Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.
Department of Surgery, Central Clinical School, Monash University, The Alfred Centre, Melbourne, Victoria, Australia.
ANZ J Surg. 2021 Oct;91(10):1996-2001. doi: 10.1111/ans.16626. Epub 2021 Feb 1.
Spiradenocarcinoma is a rare skin adnexal neoplasm that may behave aggressively. It is often associated with a benign slow-growing spiradenoma that has undergone malignant transformation. Given the paucity of cases in the literature, there is a lack of consensus on treatment.
The terms 'malignant spiradenoma' or 'spiradenocarcinoma' were systematically used to search the PubMed, MEDLINE and Google Scholar databases. A total of 182 cases of spiradenocarcinoma were identified as eligible for this comprehensive literature review.
Spiradenocarcinoma was commoner in older age and Caucasian race. In most cases, surgical excision for local disease is the mainstay of treatment. Lymph node dissection is usually reserved for those with suspected or confirmed lymph node metastases. High rates of local recurrence (20.8%), metastasis (37.4%) and mortality (19.1%) were identified, prompting some authors to suggest regular follow up including chest X-rays and liver function tests.
Patients with spiradenocarcinoma may benefit from a magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography/computed tomography to establish the extent of disease. We recommend wide local excision as the treatment of choice to achieve surgical margins of ≥1 cm, with node resection to be determined on a case-to-case basis. Regular follow up is important given the high rate of local recurrence, metastasis and mortality. This should include an examination of the regional lymph nodes. Further research is required to refine an evidence-based approach to spiradenocarcinoma.
Spiradenocarcinoma 是一种罕见的皮肤附属器肿瘤，可能具有侵袭性。它通常与良性生长缓慢的 spiradenoma 相关，后者发生了恶性转化。由于文献中病例稀少，因此在治疗方面缺乏共识。
系统地使用“恶性 spiradenoma”或“spiradenocarcinoma”这两个术语在 PubMed、MEDLINE 和 Google Scholar 数据库中进行搜索。共确定了 182 例 spiradenocarcinoma 病例符合本综述的纳入标准。
Spiradenocarcinoma 更常见于老年和白种人。在大多数情况下，手术切除局部病变是主要的治疗方法。淋巴结清扫通常保留给那些有可疑或确诊的淋巴结转移的患者。局部复发率（20.8%）、转移率（37.4%）和死亡率（19.1%）较高，这促使一些作者建议定期进行随访，包括胸部 X 光检查和肝功能检查。
Spiradenocarcinoma 患者可能受益于磁共振成像和氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描以确定疾病的范围。我们建议广泛的局部切除作为首选治疗方法，以实现≥1cm 的手术切缘，淋巴结切除应根据具体情况确定。鉴于局部复发、转移和死亡率较高，定期随访非常重要。这应包括对区域淋巴结的检查。需要进一步研究来完善基于证据的 spiradenocarcinoma 治疗方法。
