Prasad Vikram, Kao Wynn H, Kao Grace F
Department of Dermatology, The George Washington University School of Medicine, Washington, DC, USA.
Department of Dermatology, University of Maryland School of Medicine, Baltimore, USA.
Cutis. 2016 Dec;98(6):E16-E19.
Primary cutaneous apocrine carcinomas are uncommon malignant neoplasms that can be difficult, if not impossible, to distinguish histologically from metastatic breast carcinomas. We present the case of a 71-year-old man with a 5-year history of extensive ulcerated plaques on the posterior neck and posterior scalp. Biopsy revealed a poorly differentiated infiltrating adenocarcinoma consistent with either primary cutaneous apocrine carcinoma or occult metastatic breast carcinoma. Immunohistochemical analysis demonstrated positive staining for cytokeratin (CK) 7, estrogen receptor, and progesterone receptor, and negative staining for p63, podoplanin, CK20, and thyroid transcription factor 1. Extensive radiologic imaging studies showed no evidence of occult breast or other internal malignancies. Based on the indolent clinical course, lack of evidence for an internal primary site, and immunohistochemical staining, the lesion was determined to be consistent with a cutaneous neoplasm with features of apocrine differentiation. This case highlights the distinction between apocrine carcinoma and other primary adnexal carcinomas for which p63 and D2-40 have been reported to be sensitive and specific markers but are negative in apocrine carcinomas.
原发性皮肤大汗腺癌是一种罕见的恶性肿瘤，在组织学上即使并非不可能，也很难与转移性乳腺癌相区分。我们报告一例71岁男性病例，其颈部后方和头皮后方有广泛溃疡斑块，病史5年。活检显示为低分化浸润性腺癌，与原发性皮肤大汗腺癌或隐匿性转移性乳腺癌相符。免疫组织化学分析显示细胞角蛋白（CK）7、雌激素受体和孕激素受体呈阳性染色，而p63、足板蛋白、CK20和甲状腺转录因子1呈阴性染色。广泛的放射影像学检查未发现隐匿性乳腺癌或其他内部恶性肿瘤的证据。基于惰性的临床病程、缺乏内部原发部位的证据以及免疫组织化学染色，该病变被确定与具有大汗腺分化特征的皮肤肿瘤相符。本病例突出了大汗腺癌与其他原发性附属器癌之间的区别，据报道p63和D2-40是后者敏感且特异的标志物，但在大汗腺癌中呈阴性。
