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The Role of Androgen Receptors in the Clinical Course of Nevus Sebaceus of Jadassohn Katherine S

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The Role of Androgen Receptors in the Clinical Course of Nevus Sebaceus of Jadassohn Katherine S The Role of Androgen Receptors in the Clinical Course of Nevus Sebaceus of Jadassohn Katherine S. Hamilton, M.D., Sandra Johnson, M.D., Bruce R. Smoller, M.D. Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee (KSH); and Departments of Dermatology (SJ, BRS) and Pathology (SJ), University of Arkansas for Medical Services, Little Rock, Arkansas During puberty, they usually enlarge and become Nevus sebaceus of Jadassohn (NSJ) is a benign, con- elevated, verrucous, or nodular and may appear genital hamartoma that often presents at birth, ap- brown (1, 2). In late childhood and adulthood, there pears to regress in childhood, and grows during is a significant risk of developing a secondary tu- puberty, suggesting possible hormonal control. We mor, the most common of which are syringocysta- studied 18 cases of NSJ from children and adults for denoma papilliferum and basal cell carcinoma (1, immunohistochemical evidence of androgen recep- 3). Myriad other cutaneous appendageal neoplasms tor expression. The lesions were evaluated for loca- have also been reported to arise within NSJ. tion and pattern of immunostaining, and these Androgen receptors (AR) are nuclear ligand–de- findings were compared between age groups, sexes, pendent transcription factors of the steroid super- and to androgen receptor expression in normal family that bind testosterone and dihydroxytestos- skin. Androgen receptor positivity was seen in the terone (4). AR have been identified in normal sebaceous glands, in eccrine glands with and with- cutaneous structures and in some epithelial tu- out apocrine change, and rarely in keratinocytes in mors. In normal skin, AR have been localized to the sebaceous nevi. There were no significant differ- sebocytes and to some dermal papillae in anagen ences in staining location or pattern between the and telogen hair follicles (5). They are thought to age groups or sexes. Normal skin showed similar play a role in pilosebaceous development during staining in the sebaceous glands but did not show puberty (6). Immunohistochemical studies have lo- staining of the eccrine glands or keratinocytes. An- cated androgen receptors in sebaceous tumors, in- drogen receptors are present in all epithelial com- cluding adenomas, carcinomas, and nevi, as well as ponents of NSJ, but there is no change in androgen in chondroid syringomas and focally in basal cell receptor expression during puberty. carcinomas (7, 8). Because of the prominence of NSJ in the neonatal KEY WORDS: Androgen, Androgen receptor, Epithe- period, relative quiescence in childhood, and in- lial neoplasm, Nevus sebaceus of Jadassohn, Seba- creased growth during puberty, as well as the an- ceous nevus, Skin tumor. drogen receptor activity previously reported in se- Mod Pathol 2001;14(6):539–542 baceous neoplasms, we were interested in the possible role of androgen receptors in the evolution Nevus sebaceus of Jadassohn (NSJ) is a hamar- of NSJ. Specifically, our interest was in the follow- tomatous tumor composed of benign epithelial ing: what cutaneous structures contain AR and in components including sebaceous glands, epithe- what distribution are they present within these le- lium, and eccrine glands, often with apocrine sions, does AR expression vary by age or sex, and is change. In newborn infants, NSJ often appear as AR expression different from that in normal skin? slightly verrucous, yellowish hairless plaques. In children, these tumors are well-circumscribed, flat, waxy yellow-tan or yellow-orange, often hairless MATERIALS AND METHODS lesions and are much less prominent than at birth. Eighteen cases of NSJ were obtained from the surgical pathology files of the University of Arkan- Copyright © 2001 by The United States and Canadian Academy of sas for Medical Sciences Department of Pathology. Pathology, Inc. VOL. 14, NO. 6, P. 539, 2001 Printed in the U.S.A. The patients ranged in age from 8 to 41, with 7 Date of acceptance: February 14, 2001. females and 11 males. All lesions were on the head Address reprint requests to: Bruce R. Smoller, M.D., University of Arkansas for Medical Services, 4301 West Markam, Slot 517, Little Rock, AR 72205- or neck. Four cases of normal skin from the head or 7199; e-mail: [email protected]; fax: 501-603-1479. neck containing sebaceous glands were also exam- 539 ined as external controls. All specimens were for- malin fixed and paraffin embedded. Routine hema- toxylin-eosin–stained slides were reviewed, and immunohistochemistry was performed on 4-␮m- thick sections. Sections were deparaffinized and underwent antigen retrieval by heat treatment in DAKO Target Retrieval solution (DAKO, Carpinte- ria, CA) for 20 minutes. Prediluted monoclonal mouse antibodies corresponding to amino acids 299 through 315 of the human androgen receptor were applied using the Immunocruz Staining Sys- tem (Santa Cruz Biotechnology Inc, Santa Cruz, CA) as described elsewhere (8). The tissue was allowed to incubate with the primary antibody for 2 hours FIGURE 1. Strong nuclear staining in a hyperplastic sebaceous gland. and then with the biotinylated secondary antibody The staining is primarily located in basally located sebocytes, with for 30 minutes. The signal was detected with a decreased staining toward the center of the gland. 