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1
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Chen Y, Wu M, Chen L, Li Z, Zhou Z, Li W, Zhang G. ALA-PDT combined with CO 2 laser in the treatment of malignant hidroacanthoma simplex: A case report. Photodiagnosis Photodyn Ther 2024; 49:104299. [PMID: 39089478 DOI: 10.1016/j.pdpdt.2024.104299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/12/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
Hidroacanthoma simplex (HS) is a rare skin appendage tumor that typically appears on the trunk and lower limbs in the elderly. Although HS is a predominantly benign condition, the presence of cellular atypia and dermal infiltration on histological examination indicates malignant HS (MHS). 5-aminolaevulinic acid photodynamic therapy (ALA-PDT) uses a photosensitizer and corresponding light source to cause irreversible damage or death of target cells through a photochemical reaction. Here, we reported the successful treatment of a MHS patient with ALA-PDT using plum-blossom needle pretreatment combined with CO2 laser. After five courses of ALA-PDT, the lesions were completely resolved, and the autonomic activity and smooth surface of the left ring finger were restored. This suggests that ALA-PDT is an effective, minimally invasive and safe treatment modality for MHS.
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Affiliation(s)
- Yulu Chen
- Skin Cancer Center & Department of Phototherapy, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China; Institute of Photomedicine, School of Medicine, Tongji University, Shanghai, China
| | - Mingshun Wu
- Skin Cancer Center & Department of Phototherapy, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China; Institute of Photomedicine, School of Medicine, Tongji University, Shanghai, China
| | - Lianjun Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhenlin Li
- Skin Cancer Center & Department of Phototherapy, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China; Institute of Photomedicine, School of Medicine, Tongji University, Shanghai, China
| | - Zhongxia Zhou
- Skin Cancer Center & Department of Phototherapy, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China; Institute of Photomedicine, School of Medicine, Tongji University, Shanghai, China
| | - Wei Li
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Guolong Zhang
- Skin Cancer Center & Department of Phototherapy, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China; Institute of Photomedicine, School of Medicine, Tongji University, Shanghai, China.
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Maharjan S, Shrestha O, Baral R, Bhattarai A. An unusual case of eccrine porocarcinoma on the axilla with nodal involvement: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241256868. [PMID: 38812832 PMCID: PMC11135088 DOI: 10.1177/2050313x241256868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 05/06/2024] [Indexed: 05/31/2024] Open
Abstract
Ecrrine porocarcinoma, a rare aggressive skin tumor, develops from sweat glands located in lower limbs, followed by the head and neck, trunk, and upper limbs. The incidence represents only about 0.005% of all cutaneous malignant tumors. The most common site is the lower extremities in elderly patients. As it has a high chance of metastases and recurrence after surgery, mainstay of treatment modality is wide local excision or Mohs (micrographically oriented histographic surgery) micrographic surgery. Mohs micrographic surgery (MMS) is a more effective treatment modality for tumors located in cosmetically and functionally important areas of the head and neck. We present a 56-years-old male patient with a large fungating eccrine tumor on the left axilla with ipsilateral nodal involvement on histomorphological grounds supported with immunohistochemical studies.
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Affiliation(s)
- Sabita Maharjan
- Department of Pathology, Nobel Medical College Teaching Hospital Pvt. Ltd., Biratnagar, Nepal
| | - Oshan Shrestha
- Department of Pathology, Nobel Medical College Teaching Hospital Pvt. Ltd., Biratnagar, Nepal
| | - Reetu Baral
- Department of Pathology, Nobel Medical College Teaching Hospital Pvt. Ltd., Biratnagar, Nepal
| | - Amit Bhattarai
- Department of General Surgery, Nobel Medical College Teaching Hospital Pvt. Ltd., Biratnagar, Nepal
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3
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Bienstman T, Güvenç C, Garmyn M. Porocarcinoma: Clinical and Histological Features, Immunohistochemistry and Outcomes: A Systematic Review. Int J Mol Sci 2024; 25:5760. [PMID: 38891945 PMCID: PMC11172007 DOI: 10.3390/ijms25115760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Porocarcinoma (PC) is a rare adnexal tumor, mainly found in the elderly. The tumor arises from the acrosyringium of eccrine sweat glands. The risk of lymph node and distant metastasis is high. Differential diagnosis with squamous cell carcinoma is difficult, although NUT expression and YAP1 fusion products can be very useful for diagnosis. Currently, wide local excision is the main surgical treatment, although Mohs micrographic surgery is promising. To date, there is no consensus regarding the role of sentinel lymph node biopsy and consequential lymph node dissection. No guidelines exist for radiotherapy, which is mostly performed based on tumor characteristics and excision margins. Only a few studies report systemic treatment for advanced PC, although therapy with pembrolizumab and EGFR inhibitors show promise. In this review, we discuss epidemiology, clinical features, histopathological features, immunohistochemistry and fusion products, surgical management and survival outcomes according to stage, surgical management, radiotherapy and systemic therapy.
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Affiliation(s)
- Thomas Bienstman
- Department of Dermatology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Canan Güvenç
- Department of Oncology, Laboratory of Dermatology, Catholic University of Leuven, 3000 Leuven, Belgium
| | - Marjan Garmyn
- Department of Dermatology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Oncology, Laboratory of Dermatology, Catholic University of Leuven, 3000 Leuven, Belgium
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4
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Wu ZW, Zhu WJ, Huang S, Tan Q, You C, Hu DG, Li LN. Eccrine porocarcinoma in the tempus of an elderly woman: A case report. World J Clin Cases 2024; 12:1523-1529. [PMID: 38576807 PMCID: PMC10989442 DOI: 10.12998/wjcc.v12.i8.1523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/19/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Eccrine porocarcinoma (EPC) is a rare skin tumor that mainly affects the elderly population. Tumors often present with slow growth and a good prognosis. EPCs are usually distinguished from other skin tumors using histopathology and immunohistochemistry. However, surgical management alone may be inadequate if the tumor has metastasized. However, currently, surgical resection is the most commonly used treatment modality. CASE SUMMARY A seventy-four-year-old woman presented with a slow-growing nodule in her left temporal area, with no obvious itching or pain, for more than four months. Histopathological examination showed small columnar and short spindle-shaped cells; thus, basal cell carcinoma was suspected. However, immunohistochemical analysis revealed the expression of cytokeratin 5/6, p63 protein, p16 protein, and Ki-67 antigen (40%), and EPC was taken into consideration. The skin biopsy was repeated, and hematoxylin and eosin staining revealed ductal differentiation in some cells. Finally, the patient was diagnosed with EPC, and Mohs micrographic surgery was performed. We adapted follow-up visits in a year and not found any recurrence of nodules. CONCLUSION This case report emphasizes the diagnosis and differentiation of EPC.
