Diago Adrián, Requena Luis, Traves Víctor, Requena Celia
Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.
Department of Dermatology, Fundación Jiménez Díaz, Madrid, Spain; and.
Am J Dermatopathol. 2020 Feb;42(2):122-124. doi: 10.1097/DAD.0000000000001466.
Solid carcinoma, probably the solid variant of microcystic adnexal carcinoma, is an apocrine adnexal tumor first described in 1998. The authors report an additional new case of the tumor at an unusual localization. A 78-year-old man presented with an asymptomatic firm plaque on his right thigh that had been present for 15 years. A biopsy was taken, and then, the lesion was removed. A pathological study showed a huge number of islands made up of aggregations of neoplastic epithelial cells. The epithelial islands showed variable sizes and shapes at scanning magnification, arranged columns, cords, and strands at the basis of the tumor. The neoplastic cells were embedded within a fibrotic stroma. Ductal differentiation, cystic structures, and neurotropism were also observed. Immunohistochemically, the neoplastic cells expressed high-molecular-weight keratin (cytokeratin 5/6), broad-spectrum keratin (AE1/AE3), p40, and p63. No immunoreactivity was found for BerEP4, cytokeratin 7, cytokeratin 19, cytokeratin 20, chromogranin A, carcinoembryonic antigen, and S-100. The lesion was completely removed with slow-Mohs micrographic surgery. Two stages and previous debulking were necessary to obtain free margins. The second stage included the muscular fascia. The patient remains free of tumor after a year of follow-up. Solid microcystic adnexal carcinoma is a rare skin tumor that seems to occur more frequently in the scalp than in the face, but no area of the body can be excluded, as reported in our case. Differential diagnosis should include sclerosing and clear-cell basal cell carcinoma, clear-cell dermal duct tumor, or desmoplastic trichoepithelioma. Mohs micrographic surgery is the treatment of choice.
实性癌，可能是微囊性附属器癌的实性变体，是一种顶泌汗腺附属器肿瘤，于1998年首次被描述。作者报告了该肿瘤在一个不寻常部位的又一例新病例。一名78岁男性，其右大腿出现一个无症状的坚实斑块，已存在15年。进行了活检，随后切除了病变。病理研究显示大量由肿瘤性上皮细胞聚集形成的岛状结构。在扫描放大倍数下，上皮岛大小和形状各异，在肿瘤底部排列成柱状、索状和条索状。肿瘤细胞包埋于纤维化的间质中。还观察到导管分化、囊性结构和嗜神经性。免疫组化显示，肿瘤细胞表达高分子量角蛋白（细胞角蛋白5/6）、广谱角蛋白（AE1/AE3）、p40和p63。未发现BerEP4、细胞角蛋白7、细胞角蛋白19、细胞角蛋白20、嗜铬粒蛋白A、癌胚抗原和S-100的免疫反应性。通过慢速莫氏显微外科手术完全切除了病变。为获得切缘阴性需要两个阶段及先前的减瘤手术。第二阶段包括肌肉筋膜。经过一年的随访，患者无肿瘤复发。实性微囊性附属器癌是一种罕见的皮肤肿瘤，似乎在头皮比在面部更常见，但正如我们病例中所报道的，身体的任何部位都不能排除。鉴别诊断应包括硬化性和透明细胞基底细胞癌、透明细胞真皮导管瘤或促结缔组织增生性毛发上皮瘤。莫氏显微外科手术是首选的治疗方法。
