Wick M R, Cooper P H, Swanson P E, Kaye V N, Sun T T
Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis.
Arch Dermatol. 1990 Feb;126(2):189-94. doi: 10.1001/archderm.126.2.189.
Since its initial description, microcystic adnexal carcinoma (MAC) of the skin has been controversial. In particular, it features keratin production of the type seen in some pilar neoplasms , and has been thought to pursue partial follicular differentiation. Diagnostically, MAC may be difficult to separate from desmoplastic trichoepithelioma (DTE) in superficial biopsy specimens. We studied 12 MACs, 22 malignant eccrine acrospiromas, 7 sudoriferous syringometaplasias, 6 syringomas, 5 DTEs, and 40 other benign pilar neoplasms immunohistochemically. Paraffin sections and antibodies to "hard" (pilar) keratins. epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), Leu-M1, and S100 protein were employed. The MACs exhibited reactivity for hard keratin subclasses AE 13 and AE 14, EMA, CEA, and Leu-M1. Desmoplastic trichoepitheliomas expressed positivity for AE 14, EMA, and Leu-M1 focally, but lacked the other specified markers. Syringomas and malignant acrospiromas displayed EMA, CEA, and AE 14 reactivity, and 5 syringometaplastic lesions were AE 14-reactive. Benign pilar tumors aside from DTEs were reactive only for AE 13, AE 14, or both. These data indicate that MAC exhibits an immunophenotype that is a "hybrid" of those seen in pure sweat glandular and follicular neoplasms, and suggest that it may indeed show combined pilar and sudoriferous differentiation. Based on these results, it also appears that immunohistochemical analysis may be useful in the diagnostic separation of MAC and DTE.
自首次被描述以来，皮肤微囊性附属器癌（MAC）一直存在争议。特别是，它具有一些毛发肿瘤中所见类型的角蛋白生成，并被认为具有部分毛囊分化。在诊断方面，在浅表活检标本中，MAC可能难以与促结缔组织增生性毛发上皮瘤（DTE）区分开来。我们对12例MAC、22例恶性小汗腺末端螺旋瘤、7例汗腺导管化生、6例汗管瘤、5例DTE以及40例其他良性毛发肿瘤进行了免疫组织化学研究。采用石蜡切片以及针对“硬”（毛发）角蛋白、上皮膜抗原（EMA）、癌胚抗原（CEA）、Leu-M1和S100蛋白的抗体。MAC对硬角蛋白亚类AE 13和AE 14、EMA、CEA和Leu-M1呈阳性反应。促结缔组织增生性毛发上皮瘤局部表达AE 14、EMA和Leu-M1阳性，但缺乏其他特定标志物。汗管瘤和恶性末端螺旋瘤显示EMA、CEA和AE 14阳性反应，5例汗腺导管化生病变呈AE 14阳性反应。除DTE外的良性毛发肿瘤仅对AE 13、AE 14或两者呈阳性反应。这些数据表明，MAC表现出一种免疫表型，是纯汗腺和毛囊肿瘤中所见免疫表型的“混合体”，并提示它可能确实表现出毛发和汗腺的联合分化。基于这些结果，免疫组织化学分析似乎也有助于MAC和DTE的诊断鉴别。
