BACKGROUND: Seventy-one cases of scar-related and spontaneous endometriosis of the skin and superficial soft tissue were studied, with a focus on atypical features and types of müllerian differentiation. All patients were women, whose ages ranged from 22 to 65 years (median, 32 years). METHODS: Histological, immunohistochemical, and electronmicroscopic studies were performed. Clinical information was ascertained via a questionnaire solicited by the referring physicians. RESULTS: All types of metaplastic changes of müllerian epithelium were found, including tubal (61%), oxyphilic (15%), hobnail (10%), mucinous (4%), and papillary syncytial (3%) metaplasia. Atypical features included reactive atypia (23%) and atypical mitoses in glandular epithelium (6%). Stromal changes included smooth muscle metaplasia (31%), decidualization (<1%), stromal endometriosis (<1%), and elastosis (<1%). Other features recognized included lipoblast-like cells (15%), some with intranuclear inclusions; atypical/degenerative myocytes (10%); spiral arteries (4%); and perineurial invasion (<1%). CD56 staining identified large granular lymphocytes in 15 of 20 studied specimens. Ultrastructurally, these cells showed cytoplasmic granules, some with a delimiting membrane. LIMITATIONS: This study utilizes tissue specimens that mainly were received as consultations; therefore some inherent selection bias exists. Specimens were randomly selected for CD56 immunostaining, leading also to potential sampling error. CONCLUSIONS: All types of müllerian metaplasia can be encountered in cutaneous endometriosis. In addition, so-called atypical features described in endometriosis affecting other anatomic sites may be seen in the skin. Some features may represent a diagnostic pitfall.
- MeSH
- antigen CD56 analýza MeSH
- chirurgie operační škodlivé účinky MeSH
- dospělí MeSH
- elektronová mikroskopie MeSH
- endometrióza patologie MeSH
- epitel patologie MeSH
- imunohistochemie MeSH
- jizva patologie MeSH
- kožní nemoci patologie MeSH
- kůže patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metaplazie patologie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- mnohočetné primární nádory chirurgie patologie MeSH
- nádory hlavy a krku chirurgie patologie MeSH
- nádory mazových žláz chirurgie patologie MeSH
- névus chirurgie patologie MeSH
- sebaceózní adenokarcinom chirurgie patologie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Tubular adenoma (TA) and syringocystadenoma papilliferum (SCAP) may show histopathological overlap, with some lesions having features of both neoplasms (SCAP + TA). TA has been recently suggested to represent a carcinoma. Four observers blindly assessed 67 cases of TA, SCAP, and their lookalikes (poroma, apocrine adenoma, apocrine carcinoma; all lesions focally featuring a pseudopapillary pattern), and classified the lesions into one of four categories: (1) TA, (2) SCAP, (3) SCAP + TA, and (4) others. Lesions were also classified as benign or malignant. In only 29 cases was there unanimous agreement among the four observers, who classified 22 lesions as TA, three as SCAP, and four cases as others. Of the 38 cases where there was interobserver diagnostic variation, in 30, the diagnosis varied between TA or SCAP or SCAP + TA; the remainder fell in the others category. Analysis of the factors leading to interobserver variability indicated that diagnostic problems occurred when there were any of the following: epidermal acanthosis, papillomatosis, connection of the neoplastic tubules to the overlying epidermis and/or follicular infundibula, and plasma cell infiltration. These features accounted for the morphological overlap between TA and SCAP. All observers agreed that the lesions were benign; the only apocrine carcinoma included was recognized as such by all observers. From the study, it was concluded that TA may arise in the deep dermis without any epidermal connection, or, in other cases, it may be more superficially located with or without an epidermal connection. It may be reasonably inferred that, possibly as a response to infection, there may be accompanying plasma cells and variable acanthosis and papillomatosis, such that the appearances are those of "pure" SCAP, or lesions may have features "intermediate" or overlapping between TA and SCAP.
