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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
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