Skin Adnexal Tumors-An Overview

SkinSkin AdnexalAdnexal TumorsTumors--AnAn OverviewOverview

PaulPaul K.K. Shitabata,Shitabata, M.D.M.D. DermatopathologistDermatopathologist APMGAPMG AA Bump!Bump!

„ NonspecificNonspecific clinicalclinical appearanceappearance „ UsuallyUsually minimalminimal skinskin changeschanges „ HeadHead andand neck,neck, trunktrunk SiteSite SpecificSpecific TumorsTumors

„ ExtremitiesExtremities „ Papillary digital adenocarcinoma „ Papillary eccrine adenoma „ AxillaeAxillae „ Apocrine carcinoma „ VulvaVulva andand PerineumPerineum „ Hidradenoma papilliferum „ Extramammary Paget’s disease „ Ductopapillary apocrine carcinoma CluesClues toto UnderlyingUnderlying DiseaseDisease

„ GenodermatosisGenodermatosis „ TurbanTurban TumorTumor „ AncellAncell--SpieglerSpiegler syndromesyndrome „ Cowden’sCowden’s syndromesyndrome „ MuirMuir--TorreTorre syndromesyndrome „ ClearClear cellcell syringomasyringoma PotentialPotential MultiplicityMultiplicity

„ CylindromaCylindroma (Turban(Turban tumortumor syndrome)syndrome) „ SyringomaSyringoma „ PoromaPoroma „ TrichoepitheliomaTrichoepithelioma „ TrichilemmomaTrichilemmoma (Cowden’s(Cowden’s syndrome)syndrome) „ SebaceousSebaceous tumorstumors (Muir(Muir--TorreTorre syndrome)syndrome) ChildhoodChildhood TumorsTumors

„ SyringomaSyringoma „ SyringocystadenomaSyringocystadenoma papilliferumpapilliferum „ PoromaPoroma „ CylindromaCylindroma „ PilomatrixomaPilomatrixoma „ TrichoepitheliomaTrichoepithelioma HistopathologicHistopathologic CategoriesCategories

„ EccrineEccrine „ FollicularFollicular „ SebaceousSebaceous „ ApocrineApocrine „ MixedMixed SweatSweat GlandGland NeoplasmsNeoplasms ((EccrineEccrine))

„ CylindromaCylindroma „ SpiradenomaSpiradenoma „ AcrospiromaAcrospiroma „ SyringomaSyringoma „ HidrocystomaHidrocystoma „ PoromaPoroma „ MixedMixed tumortumor „ PapillaryPapillary eccrineeccrine adenomaadenoma „ SyringofibroadenomaSyringofibroadenoma CluesClues toto EccrineEccrine TumorsTumors

„ DuctalDuctal oror tubulartubular differentiationdifferentiation „ TubulesTubules notnot linedlined byby corneocytescorneocytes inin crenulatedcrenulated patternpattern (sebaceous(sebaceous ducts)ducts) „ NotNot linedlined byby cellscells withwith decapitationdecapitation secretionsecretion

FollicularFollicular NeoplasmsNeoplasms

Location Benign Malignant Outer Hair sheath Tumor of the follicular Trichilemmal carcinoma infundibulum Malignant proliferating pilarpilar Pilar sheath acanthoma tumor Winer’s pore Trichoadenoma Trichilemmoma Proliferating pilar tumor Germanitive epithelium Trichofolliculoma Trichofollicular carcinoma Trichoepithelioma Trichoepithelial carcinoma Desmoplastic trichoepithelioma Pilomatrix carcinoma Pilomatrixoma Mixed epithelium and Basaloid follicular hamartoma mesenchyme Trichoblastoma Pilar mesenchyme Trichodiscoma Perifollicular fibroma Fibrofolliculoma Follicular myxoma Leiomyoma CluesClues toto FollicularFollicular NeoplasmsNeoplasms

„ RecapitulateRecapitulate HairHair FolliclesFollicles „ FollicularFollicular bulbbulb andand papillapapilla „ MatricalMatrical cellscells „ ShadowShadow cellscells „ TrichohyalinTrichohyalin granulesgranules

SebaceousSebaceous NeoplasmsNeoplasms

„ Hyperplasias „ Senile „ Premature „ Nevus sebaceus of Jadassohn „ Benign „ Sebaceous adenoma „ Basosebaceous epithelioma „ Superficial epithelioma with sebaceous differentiation „ Sebaceoma „ Malignant „ Ocular sebaceous carcinoma „ Extraocular „ Carcinoma with mixed adnexal differentiation CluesClues toto SebaceousSebaceous NeoplasmsNeoplasms

„ SebocytesSebocytes oror tubuletubule resemblingresembling sebaceoussebaceous ductduct „ HolocrineHolocrine secretionsecretion

ApocrineApocrine NeoplasmsNeoplasms

„ HidrocystomaHidrocystoma „ TubularTubular adenomaadenoma „ SyringocystadenomaSyringocystadenoma papilliferumpapilliferum „ HidradenomaHidradenoma papilliferumpapilliferum „ ExtramammaryExtramammary Paget’sPaget’s diseasedisease CluesClues toto ApocrineApocrine NeoplasmsNeoplasms

„ DuctalDuctal changeschanges withwith apocrineapocrine snoutingsnouting (decapitation(decapitation secretion)secretion)

MixedMixed NeoplasmsNeoplasms

„ MicrocysticMicrocystic adnexaladnexal carcinomacarcinoma „ LymphoepitheliomaLymphoepithelioma--likelike carcinomacarcinoma ofof thethe skinskin „ MalignantMalignant mixedmixed tumorstumors

HistologicHistologic CluesClues forfor BenignBenign vs.vs. MalignantMalignant

BenignBenign MalignantMalignant VerticallyVertically orientedoriented HorizontallyHorizontally orientedoriented BordersBorders smoothsmooth BordersBorders infiltrativeinfiltrative CytologicallyCytologically blandbland CytologicallyCytologically atypicalatypical MitoticMitotic figuresfigures usuallyusually MitoticMitotic figuresfigures usuallyusually scarcescarce abundantabundant LymphovascularLymphovascular invasioninvasion LymphovascularLymphovascular invasioninvasion absentabsent maymay bebe presentpresent

TreatmentTreatment forfor CarcinomasCarcinomas

„ WideWide excisionexcision „ PhysicalPhysical examinationexamination toto rulerule outout lymphlymph nodenode metastasismetastasis „ SentinelSentinel lymphlymph node?node? „ DigitalDigital PapillaryPapillary AdenocarcinomaAdenocarcinoma „ EccrineEccrine carcinomascarcinomas

PrognosisPrognosis

„ SkinSkin toto skinskin metastasesmetastases „ PorocarcinomasPorocarcinomas „ SebaceousSebaceous carcinomacarcinoma „ RegionalRegional LymphLymph nodenode metastasismetastasis „ Lung,Lung, liver,liver, bonebone metastasismetastasis