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Affiliation(s)
- Zhi-Wei Wu
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Wen-Jie Zhu
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Shan Huang
- Department of Laser and Cosmetic Dermatology, Ganzhou Dermatology Hospital, Ganzhou 341000, Jiangxi Province, China
| | - Qi Tan
- Department of Dermatology, Tongxiang Dermatology Hospital, Jiaxing 314000, Zhejiang Province, China
| | - Cong You
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Dian-Gui Hu
- Department of Infectious Diseases, The Fifth people’s Hospital of Ganzhou, Ganzhou 341000, Jiangxi Province, China
| | - Long-Nian Li
- Department of Dermatology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
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5
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Adnexal and Sebaceous Carcinomas. Dermatol Clin 2022; 41:117-132. [DOI: 10.1016/j.det.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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6
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Westphal D, Garzarolli M, Sergon M, Horak P, Hutter B, Becker JC, Wiegel M, Maczey E, Blum S, Grosche-Schlee S, Rütten A, Ugurel S, Stenzinger A, Glimm H, Aust D, Baretton G, Beissert S, Fröhling S, Redler S, Surowy H, Meier F. High tumour mutational burden and EGFR/MAPK pathway activation are therapeutic targets in metastatic porocarcinoma. Br J Dermatol 2021; 185:1186-1199. [PMID: 34185311 DOI: 10.1111/bjd.20604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Eccrine porocarcinoma (EPC) is a rare skin cancer arising from the eccrine sweat glands. Due to the lack of effective therapies, metastasis is associated with a high mortality rate. OBJECTIVES To investigate the drivers of EPC progression. METHODS We carried out genomic and transcriptomic profiling of metastatic EPC (mEPC), validation of the observed alterations in an EPC patient-derived cell line, confirmation of relevant observations in a large patient cohort of 30 tumour tissues, and successful treatment of a patient with mEPC under the identified treatment regimens. RESULTS mEPC was characterized by a high tumour mutational burden (TMB) with an ultraviolet signature, widespread copy number alterations and gene expression changes that affected cancer-relevant cellular processes such as cell cycle regulation and proliferation, including a pathogenic TP53 (tumour protein 53) mutation, a copy number deletion in the CDKN2A (cyclin dependent kinase inhibitor 2A) region and a CTNND1/PAK1 [catenin delta 1/p21 (RAC1) activated kinase 1] gene fusion. The overexpression of EGFR (epidermal growth factor receptor), PAK1 and MAP2K1 (mitogen-activated protein kinase kinase 1; also known as MEK1) genes translated into strong protein expression and respective pathway activation in the tumour tissue. Furthermore, a patient-derived cell line was sensitive to EGFR and MEK inhibition, confirming the functional relevance of the pathway activation. Immunohistochemistry analyses in a large patient cohort showed the relevance of the observed changes to the pathogenesis of EPC. Our results indicate that mEPC should respond to immune or kinase inhibitor therapy. Indeed, the advanced disease of our index patient was controlled by EGFR-directed therapy and immune checkpoint inhibition for more than 2 years. CONCLUSIONS Molecular profiling demonstrated high TMB and EGFR/MAPK pathway activation to be novel therapeutic targets in mEPC.
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Affiliation(s)
- D Westphal
- Department of Dermatology, University Hospital Carl Gustav Carus at Technische Universität (TU) Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - M Garzarolli
- Department of Dermatology, University Hospital Carl Gustav Carus at Technische Universität (TU) Dresden, Dresden, Germany
| | - M Sergon
- Institute of Pathology, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - P Horak
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and DKFZ, Heidelberg, Germany
| | - B Hutter
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Computational Oncology, Molecular Diagnostics Program, NCT Heidelberg and DKFZ, Heidelberg, Germany.,Division of Applied Bioinformatics, DKFZ, Heidelberg, Germany
| | - J C Becker
- Department of Dermatology, University Hospital Essen, Essen, Germany.,Translational Skin Cancer Research, DKTK, Partner Site Essen, Essen, Germany
| | - M Wiegel
- Department of Dermatology, University Hospital Carl Gustav Carus at Technische Universität (TU) Dresden, Dresden, Germany
| | - E Maczey
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - S Blum
- Institute and Policlinic of Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - S Grosche-Schlee
- Clinic and Policlinic of Nuclear Medicine, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - A Rütten
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | - S Ugurel
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - A Stenzinger
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - H Glimm
- Translational Functional Cancer Genomics, NCT Heidelberg and DKFZ, Heidelberg, Germany.,Department of Translational Medical Oncology NCT Dresden and DKFZ, Dresden, Germany.,Center for Personalized Oncology, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany.,DKTK, Dresden, Germany
| | - D Aust
- National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.,Institute of Pathology, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany.,Tumor and Normal Tissue Bank of the UCC/NCT Site Dresden, NCT Dresden and University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - G Baretton
- National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.,Institute of Pathology, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany.,Tumor and Normal Tissue Bank of the UCC/NCT Site Dresden, NCT Dresden and University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - S Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus at Technische Universität (TU) Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - S Fröhling
- German Cancer Consortium (DKTK), Heidelberg, Germany.,Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and DKFZ, Heidelberg, Germany
| | - S Redler
- Institute of Human Genetics, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - H Surowy
- Institute of Human Genetics, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - F Meier
- Department of Dermatology, University Hospital Carl Gustav Carus at Technische Universität (TU) Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.,Skin Cancer Center at the University Cancer Center Dresden, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
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7
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[Management of malignant adnexal neoplasms of the skin]. Hautarzt 2021; 72:619-632. [PMID: 34137901 DOI: 10.1007/s00105-021-04829-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Malignant adnexal neoplasms of the skin are a heterogeneous group of rare malignancies with eccrine, apocrine, sebaceous and follicular differentiation. Essential clinical practice recommendations for the overall management of these cancers are presented. Moreover, specific evidence-based findings according to diagnosis, therapy and follow-up of porocarcinoma, sebaceous carcinoma and microcystic adnexcarcinoma will be explained.