3,3'-diaminobenzidene in chromogen solution with Imidazole-HCl buffer at pH 7.5 (DAKO liquid 3,3'- diaminobenzidine large-volume substrate-chromogen apocrine glands, whereas the ductular epithelium system) with brown staining at the site of antibody was nonimmunoreactive (Fig. 2). The percentage of binding. AR positivity was defined as strong nuclear immunoreactive eccrine/apocrine cells ranged staining, easily observed at scanning magnification. from Ͻ5% to 26–50%. There was no difference in The percentage of positive nuclei within sebaceous eccrine/apocrine staining based on age or sex. Four glands, eccrine glands, and keratinocytes was of 18 cases showed nuclear positivity in keratino- scored from 0–4 using the following scheme: 0–5% cytes, with a predominant basilar staining pattern, ϭ 0, 5–25% ϭ 1, 26–50% ϭ 2, 51–75% ϭ 3, and and a percentage of staining cells ranging from 76–100% ϭ 4 (Table 1). Adjacent normal sebaceous Ͻ5% to 26–50% (Fig. 3). Again, there was no differ- glands served as positive internal controls and ad- ence in keratinocyte immunoreactivity between jacent normal skin without sebaceous glands males and females or children and adults. One case served as negative internal controls. The specimens contained a secondary neoplasm, a basal cell car- were analyzed for site, pattern, and percentage of cinoma, which was nonimmunoreactive. Other cu- immunostaining. taneous appendage neoplasms were not detected in any of the cases selected for inclusion in the study. RESULTS Normal skin showed similar staining of seba- All (18/18) cases of NSJ contained hyperplastic ceous glands, with all cases showing nuclear posi- sebaceous glands with strong nuclear AR immuno- tivity in sebocytes; however, the percentage of pos- staining. The pattern of staining in the sebaceous itive sebocytes was less than that seen in the glands was primarily basilar, with extension of sebaceous nevi (Table 3). The pattern of sebocyte staining toward the center of the sebaceous glands staining was similar, with a predominance of stain- (Fig. 1). The percentage of staining sebocytes ing in the basal layer. In addition, there was no ranged from 26–50% to Ͼ75% (Table 2). There was staining of eccrine glands or ducts, nor of the ker- no difference in staining distribution or extent be- atinocytes in the normal skin. Apocrine glands were tween males and females or between children and not present in any of the sections of normal skin adults (Tables 2 and 3). Fifteen (15/18) cases con- examined, as these sections were taken from nor- tained eccrine glands within the sections examined, mal skin on the head and neck. and 9 of these 15 cases showed apocrinization of the eccrine glands (or ectopic apocrine glands). DISCUSSION There was patchy immunostaining of the eccrine/ We examined a series of NSJ removed from pa- tients of both sexes and all ages with antibodies TABLE 1. Scoring of Immunostaining directed against androgen receptors. Androgen re- ceptors were present within the nuclei of sebocytes Number of Cells Staining (%) Score in NSJ from all patients studied. There were no 0–5 0 6–25 1 differences in the quality of the staining pattern. 26–50 2 However, in all cases of NSJ, the extent of the stain- 51–75 3 ing within sebaceous glands was far more impres- Ͼ 75 4 sive than that seen in sebaceous glands from nor- 540 Modern Pathology TABLE 2. Androgen Receptor Staining Distribution and Extent in Nevus Sebaceus of Jadassohn Age Case Sex Sebocyte Positivity Eccrine/Apocrine Gland Positivity Keratinocyte Positivity (y) 18F 2 0 0 210M 3 — 2 311M 4 3 0 411F 1 1 0 512M 3 1 0 613M 4 2 2 713M 3 1 0 813M 3 2 0 914F 2 2 0 10 15 M 2 — 0 11 16 F 3 1 0 12 16 M 3 2 0 13 16 M 3 1 0 14 18 M 2 1 0 15 32 F 3 1 0 16 34 F 4 2 1 17 39 F 3 — 0 18 41 M 3 1 1 Extent of nuclear positivity was scored as 0–5% ϭ 0, 6–25% ϭ 1, 26–50% ϭ 2, 51–75% ϭ 3, and Ͼ75% ϭ 4. FIGURE 2. Eccrine glands of a nevus sebaceus with apocrinization FIGURE 3. Few cases showed nuclear staining in keratinocytes, as is and strong focal nuclear staining in the glands, with no positivity in seen in this case, where the staining is occasional and scattered. ductular epithelium. TABLE 3. Androgen Receptor Staining in Nevus Sebaceus of Jadassohn by Age Group, Compared with mal control subjects. Of additional interest, Staining in Normal Skin eccrine/apocrine glands demonstrated patchy la- Group Sebocytes Eccrine/Apocrine Glands Keratinocytes beling with anti-androgen receptor antibodies in NSJ cases (y) the majority of cases of NSJ.
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