- MeSH
- adenom potní žlázy diagnóza klasifikace MeSH
- cystadenom diagnóza klasifikace MeSH
- dermatologie metody MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mnohočetné primární nádory diagnóza MeSH
- nádory potních žláz diagnóza klasifikace MeSH
- odchylka pozorovatele MeSH
- patologie metody MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- multicentrická studie MeSH
To test the hypothesis of whether cellular blue nevi (CBN) may originate from "ordinary" compound and dermal nevi, a total of 275 melanocytic nevi including 59 CBN, 34 ordinary blue nevi, 87 combined nevi (including 43 so-called clonal nevi), 35 deep penetrating nevi, and 60 ordinary compound and dermal nevi (30 of each) were studied for the presence of so-called ball-in-mitts and microalveolar structures. A ball-in-mitts structure was defined as a single centrally placed melanocyte with a round to oval nucleus (the "ball" cell) and a clear, dusty, or pigmented cytoplasm encircled by a single dendritic cell (the "mitt" cell) with an oval to spindle-shaped nucleus and slender bipolar processes containing melanin and surrounding at least one fourth of the ball's diameter. A microalveolar structure was defined as a group of 2 to 10 centrally placed melanocytes with round to oval nuclei and clear, dusty, or pigmented cytoplasm (balls) surrounded by one or more cells (mitts) with spindle-shaped nuclei and slender bipolar processes containing melanin. Microscopically, ball-in-mitt and microalveolar structures were detected in all types of nevi studied, with the highest incidence in combined nevi (82%), CBN (76%), and ordinary "nonblue" nevi (73%). In CBN, ball-in-mitts and microalveolar structures tended to be located in the deeper portion of the lesions, whereas in ordinary nonblue nevi, they were most often found superficially, just below the epidermis; in clonal nevi, these structures were often confined to the "clonal" parts. Immunohistochemically, ball-in-mitts and microalveolar structures were positive for HMB45. Ultrastructurally, the balls tended to have round to oval nuclei, whereas the mitts possessed oval, elongated to spindled nuclei. Melanosomes were found in various stages in the cells of both structures. The cytoplasm of the mitts typically formed elongated polar processes, sometimes with club-like widenings at the ends, completely or partially encircling the balls. In the microalveolar structures, the adjacent cells forming the mitts surrounded the ball cells like a chain. Our study suggests that some or even most cases of CBN may evolve from ordinary nonblue nevi. This process may involve several steps and is probably reflected by the appearances of combined nevi, deep penetrating nevi, and CBN. These nevi often show a morphological overlap, and ball-in-mitts and microalveolar structures found in various stages of their development seem to greatly account for this overlap.
- MeSH
- antigeny nádorové MeSH
- buněčné jádro patologie ultrastruktura MeSH
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- melanocyty patologie MeSH
- mladiství MeSH
- modrý névus etiologie metabolismus patologie MeSH
- nádorové proteiny metabolismus MeSH
- nádory kůže etiologie metabolismus patologie MeSH
- névus patologie MeSH
- pigmentový névus etiologie metabolismus patologie MeSH
- předškolní dítě MeSH
- progrese nemoci MeSH
- regulace genové exprese u nádorů MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
Pleomorphic hyalinizing angiectatic tumor (PHAT) of the soft tissue is a rare distinctive tumor listed as a benign neoplasm in the new World Health Organization classification. It may recur and most reported recurrent tumors retained the typical morphological appearance of PHAT; rare tumors recurred with the appearance of a sarcoma. Reported herein is an additional example of recurrent PHAT, but in contrast to the previously described cases the present tumor morphologically qualified as a sarcoma from the very beginning; it recurred as a high-grade myxofibrosarcoma. A 76-year-old woman presented with a solitary subcutaneous tumor in the axilla that was surgically removed. Seven months later, the patient experienced a local recurrence. Microscopically, the typical features of PHAT were identified in the initial lesion, namely hyalinized, fibrin-containing vessels and pleomorphic stromal cells; there were areas of hemorrhage and necrosis. Additionally, peripherally located areas of the tumor manifested highly pleomorphic cells with frequent atypical mitoses, producing a sarcomatous appearance. The mitotic index in the sarcomatous part was 1/10 high-power fields (HPF). Hyalinized, fibrin-containing vessels were absent in these sarcomatous areas, and the stroma was myxoid. The recurrent lesion was composed of large highly pleomorphic oval, round, spindled or bizarre cells with a high mitotic rate, ranging from 3/10 HPF to 7/10 HPF. The neoplastic cells were arranged haphazardly in a myxoid matrix. Hyalinized, fibrin-containing vessels typical for PHAT were absent. PHAT may be more aggressive than previously thought, and PHAT may encompass a morphological spectrum of the lesion ranging from benign to malignant.