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8
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Fernández-Ferreira R, Alvarado-Luna G, Motola-Kuba D, Mackinney-Novelo I, Cervera-Ceballos EE, Segura-Rivera R. Intergluteal Cleft Eccrine Porocarcinoma with Metastasis to Inguinal Region and Lung: Case Report and Review of the Literature. Case Rep Oncol 2020; 13:1463-1473. [PMID: 33442371 PMCID: PMC7772857 DOI: 10.1159/000510311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 11/21/2022] Open
Abstract
Eccrine porocarcinoma (EPC) is an infrequent cutaneous neoplasm, and was described in 1963 by Pinkus and Mehregan. It is a rare type of skin tumor (0.005-0.01% of all skin tumors). Less than 300 cases have been described in the entire world medical literature. To our knowledge, no case of intergluteal cleft EPC has been reported in the literature in English and Spanish to date, so this would be the first reported case of such pathology. Metastatic EPC is less frequent, since only <10% of metastatic type have been reported and the rest as localized disease. The primary treatment of choice is surgical wide local excision of the tumor with histological confirmation of tumor-free margins. Prognosis is difficult to determine because of the rarity of EPC and the variations in natural history. There are no data to support the use of adjuvant chemotherapy or radiotherapy, and there are currently no agreed criteria to define patients at high risk of relapse. We present a 67-year-old man with intergluteal cleft eccrine tumor by biopsy. Metastasis to left inguinal region and lung was reported by contrasted abdominal and chest computed tomography. He started chemotherapy based on etoposide, vincristine, carboplatin. A review of pertinent literature is provided.
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Affiliation(s)
- Ricardo Fernández-Ferreira
- Oncology Medicine Department, Comprehensive Oncology Center “Diana Laura Riojas de Colosio,” Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Gabriela Alvarado-Luna
- Oncology Medicine Department, Comprehensive Oncology Center “Diana Laura Riojas de Colosio,” Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Daniel Motola-Kuba
- Oncology Medicine Department, Comprehensive Oncology Center “Diana Laura Riojas de Colosio,” Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Ileana Mackinney-Novelo
- Oncology Medicine Department, Comprehensive Oncology Center “Diana Laura Riojas de Colosio,” Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Eduardo Emir Cervera-Ceballos
- Oncology Medicine Department, Comprehensive Oncology Center “Diana Laura Riojas de Colosio,” Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Román Segura-Rivera
- Service of Anatomical Pathology, Medica Sur Clinic & Foundation, Mexico City, Mexico
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DEREBAŞINLIOĞLU H, NEMMEZİ KARACA S. A 20-YEAR RETROSPECTIVE ANALYSIS OF SKIN CANCERS: COMPARISON OF THE FIRST AND SECOND DECADES. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.708364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Abstract
Malignant sweat gland neoplasms are a confusing area within dermatopathology, with many entities reported under several designations in the literature. This review describes the key clinical and histopathologic features of select malignant adnexal neoplasms, including porocarcinoma, papillary carcinoma, adenoid cystic carcinoma, cribriform carcinoma, apocrine hidradenocarcinoma, malignant mixed tumor of the skin, syringoid carcinoma, cylindrocarcinoma, spiradenocarcinoma, mucinous carcinoma, polymorphous sweat gland carcinoma, microcystic adnexal carcinoma, secretory carcinoma of the skin, and primary cutaneous signet ring cell carcinoma. For entities with overlapping features, differential diagnoses are discussed.
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Affiliation(s)
- Christine S Ahn
- Department of Pathology, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Omar P Sangüeza
- Department of Pathology, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA.
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11
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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: 23] [Impact Index Per Article: 4.6] [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.
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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
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12
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Zhang Y, Zhang M, Wu W, Lu J. Zosteriform Lymphangitic Metastases of Eccrine Porocarcinoma. Indian J Dermatol 2019; 64:411-413. [PMID: 31543539 PMCID: PMC6749752 DOI: 10.4103/ijd.ijd_440_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Eccrine porocarcinoma (EPC) is a rare malignant neoplasm which originates from the intraepidermal portion of eccrine sweat glands or acrosyringium. Here, we report a unique case of cutaneous metastases of EPC presenting with an erosive plaque on the left thumb and multiple nodules on left forearm. The histopathological examination of the wrist lesion revealed islands of basaloid tumor cells with eosinophilic cytoplasm, downward infiltrating growths, ductal differentiation, and intracytoplasmic lumen formations and focally connected to the epidermis. Acrosyringeal differentiation was confirmed by positive immunohistochemical staining using antibodies to carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA) in some of porocarcinoma cells. Lymphatic embolization was shown by immunostaining of podoplanin. To the best of our knowledge, this is the first reported EPC case with a primary lesion on the left thumb and zosteriform growth pattern of lymphangitic metastases on left forearm. Our case highlights the diagnostic challenges and reveals lymphangitic metastasis mode of EPC.
