Petersson Fredrik, Nga Min En
Department of Pathology, National University Health System, Singapore.
J Cutan Pathol. 2012 Mar;39(3):372-6. doi: 10.1111/j.1600-0560.2011.01810.x. Epub 2011 Nov 12.
We present a patient with a 2-cm spiradenocarcinoma of the left arm resembling low-grade salivary gland basal cell adenocarcinoma. In addition to showing attributes of conventional spiradenoma, the benign component showed prominent areas of cystic change with focal apocrine differentiation, glands with and without mucinous differentiation, clear cell change and focal adenoid cystic carcinoma-like areas. The malignant component was composed of nodules of basaloid cells arranged in sheets with variable tendency to luminal differentiation. The nuclear atypia was low-grade, and the mitotic index was high in the malignant component (to 8/10 high power fields). Immunohistochemically, there was diffuse but variable positivity for cytokeratin 7 in both the benign and malignant components. Epithelial membrane antigen was focally positive, highlighting cells with ductal (luminal) differentiation. Expression of p63 was observed in 50 and 80% of the cells in the benign and malignant components, respectively. Calponin was negative. The proliferative index (MIB-1/Ki-67) was <3% in the benign component and up to 10% in the malignant component. Although the malignant component displayed patchy areas with nuclear p53 immunoreactivity with variable intensity, no mutation in the TP53 gene was identified.
我们报告了一名患者，其左臂有一个2厘米的汗腺癌，类似于低级别涎腺基底细胞腺癌。除了表现出传统汗腺腺瘤的特征外，良性成分还显示出明显的囊性变区域，伴有局灶性大汗腺分化、有或无黏液分化的腺体、透明细胞改变以及局灶性腺样囊性癌样区域。恶性成分由基底样细胞结节组成，呈片状排列，具有不同程度的向管腔分化的倾向。核异型性为低级别，恶性成分中的有丝分裂指数较高（每10个高倍视野中有8个）。免疫组织化学显示，良性和恶性成分中细胞角蛋白7均呈弥漫性但程度不一的阳性。上皮膜抗原局灶性阳性，突出显示具有导管（管腔）分化的细胞。p63在良性和恶性成分中的细胞表达率分别为50%和80%。钙调蛋白阴性。良性成分的增殖指数（MIB-1/Ki-67）<3%，恶性成分中高达10%。尽管恶性成分显示出核p53免疫反应性强度不一的斑片状区域，但未发现TP53基因的突变。
