Chen Helen Z, Jabin Mohamad, Tarbox Michelle, Akin Russell, Sturgeon Ashley
Dermatology, Texas Tech University Health Sciences Center, Lubbock, USA.
Medicine, Texas A&M College of Medicine, Bryan, USA.
Cureus. 2024 Jul 21;16(7):e65041. doi: 10.7759/cureus.65041. eCollection 2024 Jul.
Adnexal clear cell carcinoma exhibiting comedonecrosis (ACCCC) is a rare, cutaneous, malignant neoplasm with limited reported cases since its discovery. ACCCC is characterized by unique clinical and histological features, demanding a precise diagnosis due to its potential for aggressive behavior and early metastases, distinct from other cutaneous tumors with clear cytoplasmic cells. We present the case of an 81-year-old male with a history of multiple non-melanoma skin cancers, who presented with a 5 mm erythematous papule on his left tragus. Initial tangential shave biopsy results were invasive clear cell squamous cell carcinoma that was moderately differentiated. Subsequent Mohs micrographic surgery (MMS) necessitating a full-thickness skin graft reconstruction was performed. Histopathological examination afterward confirmed ACCCC with pleomorphic epithelial cells, clear cytoplasm, and central comedonecrosis. Immunohistochemistry supported adnexal differentiation and squamous features. To our knowledge, this is the fifteenth reported case of ACCCC as well as the first documented case of ACCCC treated with MMS, offering a novel approach to managing this rare malignancy.
伴有粉刺样坏死的附件透明细胞癌（ACCCC）是一种罕见的皮肤恶性肿瘤，自发现以来报道的病例有限。ACCCC具有独特的临床和组织学特征，因其具有侵袭性生长和早期转移的可能性，与其他具有透明细胞质细胞的皮肤肿瘤不同，需要精确诊断。我们报告一例81岁男性，有多种非黑色素瘤皮肤癌病史，其左耳屏出现一个5毫米的红斑丘疹。最初的切向剃刮活检结果为浸润性透明细胞鳞状细胞癌，中度分化。随后进行了Mohs显微外科手术（MMS），需要进行全层皮肤移植重建。术后组织病理学检查证实为ACCCC，有异形上皮细胞、透明细胞质和中央粉刺样坏死。免疫组织化学支持附件分化和鳞状特征。据我们所知，这是第15例报道的ACCCC病例，也是第一例记录用MMS治疗的ACCCC病例，为管理这种罕见恶性肿瘤提供了一种新方法。