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Affiliation(s)
- Yunfang Zhang
- Department of Oncology, Hainan Provincial Hospital of TCM, Haikou, China
| | - Ming Zhang
- Department of Dermatology, Hainan Provincial Hospital of Skin Disease, Haikou, China
| | - Weiwei Wu
- Department of Dermatology, Hainan Provincial Hospital of Skin Disease, Haikou, China
| | - Jiejie Lu
- Department of Dermatology, Hainan Provincial Hospital of Skin Disease, Haikou, China
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13
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McGuire C, Fadel Z, Samargandi O, Williams J. Primary eccrine porocarcinoma of the thumb with multiple metastases: a case report and review of the literature. Case Reports Plast Surg Hand Surg 2019; 6:88-91. [PMID: 31489340 PMCID: PMC6711107 DOI: 10.1080/23320885.2019.1647108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/17/2019] [Indexed: 01/20/2023]
Abstract
We present a case of primary eccrine porocarcinoma of the thumb in a 56-year-old male who ultimately developed multiple metastases. With so few cases of such lesions and their aggressive nature, accurate diagnosis and prompt surgical management is essential.
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Affiliation(s)
- Connor McGuire
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Zahir Fadel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Halifax, Nova Scotia, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osama Samargandi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Halifax, Nova Scotia, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jason Williams
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Halifax, Nova Scotia, Canada
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14
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Duverger L, Osio A, Cribier B, Mortier L, De Masson A, Basset-Seguin N, Lebbé C, Battistella M. Heterogeneity of PD-L1 expression and CD8 tumor-infiltrating lymphocytes among subtypes of cutaneous adnexal carcinomas. Cancer Immunol Immunother 2019; 68:951-960. [PMID: 30953116 PMCID: PMC11028315 DOI: 10.1007/s00262-019-02334-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/28/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Adnexal carcinomas are rare and heterogeneous skin tumors, for which no standard treatments exist for locally advanced or metastatic tumors. AIM OF THE STUDY To evaluate the expression of PD-L1 and CD8 in adnexal carcinomas, and to study the association between PD-L1 expression, intra-tumoral T cell CD8+ infiltrate, and metastatic evolution. MATERIALS AND METHODS Eighty-three adnexal carcinomas were included. Immunohistochemistry using anti-PD-L1 monoclonal antibodies (E1L3N and 22C3) and CD8 was performed. PD-L1 expression in tumor and immune cells, and CD8+ tumor-infiltrating lymphocyte (TIL) density were analyzed semi-quantitatively. RESULTS Among the 60 sweat gland, 18 sebaceous and 5 trichoblastic carcinomas, 11% expressed PD-L1 in ≥ 1% tumor cells, more frequently sweat gland carcinomas (13%, 8/60) including apocrine carcinoma (40%, 2/5) and invasive extramammary Paget disease (57%, 4/7). Immune cells expressed significantly more PD-L1 than tumor cells (p < 0.01). Dense CD8+ TILs were present in 60% trichoblastic, 43% sweat gland, and 39% sebaceous carcinomas. CD8+ TILs were associated with PD-L1 expression by tumor cells (p < 0.01). Thirteen patients out of 47 developed metastases (27%) with a median follow-up of 30.5 months (range 7-36). Expression of PD-L1 by tumor cells was associated with the development of metastasis in univariate analysis (HR 4.0, 95% CI 1.1-15, p = 0.0377) but not in multivariate analysis (HR 4.1, 95% CI 0.6-29, p = 0.15). CONCLUSION PD-L1 expression is highly heterogeneous among adnexal carcinoma subtypes, higher in apocrine carcinoma and invasive extramammary Paget disease, and associated with CD8+ TILs. Our data suggest the interest of evaluating anti-PD1 immunotherapy in advanced or metastatic cutaneous adnexal carcinoma.
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Affiliation(s)
- Lucie Duverger
- Pathology Department, INSERM UMR_S1165, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (APHP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Amélie Osio
- Pathology Department, INSERM UMR_S1165, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (APHP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Bernard Cribier
- Dermatology Department, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Laurent Mortier
- Dermatology Department, Centre Hospitalier Régional Universitaire (CHRU) de Lille, Lille, France
| | - Adèle De Masson
- INSERM, Unité mixte de recherche (UMR)_S976, University Paris Diderot, Paris, France
- Dermatology Department, Hôpital St Louis, APHP, Paris, France
| | - Nicole Basset-Seguin
- INSERM, Unité mixte de recherche (UMR)_S976, University Paris Diderot, Paris, France
- Dermatology Department, Hôpital St Louis, APHP, Paris, France
| | - Céleste Lebbé
- INSERM, Unité mixte de recherche (UMR)_S976, University Paris Diderot, Paris, France
- Dermatology Department, Hôpital St Louis, APHP, Paris, France
| | - Maxime Battistella
- Pathology Department, INSERM UMR_S1165, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (APHP), 1 Avenue Claude Vellefaux, 75010, Paris, France.
- INSERM, UMR_S1165, University Paris Diderot, Paris, France.
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Results of Surgical Treatment of Patients with Malignant Eccrine Poroma. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2019; 53:33-36. [PMID: 33536823 PMCID: PMC7847727 DOI: 10.14744/semb.2018.10170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/23/2018] [Indexed: 11/20/2022]
Abstract
Objectives: Malignant eccrine poroma is a rare cutaneous malignancy. This study was a review of a series of patients with malignant eccrine poroma who underwent surgical treatment conducted in order to evaluate the management techniques and outcomes of treatment modalities. Methods: All cases of surgically excised malignant eccrine poroma performed in a single clinic between 2012 and 2018 were included in the study. The details of patient age, gender, anatomical location of the tumor, histopathological features, and treatment modalities were analyzed. Results: The average tumor size was 2.53 cm (range: 0.3-7 cm). The average tumor thickness was 3.06 mm (range: 2.5-4 mm). The mean clean tumor margin after the first excision was 1.28 mm and the mean tumor margin after the second excision was 8.83 mm. No recurrence or distant metastasis was detected in any of the patients during the follow-up period. Conclusion: Unlike frequent skin cancers, rare skin cancers, like malignant eccrine poroma, don’t have definite treatment algorithms constituted from randomized trials. The findings of patient series are very useful to guide physicians in these cases.
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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: 8] [Impact Index Per Article: 1.3] [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.
