Skin Skin AdnexalAdnexal TumorsTumors--An An OverviewOverview

Paul K. Shitabata, M.D.Paul K. Shitabata, M.D.DermatopathologistDermatopathologist

APMGAPMG

A Bump!A Bump!

Nonspecific clinical appearanceNonspecific clinical appearanceUsually minimal skin changesUsually minimal skin changes

Head and neck, trunkHead and neck, trunk

Site Specific TumorsSite Specific Tumors

ExtremitiesExtremitiesPapillary digital Papillary digital adenocarcinomaadenocarcinomaPapillary Papillary eccrineeccrine adenomaadenoma

AxillaeAxillaeApocrineApocrine carcinomacarcinoma

Vulva and PerineumVulva and PerineumHidradenomaHidradenoma papilliferumpapilliferumExtramammaryExtramammary Paget’sPaget’s diseasediseaseDuctopapillaryDuctopapillary apocrineapocrine carcinomacarcinoma

Clues to Underlying DiseaseClues to Underlying Disease

GenodermatosisGenodermatosisTurban TumorTurban TumorAncellAncell--SpieglerSpiegler syndromesyndromeCowden’s syndromeCowden’s syndromeMuirMuir--TorreTorre syndromesyndrome

Clear cell Clear cell syringomasyringoma

Potential MultiplicityPotential Multiplicity

CylindromaCylindroma (Turban tumor syndrome)(Turban tumor syndrome)SyringomaSyringomaPoromaPoromaTrichoepitheliomaTrichoepitheliomaTrichilemmomaTrichilemmoma (Cowden’s syndrome)(Cowden’s syndrome)Sebaceous tumors (MuirSebaceous tumors (Muir--TorreTorre syndrome)syndrome)

Childhood TumorsChildhood Tumors

SyringomaSyringomaSyringocystadenomaSyringocystadenoma papilliferumpapilliferumPoromaPoromaCylindromaCylindromaPilomatrixomaPilomatrixomaTrichoepitheliomaTrichoepithelioma

HistopathologicHistopathologic CategoriesCategories

EccrineEccrineFollicularFollicularSebaceousSebaceousApocrineApocrineMixedMixed

Sweat Gland Sweat Gland NeoplasmsNeoplasms ((EccrineEccrine))

CylindromaCylindromaSpiradenomaSpiradenomaAcrospiromaAcrospiromaSyringomaSyringomaHidrocystomaHidrocystomaPoromaPoromaMixed tumorMixed tumorPapillary Papillary eccrineeccrine adenomaadenomaSyringofibroadenomaSyringofibroadenoma

Clues to Clues to EccrineEccrine TumorsTumors

DuctalDuctal or tubular differentiationor tubular differentiationTubules not lined by Tubules not lined by corneocytescorneocytes in in crenulated pattern (sebaceous ducts)crenulated pattern (sebaceous ducts)Not lined by cells with decapitation secretion Not lined by cells with decapitation secretion

Follicular Follicular NeoplasmsNeoplasmsLocationLocation BenignBenign MalignantMalignant

Outer Hair sheathOuter Hair sheath Tumor of the follicular Tumor of the follicular infundibuluminfundibulumPilarPilar sheath sheath acanthomaacanthomaWiner’sWiner’s poreporeTrichoadenomaTrichoadenomaTrichilemmomaTrichilemmomaProliferating Proliferating pilarpilar tumortumor

TrichilemmalTrichilemmal carcinomacarcinomaMalignant proliferating Malignant proliferating pilarpilartumortumor

GermanitiveGermanitive epitheliumepithelium TrichofolliculomaTrichofolliculomaTrichoepitheliomaTrichoepitheliomaDesmoplasticDesmoplastic trichoepitheliomatrichoepitheliomaPilomatrixomaPilomatrixoma

TrichofollicularTrichofollicular carcinomacarcinomaTrichoepithelialTrichoepithelial carcinomacarcinomaPilomatrixPilomatrix carcinomacarcinoma

Mixed epithelium and Mixed epithelium and mesenchymemesenchyme

BasaloidBasaloid follicular follicular hamartomahamartomaTrichoblastomaTrichoblastoma

PilarPilar mesenchymemesenchyme TrichodiscomaTrichodiscomaPerifollicularPerifollicular fibromafibromaFibrofolliculomaFibrofolliculomaFollicular Follicular myxomamyxomaLeiomyomaLeiomyoma

Clues to Follicular Clues to Follicular NeoplasmsNeoplasms

Recapitulate Hair FolliclesRecapitulate Hair FolliclesFollicular bulb and papillaFollicular bulb and papillaMatricalMatrical cellscellsShadow cellsShadow cellsTrichohyalinTrichohyalin granulesgranules

Sebaceous Sebaceous NeoplasmsNeoplasms

HyperplasiasHyperplasiasSenileSenilePrematurePrematureNevus Nevus sebaceussebaceus of of JadassohnJadassohn

BenignBenignSebaceous adenomaSebaceous adenomaBasosebaceousBasosebaceous epitheliomaepitheliomaSuperficial Superficial epitheliomaepithelioma with sebaceous differentiationwith sebaceous differentiationSebaceomaSebaceoma

MalignantMalignantOcular sebaceous carcinomaOcular sebaceous carcinomaExtraocularExtraocularCarcinoma with mixed Carcinoma with mixed adnexaladnexal differentiationdifferentiation

Clues to Sebaceous Clues to Sebaceous NeoplasmsNeoplasms

SebocytesSebocytes or tubule resembling sebaceous or tubule resembling sebaceous ductductHolocrineHolocrine secretionsecretion

ApocrineApocrine NeoplasmsNeoplasms

HidrocystomaHidrocystomaTubular adenomaTubular adenomaSyringocystadenomaSyringocystadenoma papilliferumpapilliferumHidradenomaHidradenoma papilliferumpapilliferumExtramammaryExtramammary Paget’sPaget’s diseasedisease

Clues to Clues to ApocrineApocrine NeoplasmsNeoplasms

DuctalDuctal changes with changes with apocrineapocrine snoutingsnouting(decapitation secretion)(decapitation secretion)

Mixed Mixed NeoplasmsNeoplasms

MicrocysticMicrocystic adnexaladnexal carcinomacarcinomaLymphoepitheliomaLymphoepithelioma--like carcinoma of the like carcinoma of the skinskinMalignant mixed tumorsMalignant mixed tumors

HistologicHistologic Clues for Clues for Benign vs. MalignantBenign vs. Malignant

BenignBenign MalignantMalignantVertically orientedVertically oriented Horizontally orientedHorizontally orientedBorders smoothBorders smooth Borders infiltrativeBorders infiltrativeCytologicallyCytologically blandbland CytologicallyCytologically atypicalatypicalMitotic figures usually Mitotic figures usually scarcescarce

Mitotic figures usually Mitotic figures usually abundantabundant

LymphovascularLymphovascular invasion invasion absentabsent

LymphovascularLymphovascular invasion invasion may be may be presentpresent

Treatment for CarcinomasTreatment for Carcinomas

Wide excision Wide excision Physical examination to rule out lymph Physical examination to rule out lymph node metastasisnode metastasisSentinel lymph node?Sentinel lymph node?

Digital Papillary Digital Papillary AdenocarcinomaAdenocarcinomaEccrineEccrine carcinomascarcinomas

PrognosisPrognosis

Skin to skin metastasesSkin to skin metastasesPorocarcinomasPorocarcinomasSebaceous carcinomaSebaceous carcinoma

Regional Lymph node metastasisRegional Lymph node metastasisLung, liver, bone metastasisLung, liver, bone metastasis