phenylephrine-hydrochloride and Carcinoma--Skin-Appendage

We report a case of an extremely rare histologic combination of pilomatrix or pilomatrical carcinoma with admixed melanocytes within the same tumor mass. Pilomatrix carcinoma is a neoplasm of low-grade malignancy that is characterized by a tendency for recurrence but low risk of metastasis. A 77-year-old male presented with a nodule on the bridge of the nose that was excised. Histologically, it was typified by asymmetry and poor circumscription, the presence of several variably sized and shaped basaloid aggregations, and surface ulceration. The tumors were composed of pleomorphic basaloid cells with prominent nucleoli and frequent mitoses (some of which were atypical) accompanied by central areas with keratotic material, shadow cells, and foci of necrosis. In addition, intermingled with the pilomatrix carcinoma, several easily identified pigmented cells with dendritic processes were present singly and as small aggregates. There was no atypia associated with the melanocytic component. Immunohistochemistry revealed the CK14 to be positive mainly within the keratinizing and the squamous epithelial elements of the tumor. The melanocytic component was strongly immunoreactive for S100, melanoma cocktail (HMB45 and Melan-A), and microphthalmia transcription factor. Pilomatrix carcinoma with melanocytes should be distinguished from the conventional pilomatrixoma with pigmentation, melanocytic matricoma, melanoma, and pigmented basal cell carcinoma with matrical differentiation. Clinicians and pathologists should be aware of the occurrence of pilomatrix carcinoma with melanocytes because of its potential for diagnosis as melanoma. This peculiar lesion recapitulates the intimate relationship existing between matrical epithelium and melanocytes in the embryonal hair follicle or in the anagen stage of the hair cycle. It is possible that sun damage played a role in stimulating migration of melanocytes among matrical cells in this case.

Topics: Aged; Biopsy, Needle; Carcinoma, Skin Appendage; Diagnosis, Differential; Follow-Up Studies; Hair Diseases; Humans; Immunohistochemistry; Male; Melanocytes; Neoplasm Staging; Nose; Pilomatrixoma; Risk Assessment; Skin Neoplasms; Treatment Outcome

A case of Malignant Syringoma (syn. = Microcystic Adnexal Carcinoma, Sclerosing Swat Duct Carcinoma) of the nose in a 44 year old female patient is reported. The tumor had been misdiagnosed as a Rhinophyma some 20 years before and had thus been treated under cosmetic aspects. Besides the appearance, the patient did not suffer any complaints and was referred to the ENT-department of the Klinikum Hannover for cosmetic reasons. Histopathological examination after removal revealed a malignant syringoma, which, due to its extensive size and subepithelial growth pattern, made a complete ablation of the entire nose and the adjacent soft tissue of the face necessary. Pathohistologically cellular atypia, invasive growth pattern, perineural and perivascular infiltration was characteristic. Quantitative DNA anaylsis revealed a tumor with a diploid stem line and only few aneuploid cells. Malignant syringoma is a rare differential diagnosis of face skin tumors. The present case is discussed based on a review of the literature.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Skin Appendage; Diagnosis, Differential; Eyelid Neoplasms; Facial Neoplasms; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Rhinophyma; Sweat Gland Neoplasms; Syringoma; Time Factors

Topics: Aged; Biomarkers, Tumor; Carcinoma, Basal Cell; Carcinoma, Skin Appendage; Dermoscopy; Female; Humans; Metaplasia; Nose; Sweat Gland Neoplasms; Sweat Glands

Sclerosing sweat duct carcinoma (SSDC) in the nose, a rare occurrence with no specific symptoms, is frequently confused with rhinophyma or other inflammatory disease. In this report, we describe a 64-year-old woman who presented with a mass on her nasal dorsum for 1 year. Initially, the tumor had been misdiagnosed as a rhinophyma and followed-up for 1 year. She was referred due to a persistent nasal and neck mass. Deep incisional biopsy was performed to produce sufficient tissue and the histopathologic results showed SSDC. We performed wide local excision and reconstruction using radial forearm musculocutaneous free flaps with a costal cartilage framework followed by bilateral neck dissection. SSDC is seldom recognized and is frequently clinically confused with benign syringoma prior to pathologic diagnosis. Wide and deep incisional biopsy is necessary for the correct diagnosis and successful treatment of SSDC.

Topics: Carcinoma, Ductal; Carcinoma, Skin Appendage; Diagnostic Errors; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Neck; Nose; Rhinophyma; Rhinoplasty; Sweat Gland Neoplasms

Topics: Adipocytes; Biopsy, Needle; Carcinoma, Skin Appendage; Female; Follow-Up Studies; Humans; Immunohistochemistry; Middle Aged; Nose; Risk Assessment; Skin Neoplasms; Treatment Outcome