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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
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17
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Shah AK, Shah AN, Patil SB. Eccrine poroma: Insights of its occurrence and differentials in the maxillofacial region. J Oral Maxillofac Pathol 2018; 22:415-417. [PMID: 30651691 PMCID: PMC6306575 DOI: 10.4103/jomfp.jomfp_243_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Arpan K Shah
- Department of Oral Pathology and Microbiology, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
| | - Amrish N Shah
- Department of Pathology, Parul Institute of Medical Sciences and Research, Vadodara, Gujarat, India
| | - Sandeep B Patil
- Department of Oral and Maxillofacial Surgery, Pandit Deendayal Upadhyay Dental College, Solapur, Maharashtra, India
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Abstract
BACKGROUND Adnexal carcinomas (ACs) are rare cutaneous malignancies of sweat gland or pilosebaceous origin. Optimal treatment and metastatic potential of AC are poorly defined. Mohs micrographic surgery (MMS) has been increasingly used to treat AC. OBJECTIVE To review selected primary cutaneous AC and their treatment outcomes with MMS. MATERIALS AND METHODS Literature review using PubMed search for articles related to primary cutaneous ACs. RESULTS Sebaceous carcinoma treated with MMS recurred and metastasized in 6.4% and 3.7%, respectively. Primary cutaneous mucinous carcinoma treated with MMS recurred and metastasized in 9.6% and 6.4%, respectively. After MMS, 4.7% of microcystic AC recurred with no reported metastases. After MMS, recurrences and metastases of trichilemmal carcinoma or hidradenocarcinoma have not been reported. Two (4.2%) regional lymph node metastases but no distant metastases or local recurrences have been reported in eccrine porocarcinoma. Squamoid eccrine duct tumor, pilomatrix carcinoma, and spiradenocarcinoma treated with MMS are also reviewed. CONCLUSION The rarity of ACs and the lack of comparative data on treatment makes conclusive recommendations on treatment difficult. Recent large case series and reviews suggest MMS is a useful and possibly superior treatment for AC and should be considered if primary cutaneous disease is suspected.
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20
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Treatment of Malignant Cutaneous Adnexal Neoplasms. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:6-23. [PMID: 28988763 DOI: 10.1016/j.ad.2017.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 12/16/2016] [Accepted: 04/15/2017] [Indexed: 12/25/2022] Open
Abstract
Malignant cutaneous adnexal neoplasms form a group of rare, typically low-grade-malignancy carcinomas with follicular, sebaceous, apocrine, or eccrine differentiation or a combination of the first 3 subtypes. Their clinical presentation is usually unremarkable, and biopsy is required to establish the differentiation subtype and the definitive diagnosis. Due to their rarity, no clear consensus has been reached on which treatment is most effective. Mohs micrographic surgery is considered to be the best option to prevent recurrence in the majority of patients. Radiotherapy and chemotherapy have been studied in very few cases and have rarely been shown to be effective.
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21
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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.
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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
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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.
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23
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Devi NRS, Valarmathi K, Lilly M, Satish S, Mishra N. Primary Axillary Porocarcinoma: A Rare Cutaneous Tumour. J Clin Diagn Res 2016; 10:ED04-6. [PMID: 27042472 DOI: 10.7860/jcdr/2016/15278.7171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 12/03/2015] [Indexed: 11/24/2022]
Abstract
Eccrine porocarcinoma, a rare cutaneous malignant tumour accounts for a fraction of sweat gland tumours. This tumour is found to originate from the intraepithelial parts of the sweat glands. It commonly involves the lower extremities in elderly patients and carries an aggressive behaviour. Cutaneous and visceral metastasis can occur and hence prompt treatment is mandatory. Surgical excision is the mainstay of treatment modality. We hereby present a case of eccrine porocarcinoma in a 50-year-old male in the right axillary region presenting as a verrucous lesion.
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Affiliation(s)
- Nalli R Sumitra Devi
- Professor, Department of Pathology, Govt Stanley Medical College , Chennai, Tamil Nadu Dr. M.G.R. Medical University, India
| | - K Valarmathi
- Professor, Department of Pathology, Govt Stanley Medical College , Chennai, Tamil Nadu Dr. M.G.R. Medical University, India
| | - Mary Lilly
- Professor, Department of Pathology, Govt Stanley Medical College , Chennai, Tamil Nadu Dr. M.G.R. Medical University, India
| | - Selvi Satish
- Assistant Professor, Department of Pathology, Govt Stanley Medical College , Chennai, Tamil Nadu Dr. M.G.R. Medical University, India
| | - Nidhi Mishra
- Post Graduate, Department of Pathology, Govt Stanley Medical College , Chennai, Tamil Nadu Dr. M.G.R. Medical University, India
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Danialan R, Mutyambizi K, Aung PP, Prieto VG, Ivan D. Challenges in the diagnosis of cutaneous adnexal tumours. J Clin Pathol 2015; 68:992-1002. [DOI: 10.1136/jclinpath-2015-203228] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The diagnosis of cutaneous adnexal neoplasms, a heterogeneous group of entities, is often perceived by practising pathologists as challenging. A systematic approach to diagnosis is necessary for classification of these lesions, which establishes the tumour differentiation (follicular, sebaceous, sweat gland or apocrine) and evaluates histological features differentiating between benign and malignant entities. Consideration of clinical history is a necessary adjunct in evaluation of the adnexal neoplasm, as characteristic anatomical sites are described for many adnexal lesions. In some instances, immunohistochemical studies may also be employed to aid the diagnosis. The differential diagnosis between primary cutaneous adnexal neoplasms and cutaneous metastases from visceral tumours may also be difficult. Clinical, radiological, histological and immunohistochemical characteristics will be further discussed, considering that the correct diagnosis has a significant impact on the patient's management and prognosis.
