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Primary cutaneous apocrine gland carcinoma from areolar tissue in a male patient with gynecomastia: a case report.

Seo KJ, Kim JJ - J Cardiothorac Surg (2015)

Bottom Line: The mass had been present for more than eight years but had grown rapidly over the past few months.The mass was a well-encapsulated cystic lesion that contained old blood material, and there was no invasion into the surrounding tissue.Herein, we report an extremely rare chest wall mass unfamiliar to thoracic surgeons.

View Article: PubMed Central - PubMed

Affiliation: Departments of Hospital Pathology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, South Korea. ywacko@catholic.ac.kr.

ABSTRACT
Primary cutaneous apocrine gland carcinoma, which is a type of sweat gland carcinoma, is an extremely rare type of cancer. Clinical courses of this type of cancer usually progress slowly but can, occasionally, be associated with rapid progression. This case report describes a 53-year-old Korean man with primary cutaneous apocrine gland carcinoma that arose from an apocrine gland in the areola tissue. The patient visited our hospital because of a large, painful chest wall mass beneath the right nipple. The mass had been present for more than eight years but had grown rapidly over the past few months. The patient was initially diagnosed with a benign cystic mass, and we performed a wide excision with a clear margin and without lymph node dissection. The mass was a well-encapsulated cystic lesion that contained old blood material, and there was no invasion into the surrounding tissue. The final pathology showed that the mass was a primary cutaneous apocrine gland carcinoma that arose from the areola apocrine sweat gland, not from the breast parenchymal tissue. Herein, we report an extremely rare chest wall mass unfamiliar to thoracic surgeons.

No MeSH data available.


Related in: MedlinePlus

Microscopic findings show an intracystic papillary projection composed of some ill-defined tumor nests in the fibrotic wall, representing the in situ lesion of the tumor (black arrows, a, H&E, 10×). Note the invasive components (black arrowheads, a, H&E) adjacent to the in situ lesion (A 10×; inset, 100×). The tumor cells have abundant eosinophilic cytoplasm and vesicular nuclei with focal “apocrine-like” decapitation secretion (b, H&E, 400×), suggesting apocrine gland carcinoma
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Fig2: Microscopic findings show an intracystic papillary projection composed of some ill-defined tumor nests in the fibrotic wall, representing the in situ lesion of the tumor (black arrows, a, H&E, 10×). Note the invasive components (black arrowheads, a, H&E) adjacent to the in situ lesion (A 10×; inset, 100×). The tumor cells have abundant eosinophilic cytoplasm and vesicular nuclei with focal “apocrine-like” decapitation secretion (b, H&E, 400×), suggesting apocrine gland carcinoma

Mentions: A 53-year-old Korean man presented to our hospital with a painful, large, round chest wall mass beneath the right nipple measuring about 10 × 10 cm in size. The skin overlying the mass was reddish and hyper-pigmented. The mass had been present for more than 8 years but had grown rapidly over the past few months. There were no palpable lymph nodes and no other breast masses on physical exams. A chest CT showed no remarkable lymph nodes and a 9.3 × 6.7 cm, well-defined, thin-walled, cystic mass with some nodular enhancing lesions in the lateral wall of the mass. This suggested a benign soft tissue mass, such as a large epidermal inclusion cyst (Fig. 1). Because we considered the mass to be a benign cystic mass, we excised it without lymph node dissection. We were able to save the nipple because the mass was limited to the subcutaneous layer beneath the areolar tissue. The mass was a well-encapsulated cystic lesion that contained old blood material, and there was no gross invasion into the surrounding tissue. Microscopic examination revealed an intracystic papillary projection (focal area with papillary projection), representing in situ carcinomatous lesions with apocrine features. A microscopic focus of the invasive carcinoma was identified in the cystic wall adjacent to the in situ lesions (Fig. 2a). Tumor cells had abundant eosinophilic cytoplasm and vesicular hyperchromatic nuclei with focal decapitation secretion (Fig. 2b). Most tumor cells were located within the in situ lesions and in the papillary projections, and the tumor tissue focally invaded the cystic wall adjacent to the papillary projections. However, the tumor had not invaded the surrounding tissue, such as subcutaneous tissue, muscle, or dermis (Fig. 2). Serial sections of the whole resected specimen failed to show breast parenchymal tissues. Immunohistochemical study showed that the tumor cells were positive for cytokeratin AE1/AE3, gross cystic disease fluid protein (GCDFP)-15 (Fig. 3a, b), and estrogen and progesterone receptors (Fig. 3c, d). Based on these findings, the preliminary pathological diagnosis was carcinoma with apocrine features. Clinical evaluations, including positron emission tomography-computed tomography (PET-CT), chest CT, abdominal and pelvic CT, colonoscopy, and duodenoscopy, were performed in order to exclude other potential primary malignancies, and no other potential primary malignancy was identified. Based on these characteristic features, we diagnosed the tumor as primary cutaneous apocrine gland carcinoma (cribriform and cystic form). The postoperative course was uneventful, and at present, 36 months after the surgery, no recurrence or metastasis has been identified, and the patient has not received any adjuvant therapy.Fig. 1


Primary cutaneous apocrine gland carcinoma from areolar tissue in a male patient with gynecomastia: a case report.

