Johnson Gina, Gardner Jerad M, Shalin Sara C
University of Arkansas for Medical Science, Department of Pathology, Little Rock, Arkansas.
J Cutan Pathol. 2017 Aug;44(8):698-702. doi: 10.1111/cup.12962. Epub 2017 Jun 13.
Polarizable calcium oxalate (CaOx) crystals have been well documented in breast biopsies, generally associated with benign apocrine metaplasia. In contrast, polarizable crystals are only rarely reported in skin adnexal neoplasms. We report 3 different cases of sweat gland tumors with polarizable crystals morphologically suggestive of CaOx: 1 apocrine hidrocystoma and 2 tubular apocrine adenomas. The histologic features were examined in 3 cases. Clinical presentation summary included 2 males and 1 female, ages 53 to 74 years, with lesions located on the left cheek, inferior vertex scalp and the left eyebrow. All 3 cases showed polarizable, geometric, plate-like and fractured, colorless crystals within the lumens of the neoplasm. Of note, these crystals were seen only on the toluidine blue-stained section of Case #1, but were not present on the corresponding permanent section. We hypothesize that polarizable crystals may be present in sweat gland neoplasms more often than previously documented, but that they may often dissolve with routine processing, accounting for their rare visibility. We highlight this rare finding, and suggest that it may be underreported. We only noted this finding in benign apocrine tumors; further investigation would be necessary to determine whether these crystals are also seen in other cutaneous adnexal neoplasms.
可极化草酸钙（CaOx）晶体在乳腺活检中已有充分记录，通常与良性大汗腺化生有关。相比之下，可极化晶体在皮肤附属器肿瘤中仅有罕见报道。我们报告了3例不同的汗腺肿瘤病例，其具有形态学上提示CaOx的可极化晶体：1例大汗腺囊瘤和2例管状大汗腺腺瘤。对这3例病例的组织学特征进行了检查。临床表现总结包括2名男性和1名女性，年龄在53至74岁之间，病变分别位于左脸颊、头顶下部头皮和左眉处。所有3例病例在肿瘤管腔内均显示有可极化、几何形状、板状且破碎的无色晶体。值得注意的是，这些晶体仅在病例1的甲苯胺蓝染色切片上可见，而在相应的永久切片上不存在。我们推测，可极化晶体在汗腺肿瘤中的出现可能比以前记录的更为常见，但它们可能经常在常规处理过程中溶解，这解释了它们罕见的可见性。我们强调这一罕见发现，并表明它可能未被充分报道。我们仅在良性大汗腺肿瘤中注意到这一发现；有必要进一步研究以确定这些晶体是否也见于其他皮肤附属器肿瘤。