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25
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Montes-Torres A, Pérez-Plaza A, Llamas-Velasco M, Gordillo C, De Argila D, García-García C, Fraga J, Marín A, Ballesteros AI, Daudén E. Eccrine porocarcinoma with extensive cutaneous metastases. Int J Dermatol 2015; 55:e156-60. [PMID: 26566927 DOI: 10.1111/ijd.13121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 10/31/2014] [Accepted: 01/02/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Eccrine porocarcinoma (EPC) is an uncommon malignant neoplasm that originates in the intraepidermal portion of the eccrine sweat duct. Although porocarcinoma is a slow-growing tumor, up to 20% of cases can metastasize to regional lymph nodes, thus increasing mortality. METHODS We describe the clinical and histopathological features and clinical course of three cases of extensive metastatic EPC diagnosed in our department over the last 10 years. RESULTS All three patients were women aged 89-96 years. They had numerous skin tumors on the left leg that were histologically and immunohistochemically diagnosed as metastatic EPC. Only one patient had a history of primary porocarcinoma, which had been excised 6 years earlier. The remaining two patients had a previous lesion diagnosed as squamous cell carcinoma. We treated the patients with palliative radiotherapy and/or chemotherapy. Only one patient is currently alive. CONCLUSIONS The cases of cutaneous and regional metastatic EPC we present occurred in elderly women with major involvement of the left leg. The third case is noteworthy, as the patient presented a long latency period before metastases appeared. Difficulties in the clinical diagnosis--and occasionally histological diagnosis--of primary EPC could delay more aggressive treatment, although optimal treatment does not always guarantee a good prognosis.
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Affiliation(s)
| | | | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Carlos Gordillo
- Department of Pathology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Diego De Argila
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Javier Fraga
- Department of Pathology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Alicia Marín
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Esteban Daudén
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain
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Tidwell WJ, Mayer JE, Malone J, Schadt C, Brown T. Treatment of eccrine porocarcinoma with Mohs micrographic surgery: a cases series and literature review. Int J Dermatol 2015. [PMID: 26205087 DOI: 10.1111/ijd.12997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Eccrine porocarcinoma (EPC) is a rare malignant tumor of the eccrine sweat gland. It is a potentially fatal neoplasm that is locally aggressive and commonly recurs. Wide surgical excision has traditionally been the treatment of choice and is curative in approximately 70-80% of cases. The disease is metastatic to lymph nodes and distant sites in 20% and 10% of cases, respectively. Metastatic EPC has not shown any great response to adjuvant chemotherapy or radiation. OBJECTIVE The purpose of this study was to evaluate the efficacy of Mohs micrographic surgery (MMS) for EPC as an alternative to wide local excision. METHODS Five patients diagnosed with EPS between 2011 and 2014 at the University of Louisville and treated with MMS were studied. Recurrence-free periods subsequent to the treatment of EPC with MMS were measured. RESULTS The five patients with EPC treated by MMS remained recurrence-free for a mean of 11 months (range: 2-26 months). CONCLUSIONS Mohs micrographic surgery is a highly effective treatment for EPC. Given the high rate of recurrence, propensity for lymph node metastases, and the often ineffective options for treating advanced disease, MMS should be considered in the treatment of all cases of EPC.
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Affiliation(s)
- William James Tidwell
- Division of Dermatology, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Jonathan E Mayer
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Janine Malone
- Division of Dermatology, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Courtney Schadt
- Division of Dermatology, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Timothy Brown
- Division of Dermatology, School of Medicine, University of Louisville, Louisville, KY, USA
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28
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Kocatüurk E, Ülkümen PK, Kizitaç U, Yüksel T, Kunter AS, Erhan SŞ. In-Transit Metastasis from Primary Cutaneous Squamous Cell Carcinoma in a Nonimmunosuppressed Patient. J Cutan Med Surg 2015; 19:167-70. [DOI: 10.2310/7750.2014.14047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background In-transit metastases are dermal and subcutanous metastatic foci located between the tumor and the closest regional lymph node. Although in-transit metastasis has been commonly described for malignant melanoma, there have been some reports of in-transit metastases arising from primary cutaneous malignancies. The risk of development of in-transit metastases is higher in patients with high-risk squamous cell carcinoma. Case Report We present a case of in-transit metastasis in a nonimmunosuppressed patient with a primary cutaneous squamous cell carcinoma.
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Affiliation(s)
- Emek Kocatüurk
- Departments of Dermatology and Pathology, Okmeydam Training and Research Hospital, Istanbul, Turkey
| | - Pelin Kuteyla Ülkümen
- Departments of Dermatology and Pathology, Okmeydam Training and Research Hospital, Istanbul, Turkey
| | - Utkan Kizitaç
- Departments of Dermatology and Pathology, Okmeydam Training and Research Hospital, Istanbul, Turkey
| | - Tülin Yüksel
- Departments of Dermatology and Pathology, Okmeydam Training and Research Hospital, Istanbul, Turkey
| | - Ayşle Seza Kunter
- Departments of Dermatology and Pathology, Okmeydam Training and Research Hospital, Istanbul, Turkey
| | - Selma Şlengiz Erhan
- Departments of Dermatology and Pathology, Okmeydam Training and Research Hospital, Istanbul, Turkey
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H.K. S, A.L. H, Ramesh DB, Soni A, V. R. Eccrine porocarcinoma: a case report. J Clin Diagn Res 2013; 7:2966-7. [PMID: 24551693 PMCID: PMC3919320 DOI: 10.7860/jcdr/2013/6964.3707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 10/28/2013] [Indexed: 11/24/2022]
Abstract
Eccrine porocarcinoma is an extremely rare malignancy of the eccrine sweat gland. It is believed to arise from the intra-epithelial portion of eccrine sweat glands. It can either arise de novo or it can develop in a long standing eccrine poroma. It often occurs in the elderly, with the mean age of occurrence being 67 years. The tumour favours extremities, particularly the legs and feet. The propensity to form multiple cutaneous metastases is an unusual feature of eccrine porocarcinoma. It is also associated with visceral metastasis, resulting in death. An early diagnosis and prompt treatment are thus essential, owing to the aggressive behaviour of the tumour. Keeping in view its rarity of occurrence, we are hereby presenting a case of eccrine porocarcinoma which occurred in a 55-year-old female.