- MeSH
- dermatofibrosarkom patologie MeSH
- fibrin metabolismus MeSH
- hyalin metabolismus MeSH
- kůže krevní zásobení metabolismus patologie MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- nádory kůže patologie MeSH
- nekróza MeSH
- sarkom metabolismus patologie MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Skin adnexal type tumors situated in the parenchyma of the breast are very rare. We report herein a case of solid-cystic hidradenoma of the breast. The tumor was situated in the parenchyma of the breast of a 55-year-old female and showed no connection to the overlying skin on ultrasound and radiology investigations, grossly and microscopically. Histologically, the tumor was identical to its cutaneous counterpart and was surrounded by breast tissue. The neoplasm was composed of solid and cystic areas. The cystic component, which predominated in the lesion, was filled with homogeneous eosinophilic material. The solid component consisted of several nodules with vague lobulated architecture protruding into the cystic spaces. The nodules were composed of cuboidal monomorphous cells that were continuous with larger polygonal cells and rare, large mucinous cells with basophilic granular cytoplasm. Several mammary ducts in close proximity to the tumor showed features of columnar cell hyperplasia. A 120-bp METC1/MAML2 fusion transcript was identified by RT-PCR and subsequent sequencing technique. This t(11;19) translocation has been reported in approximately 50% of hidradenomas of the skin.
- MeSH
- adenom potní žlázy diagnóza genetika patologie MeSH
- financování organizované MeSH
- fúzní onkogenní proteiny genetika metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- lidské chromozomy, pár 11 MeSH
- lidské chromozomy, pár 19 MeSH
- nádory prsu diagnóza genetika patologie MeSH
- prsy metabolismus patologie MeSH
- regulace genové exprese u nádorů MeSH
- translokace genetická genetika MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Presented here are three cutaneous sebaceous tumors (one carcinoma and two sebaceomas), each demonstrating a focal glandular pattern representing apocrine differentiation. The patients, two males and one female, each clinically presented with a small solitary nodule or tumor on the scalp. None of the patients had features of Muir-Torre syndrome. Surgical removal of the lesions was performed in all cases. None of the patients developed recurrence or metastasis after surgery (follow-up ranged from 18 to 24 months). The glandular areas represented a minor but significant component of the lesions and appeared as glands of various complexity, mostly as simple round or elongated tubular structures lined by a row of cuboidal to columnar cells with eosinophilic cytoplasm and round nuclei, with or without a distinct nucleolus. Decapitation secretion was evident but not prominent. In both sebaceomas, at least a portion of the glands had a peripheral small-cell layer that appeared similar to the basal/myoepithelial cells of normal eccrine and apocrine ducts. In some glands, the basal/myoepithelial cells seemed to have undergone hyperplasia, resulting in two or more rows of cells that even formed small islands, with an overall appearance reminiscent of basal cell hyperplasia in the prostate, arising in the basal layer of the prostatic glands. The descriptive terms seboapocrine carcinoma or seboapocrine sebaceoma are proposed for such lesions. These tumors may be viewed as rare histopathological variants of sebaceous carcinoma and sebaceoma, with a second type of differentiation along the lines of the folliculosebaceous-apocrine unit.
- MeSH
- apokrinní žlázy patologie MeSH
- buněčné jadérko ultrastruktura MeSH
- buněčné jádro ultrastruktura MeSH
- cytoplazma ultrastruktura MeSH
- dospělí MeSH
- hyperplazie MeSH
- karcinom patologie MeSH
- lidé MeSH
- myocyty hladké svaloviny patologie MeSH
- nádory mazových žláz patologie MeSH
- následné studie MeSH
- sebum MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- skalp patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
