Bujas Tatjana, Pavić Ivana, Lenicek Tanja, Mijić August, Kruslin Bozo, Tomas Davor
Department of Pathology, Karlovac General Hospital, Ljudevit Jurak Department of Pathology, Sestre milosrdnice University Hospital, Vinogradska cesta 29, HR-10000 Zagreb, Croatia.
Acta Dermatovenerol Croat. 2007;15(3):148-51.
Apocrine carcinomas represent a rare group of tumors with a potential for destructive local invasion, regional and distant metastases, and are equally common in both sexes. A case of a 79-year-old woman with axillary apocrine carcinoma associated with apocrine adenoma and apocrine gland hyperplasia is presented. To our knowledge, this is the first case diagnosed in a Caucasian and also the first case diagnosed in a female patient. Grossly, the tumor measured 3.2x1.5x1.2 cm and on cut section appeared granular, white to gray-tanned. Microscopically, the tumor was located in the dermis, poorly demarcated, focally necrotic with ulcerated overlying skin. It was predominantly composed of complex, closely packed tubuloglandular structures but in few areas papillary structures were also observed. The cells contained abundant eosinophilic, finely granular cytoplasm with pleomorphic nuclei and showed apocrine-like decapitation. The cytoplasm contained periodic acid Schiff diastase resistant granules. Mitoses were frequent and some were atypical. In one area, the tumor was lobular and composed of tubular structures lined with one layer of uniform cuboidal or columnar eosinophilic cells, indicating a pre-existing apocrine adenoma. Beneath the tumor, in the deep dermis and subcutaneous tissue, hyperplastic apocrine glands were also found. No additional therapy was used, and one year after the surgery the patient was alive and showed no signs of tumor spread. This and previously reported cases suggest that apocrine hyperplasia and apocrine adenoma may represent successive steps in the development of apocrine carcinoma.
顶泌汗腺癌是一组罕见的肿瘤，具有局部侵袭性、区域和远处转移的可能性，且男女发病率相当。本文报告一例79岁女性腋窝顶泌汗腺癌，伴有顶泌汗腺腺瘤和顶泌汗腺增生。据我们所知，这是首例在白种人中诊断出的病例，也是首例在女性患者中诊断出的病例。大体上，肿瘤大小为3.2×1.5×1.2 cm，切面呈颗粒状，颜色从白色到灰黄色。显微镜下，肿瘤位于真皮层，边界不清，局部坏死，表面皮肤溃疡。肿瘤主要由复杂、紧密排列的管状腺结构组成，但在少数区域也观察到乳头状结构。细胞含有丰富的嗜酸性、细颗粒状细胞质，核呈多形性，显示出顶泌汗腺样断头分泌。细胞质中含有耐高碘酸希夫淀粉酶颗粒。有丝分裂频繁，部分为非典型有丝分裂。在一个区域，肿瘤呈小叶状，由一层均匀的立方或柱状嗜酸性细胞内衬的管状结构组成，提示存在先前的顶泌汗腺腺瘤。在肿瘤下方的真皮深层和皮下组织中，也发现了增生的顶泌汗腺。未进行额外治疗，术后一年患者存活，未出现肿瘤扩散迹象。该病例及先前报道的病例表明，顶泌汗腺增生和顶泌汗腺腺瘤可能是顶泌汗腺癌发展过程中的连续阶段。