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Affiliation(s)
- Sharathkumar H.K.
- Associate Professor, Department of Pathology, Mysore Medical College and Research Institute, Mysore, India
| | - Hemalatha A.L.
- Professor and Head of Deparment, Department of Pathology, Mysore Medical College and Research Institute, Mysore, India
| | - Deepthi B. Ramesh
- Post Graduate, Department of Pathology, Mysore Medical College and Research Institute, Mysore, India
| | - Ankita Soni
- Post Graduate, Department of Pathology, Mysore Medical College and Research Institute, Mysore, India
| | - Revathi V.
- Post Graduate, Department of Pathology, Mysore Medical College and Research Institute, Mysore, India
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Successful management of metastatic eccrine porocarcinoma. Case Rep Oncol Med 2013; 2013:282536. [PMID: 24282649 PMCID: PMC3825131 DOI: 10.1155/2013/282536] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/19/2013] [Indexed: 11/17/2022] Open
Abstract
Eccrine porocarcinoma (EPC) is a rare tumor. It develops from the intraepidermal ductal portion of the eccrine sweat gland. Metastatic disease is rare. We report a new case of metastatic eccrine porocarcinoma with a successful management and a good response to docetaxel. A 54-year-old man was admitted with a mass in the breast. Biopsy specimen found carcinomatous tumor proliferation with large anastomosing ducts. Cellular atypia were noted, with eosinophilic cytoplasm and round to oval nuclei. The tumor showed positive immunoreactivity for ACE and negative to anti-PS-100. Resection was performed. One year later, he presented with local and metastatic recurrences. The patient had received 3 cycles of cisplatin and 5-fluorouracil; he progressed with increase in mass size and number of lung lesions. He has been undergoing three cycles of docetaxel with complete response in the lung and regression of the breast mass. The mass was excised. Porocarcinoma is a very rare entity and poorly understood. In the metastatic phase, it has modest or no sensitivity to anticancer treatment. Docetaxel should be considered in the metastatic eccrine porocarcinoma.
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Sgouros D, Piana S, Argenziano G, Longo C, Moscarella E, Karaarslan IK, Akalin T, Özdemir F, Zalaudek I. Clinical, Dermoscopic and Histopathological Features of Eccrine Poroid Neoplasms. Dermatology 2013; 227:175-9. [DOI: 10.1159/000354152] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 07/02/2013] [Indexed: 11/19/2022] Open
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Ishida M, Okabe H. Expression profiles of mTOR pathway proteins in porocarcinoma: A provisional immunohistochemical study. Biomed Rep 2013; 1:28-30. [PMID: 24648888 DOI: 10.3892/br.2012.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 09/28/2012] [Indexed: 11/06/2022] Open
Abstract
Porocarcinoma is a rare skin appendage carcinoma, with a poor prognosis. At present, the recommended treatment of localized porocarcinoma is wide surgical resection. Although anthracyclin-based chemotherapy or combination of 5-fluorouracil (5-FU), taxanes and cisplatin are considered to be the first-line treatment for metastatic or locally-advanced porocarcinoma, this type of tumor is recognized as relatively chemoresistant, and no standard systemic treatment has been established yet. Mammalian target of rapamycin (mTOR) is an important protein involved in carcinogenesis. mTOR phosphorylates the eukaryotic translation initiation factor 4E-binding protein 1 (4E-BP1), and then phosphorylated 4E-BP1 (p4E-BP1) triggers cell cycle progression, cell proliferation and angiogenesis. Therefore, mTOR is believed to be one of the most promising therapeutic targets in various types of carcinomas. However, the expression profiles of mTOR pathway proteins in porocarcinoma have yet to be elucidated. Therefore, we analyzed the expression of mTOR, 4E-BP1 and p4E-BP1 in five cases of porocarcinoma (four invasive and one in situ case) using immunohistochemical methods. mTOR expression was observed in the invasive porocarcinoma cases, but not in the in situ case. 4E-BP1 was expressed in all five cases. p4E-BP1 expression was observed in 3/4 invasive porocarcinoma cases, but not in the in situ case. This preliminary study clearly demonstrated the overexpression of mTOR and its downstream proteins in most of the included invasive porocarcinoma cases. Therefore, mTOR inhibitors could be considered as potential therapeutic modalities for the treatment of metastatic or locally-advanced porocarcinoma.
