gland carcinoma. Pathol Int 2012; 62:344-6. [DOI: 10.1111/j.1440-1827.2012.02793.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Koike T, Mikami T, Maegawa J, Iwai T, Wada H, Yamanaka S. Recurrent endocrine mucin-producing sweat gland carcinoma in the eyelid. Australas J Dermatol 2012; 54:e46-9. [DOI: 10.1111/j.1440-0960.2011.00857.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kim JB, Choi JH, Kim JH, Park HJ, Lee JS, Joh OJ, Song KY. A case of primary cutaneous mucinous carcinoma with neuroendocrine differentiation. Ann Dermatol 2010; 22:472-7. [PMID: 21165225 DOI: 10.5021/ad.2010.22.4.472] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/02/2010] [Accepted: 03/03/2010] [Indexed: 11/08/2022] Open
Abstract
Primary cutaneous mucinous carcinoma is a rare malignant tumor that originates from the deepest portion of the eccrine sweat duct. Common sites of involvement are the face and scalp. Biopsy shows dermal epithelial cell islands embedded in mucin pools separated by fibrous septae. It is difficult to differentiate this tumor histologically from metastatic adenocarcinoma. Recurrence after excision is common but metastases are rare. We report a primary cutaneous mucinous carcinoma with neuroendocrine differentiation on the right cheek of a 63-year-old man.
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Affiliation(s)
- June-Bum Kim
- Department of Dermatology, Seoul Veterans Hospital, Seoul, Korea
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Chang S, Shim SH, Joo M, Kim H, Kim YK. A Case of Endocrine Mucin-Producing Sweat Gland Carcinoma Co-existing with Mucinous Carcinoma - A Case Report -. KOREAN JOURNAL OF PATHOLOGY 2010. [DOI: 10.4132/koreanjpathol.2010.44.1.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sunhee Chang
- Department of Pathology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang Hwa Shim
- Department of Pathology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Mee Joo
- Department of Pathology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hanseong Kim
- Department of Pathology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Yong Kyu Kim
- Department of Plastic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
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MESH Headings
- Adenocarcinoma, Mucinous/diagnosis
- Adenocarcinoma, Mucinous/epidemiology
- Adenocarcinoma, Mucinous/therapy
- Carcinoma, Signet Ring Cell/diagnosis
- Carcinoma, Signet Ring Cell/epidemiology
- Carcinoma, Signet Ring Cell/therapy
- Combined Modality Therapy/methods
- Diagnosis, Differential
- Eyelid Neoplasms/diagnosis
- Eyelid Neoplasms/epidemiology
- Eyelid Neoplasms/therapy
- Facial Neoplasms/diagnosis
- Facial Neoplasms/epidemiology
- Facial Neoplasms/therapy
- Humans
- Incidence
- Mycosis Fungoides/diagnosis
- Mycosis Fungoides/epidemiology
- Mycosis Fungoides/therapy
- Prognosis
- Sarcoma, Kaposi/diagnosis
- Sarcoma, Kaposi/epidemiology
- Sarcoma, Kaposi/therapy
- Skin Neoplasms/diagnosis
- Skin Neoplasms/epidemiology
- Skin Neoplasms/therapy
- Sweat Gland Neoplasms/diagnosis
- Sweat Gland Neoplasms/epidemiology
- Sweat Gland Neoplasms/therapy
- Syringoma/diagnosis
- Syringoma/epidemiology
- Syringoma/therapy
- United States/epidemiology
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Affiliation(s)
- Jonathan W Kim
- Department of Ophthalmology, Stanford University Medical Center, Stanford, CA 94304, USA
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Volante M, Righi L, Asioli S, Bussolati G, Papotti M. Goblet cell carcinoids and other mixed neuroendocrine/nonneuroendocrine neoplasms. Virchows Arch 2007; 451 Suppl 1:S61-9. [PMID: 17684764 DOI: 10.1007/s00428-007-0447-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 06/06/2007] [Indexed: 01/06/2023]
Abstract
Within the spectrum of neuroendocrine tumors arising in different organs, intermediate and controversial entities exist displaying a coexistence of neuroendocrine and nonneuroendocrine cell populations, and that are grouped under terms such as "goblet cell carcinoid", "mixed endocrine-exocrine carcinoma", "combined carcinomas", or "adenocarcinoma with neuroendocrine differentiation". These tumors may display variable amounts of the two components, potentially ranging from 1 to 99%, and variable structural patterns, ranging from single scattered neuroendocrine cells to a well-defined neuroendocrine tumor cell component organized in typical organoid, trabecular, or solid growth patterns. Although variably included in the site-specific World Health Organization classification schemes, clear definitions and diagnostic features are still missing, as well as a definite knowledge of their biological properties and histogenesis. In the present report, the main characteristics of tumors showing mixed neuroendocrine and nonneuroendocrine features will be described, using morphological patterns and site of origin as schematic guidelines. Moreover, molecular and clinical aspects, which might help to understand their possible histogenesis and biological behavior, will be reviewed.
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Affiliation(s)
- Marco Volante
- Department of Clinical and Biological Sciences, University of Turin and San Luigi Hospital, Regione Gonzole10, 10043, Orbassano, Torino, Italy.
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