Requena L, Sánchez Yus E, Santa Cruz D J
Department of Dermatology, Hospital Universitario San Carlos, Universidad Complutense, Madrid, Spain.
Am J Dermatopathol. 1992 Jun;14(3):186-94. doi: 10.1097/00000372-199206000-00002.
Eight cases of apocrine (tubular branching lumina) type cutaneous mixed tumors with follicular and sebaceous differentiation are presented. All eight tumors arose on facial skin; six patients were male and two were female. The lesions showed a cystic or nodular clinical appearance and were surgically excised. Histopathological examination confirmed the diagnosis of apocrine type of cutaneous mixed tumor in each case. Follicular differentiation consisted of (a) keratinous cysts with infundibular keratinization (infundibular differentiation); (b) hair bulbs with papillary mesenchyma, matricial differentiation with basophilic, transitional, and shadow cells, trichohyaline granules, vellous hair shafts, and clear cells of the outer root sheath (anagen differentiation); and (c) epithelial columns composed of inner cells with plump oval nuclei and scant cytoplasm, and similar cells at the periphery that were arranged in a palisade, resembling the inferior segment of a normal hair follicle in telogen. Sebaceous differentiation was represented by mature sebaceous cells, either as single cells or as small islands, within epithelial tracts of the tumor. The proportion of the areas showing these different types of differentiation varied among lesions, but some follicular differentiation was always present, whereas three cases lacked sebaceous differentiation. Immunohistochemical analysis in three cases with respect to their eccrine or apocrine differentiation showed contradictory results as in a previously reported series of cutaneous mixed tumors. The presence of follicular and sebaceous differentiation in the apocrine (tubular branching lumina) type of cutaneous mixed tumor is a confirmation of the apocrine nature of this neoplasm as well as an expression of the common embryologic derivation of all elements of the folliculosebaceous-apocrine unit.
本文报告了8例具有毛囊和皮脂腺分化的大汗腺（管状分支管腔）型皮肤混合瘤。所有8例肿瘤均发生于面部皮肤；6例为男性，2例为女性。病变表现为囊性或结节性外观，均行手术切除。组织病理学检查证实每例均为大汗腺型皮肤混合瘤。毛囊分化包括：（a）具有漏斗部角化的角质囊肿（漏斗部分化）；（b）带有乳头间充质的毛球，具有嗜碱性、过渡性和影子细胞、毛透明颗粒、毳毛和外根鞘透明细胞的基质分化（生长期分化）；以及（c）由具有丰满椭圆形核和少量细胞质的内层细胞组成的上皮柱，周边有类似细胞呈栅栏状排列，类似于休止期正常毛囊的下段。皮脂腺分化表现为肿瘤上皮条索内的成熟皮脂腺细胞，可为单个细胞或小岛屿状。不同病变中显示这些不同类型分化的区域比例各不相同，但总是存在一些毛囊分化，而3例缺乏皮脂腺分化。3例关于其小汗腺或大汗腺分化的免疫组织化学分析结果与先前报道的一系列皮肤混合瘤一样相互矛盾。大汗腺（管状分支管腔）型皮肤混合瘤中毛囊和皮脂腺分化的存在证实了该肿瘤的大汗腺性质，也表达了毛囊皮脂腺-大汗腺单位所有成分共同的胚胎学起源。