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Affiliation(s)
- Mitsuaki Ishida
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Hidetoshi Okabe
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
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Kagotani A, Ishida M, Yoshida K, Okabe H. Fine-needle aspiration findings of metastatic porocarcinoma. Diagn Cytopathol 2012; 42:280-2. [DOI: 10.1002/dc.22919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/26/2012] [Accepted: 06/06/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Akiko Kagotani
- Division of Diagnostic Pathology; Department of Clinical Laboratory Medicine; Shiga University of Medical Science; Shiga Japan
| | - Mitsuaki Ishida
- Division of Diagnostic Pathology; Department of Clinical Laboratory Medicine; Shiga University of Medical Science; Shiga Japan
| | - Keiko Yoshida
- Division of Diagnostic Pathology; Department of Clinical Laboratory Medicine; Shiga University of Medical Science; Shiga Japan
| | - Hidetoshi Okabe
- Division of Diagnostic Pathology; Department of Clinical Laboratory Medicine; Shiga University of Medical Science; Shiga Japan
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Vleugels FR, Girouard SD, Schmults CD, Ng AK, Russell SE, Wang LC, Buzney EA. Metastatic eccrine porocarcinoma after Mohs micrographic surgery: a case report. J Clin Oncol 2012; 30:e188-91. [PMID: 22689795 DOI: 10.1200/jco.2011.40.6843] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Frank R Vleugels
- University of Cincinnati School of Medicine, Cincinnati, OH, USA
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36
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Asuquo M, Ngim O, Nya A, Omotoso J, Asuquo ME. Malignant adnexal tumors: diagnostic and therapeutic challenges in Calabar, Nigeria. Int J Dermatol 2012; 51:619-21. [PMID: 22515592 DOI: 10.1111/j.1365-4632.2010.04575.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sun Kim M, Rae Lee H, Lee JH, Son SJ, Song KY. Malignant hidroacanthoma simplex: arising in hidroacanthoma simplex mimicking clonal seborrheic keratosis. Int J Dermatol 2012; 52:258-60. [PMID: 22353024 DOI: 10.1111/j.1365-4632.2010.04845.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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38
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Wong A, Hughes C, Luu X, Ricci A, Babigian A. Subungal malignant eccrine porocarcinoma: An unusual presentation. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-011-0673-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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39
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Kwah YC, Husain A. Break a Sweat in the Diagnosis and Management of a Flesh-Colored Nodule. J Am Geriatr Soc 2012; 60:164-5. [DOI: 10.1111/j.1532-5415.2011.03743.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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Choi CM, Cho HR, Lew BL, Sim WY. Eccrine porocarcinoma presenting with unusual clinical manifestations: a case report and review of the literature. Ann Dermatol 2011; 23 Suppl 1:S79-83. [PMID: 22028580 PMCID: PMC3199430 DOI: 10.5021/ad.2011.23.s1.s79] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 10/04/2010] [Accepted: 10/04/2010] [Indexed: 11/08/2022] Open
Abstract
Eccrine porocarcinoma is a rare neoplasm that originates from the intraepidermal ductal portion of the eccrine sweat gland, and it usually occurs on the pre-existing lesion of benign eccine poroma. Its occurrence is more common in females and elderly persons. We present a case of a 44-year-old man who suffered from eccrine porocarcinoma, which developed on the right scrotum and pelvic area with metastases to the lung, adrenal gland, esophagus, ureter, and distant lymph nodes. Here we report on a unique case of eccrine porocarcinoma that developed primarily on the scrotum, which is an uncommon site, and showed rapid metastasis to the internal organs.
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Affiliation(s)
- Chang-Min Choi
- Department of Dermatology, Kyunghee University Hospital at Gangdong, Seoul, Korea
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41
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Belin E, Ezzedine K, Stanislas S, Lalanne N, Beylot-Barry M, Taieb A, Vergier B, Jouary T. Factors in the surgical management of primary eccrine porocarcinoma: prognostic histological factors can guide the surgical procedure. Br J Dermatol 2011; 165:985-9. [DOI: 10.1111/j.1365-2133.2011.10486.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ishida M, Hotta M, Kushima R, Okabe H. A case of porocarcinoma arising in pigmented hidroacanthoma simplex with multiple lymph node, liver and bone metastases. J Cutan Pathol 2011; 38:227-31. [PMID: 19788447 DOI: 10.1111/j.1600-0560.2009.01440.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Porocarcinoma is a rare skin appendage carcinoma that may arise de novo or be associated with pre-existing poroma and hidroacanthoma simplex (HAS). Here, we report a case of porocarcinoma arising in pigmented HAS, which led to death from multiple lymph node, liver and bone metastases. A 72-year-old Japanese man presented with a brown to focal black flat plaque, measuring 17 × 12 mm, on the posterior region of his right thigh. Histopathological study of the tumor revealed that there was intraepidermal proliferation of small-sized basaloid cells, and it exhibited the 'Jadassohn phenomenon', with dendritic melanocytes, and a few ductal structures were observed. Continuing to the intraepidermal nests, the invasive proliferation of large polygonal cells with occasional intracytoplasmic ductal structures was observed. Carcinoembryonic antigen and epithelial membrane antigen were expressed in some carcinoma cells and they highlighted the intracytoplasmic ductal structures. Multiple lymph node, liver and bone metastases were observed, and the patient died 8 months after the initial surgery. Clinical diagnosis of HAS is extremely rare. Porocarcinoma may be associated with pre-existing HAS and sometimes shows aggressive behavior. Therefore, pigmented HAS must be included in the differential diagnosis of brown or black lesions. Ishida M, Hotta M, Kushima R, Okabe H. A case of porocarcinoma arising in pigmented hidroacanthoma simplex with multiple lymph node, liver and bone metastases.
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Affiliation(s)
- Mitsuaki Ishida
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science, Otsu, Shiga, Japan.
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Luz MDA, Ogata DC, Montenegro MFG, Biasi LJ, Ribeiro LC. Eccrine porocarcinoma (malignant eccrine poroma): a series of eight challenging cases. Clinics (Sao Paulo) 2010; 65:739-42. [PMID: 20668633 PMCID: PMC2910864 DOI: 10.1590/s1807-59322010000700014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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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]
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Avilés-Izquierdo J, Velázquez-Tarjuelo D, Lecona-Echevarría M, Lázaro-Ochaita P. Características dermatoscópicas del poroma ecrino. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)70231-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Park J, Kwon H, Cho MK, Park YL, Lee SY, Lee JS, Whang KU. A Case of Malignant Eccrine Poroma Developing on the Suprapubic Area. Ann Dermatol 2008; 20:37-40. [PMID: 27303157 DOI: 10.5021/ad.2008.20.1.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Malignant eccrine poroma is a rare skin appendageal tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It may develop either spontaneously or from a long-standing eccrine poroma. It usually affects the aged and is located most commonly on lower extremities. We report a case of malignant eccrine poroma occurring on the suprapubic area of a 75-year-old Korean man. He underwent wide excision and flap coverage.
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Affiliation(s)
- Joon Park
- Department of Dermatology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Hyuk Kwon
- Department of Dermatology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Moon Kyun Cho
- Department of Dermatology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Young Lip Park
- Department of Dermatology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Sung Yul Lee
- Department of Dermatology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Jong Suk Lee
- Department of Dermatology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Kyu Uang Whang
- Department of Dermatology, College of Medicine, Soonchunhyang University, Seoul, Korea
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Abstract
A 71-year-old white woman sought treatment for poroma of the right lower eyelid. Excisional biopsy was performed, and the specimen had histologic features consistent with poroma. One year after excision, there has been no recurrence of the lesion. Clinicians should be aware that poroma can occur in regions other than the hands and feet.
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