Saboorian M H, Kenny M, Ashfaq R, Albores-Saavedra J
Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235-9072, USA.
Arch Pathol Lab Med. 1996 May;120(5):501-4.
Although the vast majority of eccrine spiradenomas behave in a benign fashion, 23 cases of malignant transformation have been reported to date. We describe a unique example of malignant eccrine spiradenoma that arose in the right breast of a 68-year-old woman. The quiescent mass, which was present for approximately 50 years, experienced sudden enlargement with erythematous changes of the overlying skin and nipple discharge. Microscopically, the tumor showed the typical features of an eccrine spiradenoma with areas of adenocarcinoma, squamous cell carcinoma, and sarcoma. The sarcomatous component consisted of rhabdomyosarcoma and osteosarcoma. The immunoperoxidase staining revealed p53 protein expression only in the carcinomatous and sarcomatous components. This suggests that accumulation of p53 protein may be an important event in the malignant transformation of spiradenomas. Because of its location and biphasic nature, this malignant eccrine spiradenoma should be distinguished from metaplastic breast carcinoma. To our knowledge, this represents the first carcinosarcomatous transformation of eccrine spiradenoma in the breast. This case led us to conclude that breast tissue, which often undergoes apocrine metaplasia and gives rise to apocrine neoplasms, is also capable of originating benign and malignant tumors with eccrine sweat duct phenotype.
尽管绝大多数小汗腺螺旋腺瘤表现为良性，但迄今为止已有23例恶变的报道。我们描述了一例发生在一名68岁女性右乳的恶性小汗腺螺旋腺瘤的独特病例。这个静止存在了约50年的肿块突然增大，其上方皮肤出现红斑改变并伴有乳头溢液。显微镜下，肿瘤呈现小汗腺螺旋腺瘤的典型特征，并伴有腺癌、鳞状细胞癌和肉瘤区域。肉瘤成分包括横纹肌肉瘤和骨肉瘤。免疫过氧化物酶染色显示p53蛋白仅在癌性和肉瘤性成分中表达。这表明p53蛋白的积累可能是螺旋腺瘤恶变过程中的一个重要事件。由于其位置和双相性，这种恶性小汗腺螺旋腺瘤应与乳腺化生性癌相鉴别。据我们所知，这是首例乳腺小汗腺螺旋腺瘤发生癌肉瘤转化的病例。该病例使我们得出结论，经常发生顶泌化生并产生顶泌性肿瘤的乳腺组织，也能够起源具有小汗腺导管表型的良性和恶性肿瘤。
