Kazakov Dmitry V, Kacerovska Denisa, Skalova Alena, Zelger Bernhard, Schaller Jörg, Shelekhova Ksenia, Michal Michal
Sikl's Department of Pathology, Charles University Medical Faculty Hospital, Pilsen, Czech Republic.
Am J Dermatopathol. 2011 Dec;33(8):775-9. doi: 10.1097/DAD.0b013e31820b7b9c.
Apocrine mixed tumor of the skin is a benign adnexal neoplasm usually posing no diagnostic problem for a histopathologist. The purpose of our investigation is to present a small series of 4 benign cutaneous apocrine mixed tumors of the skin that contained small foci of intravascular tumor deposits, a feature not previously described, to the best of our knowledge. The 4 lesions were identified retrospectively after a review of 312 apocrine mixed tumors and 51 eccrine mixed tumors in the collective files of the authors. In all cases, this feature was originally overlooked. The patients were 3 men and 1 woman, ranging in age at diagnosis from 29 to 66 years. Locations included nose (2), forehead (1), and the fifth toe (1). Histopathologically, all 4 neoplasms demonstrated typical features of a benign apocrine mixed tumor; 2 cases were classified as hyaline cell-rich tumors. In all cases, there were either blood or lymphatic vessels containing small intraluminal collections of neoplastic cells, which had the appearances of hyaline cells and immunohistochemically expressed cytokeratins and were partly immunoreactive for S-100 protein and calponin, thus indicating the myoepithelial phenotype. The intravascular location of the neoplastic cells was confirmed by CD31 staining. The nature of the vessels (lymphatics vs. blood vessels) was supported by staining for alpha smooth muscle actin, which stained pericytes in blood vessels. Lymphatic vessels were also stained for D2-40. No eccrine mixed tumor manifested intravascular tumor deposits. Follow-up of the patients revealed no recurrences or metastasis (range: 2-21 years). It is concluded that occurrence of intravascular involvement in benign apocrine mixed tumor of the skin is rare (approximately 1%-2%). This feature is discrete and is easy to overlook. At present, its significance is not completely clear. Until proved otherwise in future, we suggest to consider intravascular deposits in cutaneous apocrine mixed tumors as an innocuous phenomenon.
皮肤大汗腺混合瘤是一种良性附属器肿瘤，通常对组织病理学家来说不存在诊断问题。据我们所知，我们此次研究的目的是报告一小系列4例皮肤良性大汗腺混合瘤，这些肿瘤含有血管内肿瘤沉积的小病灶，这一特征此前未曾描述过。在回顾作者的综合档案中312例大汗腺混合瘤和51例小汗腺混合瘤后，对这4个病变进行了回顾性鉴定。在所有病例中，这一特征最初都被忽视了。患者为3名男性和1名女性，诊断时年龄在29至66岁之间。病变部位包括鼻子（2例）、前额（1例）和第五趾（1例）。组织病理学上，所有4例肿瘤均表现出良性大汗腺混合瘤的典型特征；2例被分类为富含透明细胞的肿瘤。在所有病例中，均有血管或淋巴管内含有小的腔内肿瘤细胞团，这些细胞团呈透明细胞外观，免疫组化表达细胞角蛋白，部分对S-100蛋白和平滑肌肌动蛋白呈免疫反应，从而表明其肌上皮表型。肿瘤细胞的血管内位置通过CD31染色得以证实。α平滑肌肌动蛋白染色支持血管的性质（淋巴管与血管），其可使血管周细胞染色。淋巴管也用D2-40染色。没有小汗腺混合瘤表现出血管内肿瘤沉积。对患者的随访显示无复发或转移（范围：2至21年）。结论是皮肤良性大汗腺混合瘤中血管内受累情况罕见（约1%-2%）。这一特征不明显，容易被忽视。目前，其意义尚不完全清楚。在未来未被证明相反情况之前，我们建议将皮肤大汗腺混合瘤中的血管内沉积视为一种无害现象。
