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.