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A case of eccrine porocarcinoma: usefulness of immunostain for s-100 protein in the diagnoses of recurrent and metastatic dedifferentiated lesions.

Kurisu Y, Tsuji M, Yasuda E, Shibayama Y - Ann Dermatol (2013)

Bottom Line: Three months later, metastasis to the lungs was found.Nevertheless, scattered immunoreactive cells for S-100 protein were maintained in these dedifferentiated lesions.S-100 protein positive cells could be an aid to diagnose, even if histologic findings of recurrent and metastatic lesions have changed by dedifferentiation.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Osaka Medical College, Takatsuki, Japan.

ABSTRACT
Eccrine porocarcinoma is a rare malignant tumor. Immunostain for S-100 protein, in addition to epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA), is described to be useful in the diagnosis. Herein, we report a case of eccrine porocarcinoma with immunostain for S-100 protein which was useful in diagnoses of recurrent and metastatic lesions. The primary lesion in the left inguinal region was excised, but it recurred on the same site 14 months after the resection. The recurrent lesion showed epithelioid melanocytic findings. Three months later, metastasis to the lungs was found. Since these recurrent and metastatic lesions were dedifferentiated, typical histologic findings of eccrine porocarcinoma disappeared in biopsied specimens. Nevertheless, scattered immunoreactive cells for S-100 protein were maintained in these dedifferentiated lesions. S-100 protein positive cells could be an aid to diagnose, even if histologic findings of recurrent and metastatic lesions have changed by dedifferentiation.

No MeSH data available.


Related in: MedlinePlus

Immunostain for S-100 protein reveals scattered positive cells in the primary lesion (×200).
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Figure 4: Immunostain for S-100 protein reveals scattered positive cells in the primary lesion (×200).

Mentions: A 78-year-old Japanese woman visited our hospital, complaining about the left inguinal skin tumor, increasing in size (Fig. 1). Since biopsy revealed the lesion is malignant, the dermal tumor was excised, and local lymphadenectomy was also performed. Neoplastic cells proliferated in lobular downwards growth, and connected to the epidermis (Fig. 2). The neoplastic cells have atypical oval nucleus, and mitotic figures were found. A small number of lumens were observed in the nests. Melanin granules were not found. Immunostain for carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA) is positive at the rims of the lumens (Fig. 3). Majority of the lesion was immunoreactive for AE1/AE3. On immunohistochemistry for S-100 protein, scattered stained dendritic cells were found (Fig. 4). On that for HMB-45 and Melan-A, scattered positive cells were found partially. Some tumor cells appeared to be periodic acid schiff (PAS) stain positive, and PAS-positive substance was digested by diastase. There was no nodal metastasis. According to these facts, the diagnosis of EPC was confirmed. After fourteen months, a tumor occurred in the same location. Epithelioid cells diffusely proliferated in the subcutaneous tissues (Fig. 5). The histology looked like epithelioid melanoma. Immunostain for CEA and EMA was negative, but immunoreactivity for AE1/AE3 was diffusely observed. Scattered S-100 protein positive cells were found (Fig. 6). But, immunoreactivity for Melan-A and HMB-45 disappeared. The cells contain no PAS-positive glycogen. Since the tumor location is same with that of the primary lesion, and the stainings for S-100 protein and AE1/AE3 between the two are similar, the lesion was diagnosed as recurrent EPC with dedifferentiation. Three months later, metastasis to the lungs was found. Biopsied specimens showed similar histologic findings of the secondary inguinal lesion, and the diagnosis of dedifferentiated metastatic EPC was made. Immunoreactivity for AE1/AE3 was diffusely observed, and scattered immunoreactive cells for S-100 protein were also maintained. Nevertheless, immunostains for EMA, HMB-45, and Melan-A were all negative. Two months later, the patient died for aggravation of general condition.


A case of eccrine porocarcinoma: usefulness of immunostain for s-100 protein in the diagnoses of recurrent and metastatic dedifferentiated lesions.

Kurisu Y, Tsuji M, Yasuda E, Shibayama Y - Ann Dermatol (2013)

Immunostain for S-100 protein reveals scattered positive cells in the primary lesion (×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756201&req=5

Figure 4: Immunostain for S-100 protein reveals scattered positive cells in the primary lesion (×200).
Mentions: A 78-year-old Japanese woman visited our hospital, complaining about the left inguinal skin tumor, increasing in size (Fig. 1). Since biopsy revealed the lesion is malignant, the dermal tumor was excised, and local lymphadenectomy was also performed. Neoplastic cells proliferated in lobular downwards growth, and connected to the epidermis (Fig. 2). The neoplastic cells have atypical oval nucleus, and mitotic figures were found. A small number of lumens were observed in the nests. Melanin granules were not found. Immunostain for carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA) is positive at the rims of the lumens (Fig. 3). Majority of the lesion was immunoreactive for AE1/AE3. On immunohistochemistry for S-100 protein, scattered stained dendritic cells were found (Fig. 4). On that for HMB-45 and Melan-A, scattered positive cells were found partially. Some tumor cells appeared to be periodic acid schiff (PAS) stain positive, and PAS-positive substance was digested by diastase. There was no nodal metastasis. According to these facts, the diagnosis of EPC was confirmed. After fourteen months, a tumor occurred in the same location. Epithelioid cells diffusely proliferated in the subcutaneous tissues (Fig. 5). The histology looked like epithelioid melanoma. Immunostain for CEA and EMA was negative, but immunoreactivity for AE1/AE3 was diffusely observed. Scattered S-100 protein positive cells were found (Fig. 6). But, immunoreactivity for Melan-A and HMB-45 disappeared. The cells contain no PAS-positive glycogen. Since the tumor location is same with that of the primary lesion, and the stainings for S-100 protein and AE1/AE3 between the two are similar, the lesion was diagnosed as recurrent EPC with dedifferentiation. Three months later, metastasis to the lungs was found. Biopsied specimens showed similar histologic findings of the secondary inguinal lesion, and the diagnosis of dedifferentiated metastatic EPC was made. Immunoreactivity for AE1/AE3 was diffusely observed, and scattered immunoreactive cells for S-100 protein were also maintained. Nevertheless, immunostains for EMA, HMB-45, and Melan-A were all negative. Two months later, the patient died for aggravation of general condition.

Bottom Line: Three months later, metastasis to the lungs was found.Nevertheless, scattered immunoreactive cells for S-100 protein were maintained in these dedifferentiated lesions.S-100 protein positive cells could be an aid to diagnose, even if histologic findings of recurrent and metastatic lesions have changed by dedifferentiation.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Osaka Medical College, Takatsuki, Japan.

ABSTRACT
Eccrine porocarcinoma is a rare malignant tumor. Immunostain for S-100 protein, in addition to epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA), is described to be useful in the diagnosis. Herein, we report a case of eccrine porocarcinoma with immunostain for S-100 protein which was useful in diagnoses of recurrent and metastatic lesions. The primary lesion in the left inguinal region was excised, but it recurred on the same site 14 months after the resection. The recurrent lesion showed epithelioid melanocytic findings. Three months later, metastasis to the lungs was found. Since these recurrent and metastatic lesions were dedifferentiated, typical histologic findings of eccrine porocarcinoma disappeared in biopsied specimens. Nevertheless, scattered immunoreactive cells for S-100 protein were maintained in these dedifferentiated lesions. S-100 protein positive cells could be an aid to diagnose, even if histologic findings of recurrent and metastatic lesions have changed by dedifferentiation.

No MeSH data available.


Related in: MedlinePlus