Seo KJ, Kim JJ - J Cardiothorac Surg (2015)

Microscopic findings show an intracystic papillary projection composed of some ill-defined tumor nests in the fibrotic wall, representing the in situ lesion of the tumor (black arrows, a, H&E, 10×). Note the invasive components (black arrowheads, a, H&E) adjacent to the in situ lesion (A 10×; inset, 100×). The tumor cells have abundant eosinophilic cytoplasm and vesicular nuclei with focal “apocrine-like” decapitation secretion (b, H&E, 400×), suggesting apocrine gland carcinoma
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4562102&req=5

Fig2: Microscopic findings show an intracystic papillary projection composed of some ill-defined tumor nests in the fibrotic wall, representing the in situ lesion of the tumor (black arrows, a, H&E, 10×). Note the invasive components (black arrowheads, a, H&E) adjacent to the in situ lesion (A 10×; inset, 100×). The tumor cells have abundant eosinophilic cytoplasm and vesicular nuclei with focal “apocrine-like” decapitation secretion (b, H&E, 400×), suggesting apocrine gland carcinoma
Mentions: A 53-year-old Korean man presented to our hospital with a painful, large, round chest wall mass beneath the right nipple measuring about 10 × 10 cm in size. The skin overlying the mass was reddish and hyper-pigmented. The mass had been present for more than 8 years but had grown rapidly over the past few months. There were no palpable lymph nodes and no other breast masses on physical exams. A chest CT showed no remarkable lymph nodes and a 9.3 × 6.7 cm, well-defined, thin-walled, cystic mass with some nodular enhancing lesions in the lateral wall of the mass. This suggested a benign soft tissue mass, such as a large epidermal inclusion cyst (Fig. 1). Because we considered the mass to be a benign cystic mass, we excised it without lymph node dissection. We were able to save the nipple because the mass was limited to the subcutaneous layer beneath the areolar tissue. The mass was a well-encapsulated cystic lesion that contained old blood material, and there was no gross invasion into the surrounding tissue. Microscopic examination revealed an intracystic papillary projection (focal area with papillary projection), representing in situ carcinomatous lesions with apocrine features. A microscopic focus of the invasive carcinoma was identified in the cystic wall adjacent to the in situ lesions (Fig. 2a). Tumor cells had abundant eosinophilic cytoplasm and vesicular hyperchromatic nuclei with focal decapitation secretion (Fig. 2b). Most tumor cells were located within the in situ lesions and in the papillary projections, and the tumor tissue focally invaded the cystic wall adjacent to the papillary projections. However, the tumor had not invaded the surrounding tissue, such as subcutaneous tissue, muscle, or dermis (Fig. 2). Serial sections of the whole resected specimen failed to show breast parenchymal tissues. Immunohistochemical study showed that the tumor cells were positive for cytokeratin AE1/AE3, gross cystic disease fluid protein (GCDFP)-15 (Fig. 3a, b), and estrogen and progesterone receptors (Fig. 3c, d). Based on these findings, the preliminary pathological diagnosis was carcinoma with apocrine features. Clinical evaluations, including positron emission tomography-computed tomography (PET-CT), chest CT, abdominal and pelvic CT, colonoscopy, and duodenoscopy, were performed in order to exclude other potential primary malignancies, and no other potential primary malignancy was identified. Based on these characteristic features, we diagnosed the tumor as primary cutaneous apocrine gland carcinoma (cribriform and cystic form). The postoperative course was uneventful, and at present, 36 months after the surgery, no recurrence or metastasis has been identified, and the patient has not received any adjuvant therapy.Fig. 1

Bottom Line: The mass had been present for more than eight years but had grown rapidly over the past few months.The mass was a well-encapsulated cystic lesion that contained old blood material, and there was no invasion into the surrounding tissue.Herein, we report an extremely rare chest wall mass unfamiliar to thoracic surgeons.

View Article: PubMed Central - PubMed

Affiliation: Departments of Hospital Pathology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, South Korea. ywacko@catholic.ac.kr.

ABSTRACT
Primary cutaneous apocrine gland carcinoma, which is a type of sweat gland carcinoma, is an extremely rare type of cancer. Clinical courses of this type of cancer usually progress slowly but can, occasionally, be associated with rapid progression. This case report describes a 53-year-old Korean man with primary cutaneous apocrine gland carcinoma that arose from an apocrine gland in the areola tissue. The patient visited our hospital because of a large, painful chest wall mass beneath the right nipple. The mass had been present for more than eight years but had grown rapidly over the past few months. The patient was initially diagnosed with a benign cystic mass, and we performed a wide excision with a clear margin and without lymph node dissection. The mass was a well-encapsulated cystic lesion that contained old blood material, and there was no invasion into the surrounding tissue. The final pathology showed that the mass was a primary cutaneous apocrine gland carcinoma that arose from the areola apocrine sweat gland, not from the breast parenchymal tissue. Herein, we report an extremely rare chest wall mass unfamiliar to thoracic surgeons.

No MeSH data available.


Related in: MedlinePlus