Kumar K, McGregor J C, Watson J D
Department of Plastic Surgery, South-East Scotland Regional Plastic Surgery and Burns Unit, St John's Hospital, Livingston, Edinburgh, UK.
J R Coll Surg Edinb. 1998 Dec;43(6):412-4.
Microcystic adnexal carcinoma is an uncommon adnexal neoplasm. It is highly aggressive locally and its importance lies in the fact that it can be easily confused with benign adnexal tumours, particularly desmoplastic trichoepithelioma, trichoadenoma and syringoma. We report three cases of microcystic adnexal carcinoma of the skin, all three being on the face: two on the lips and one on the left eyebrow. Clinically, the neoplasms were slow growing indurated nodules or plaques. Two of the cases displayed benign features on initial biopsy and their malignant potential could not be established at that stage. On subsequent review, the three neoplasms showed all the characteristic features of microcystic adnexal carcinoma as described by Goldstein et al. and the University of Virginia study. All three patients were treated by surgery in the form of wide excision. They behaved in a highly locally malignant manner with excisions being incomplete in two of the lesions, in spite of taking an adequate margin around the clinically assessable margins. The other recurred after three years in spite of a histologically proven complete excision. Two of the tumours showed infiltration into the underlying muscle with perineural spread. Wider excision in the next stage with frozen section control achieved good clearance and after a five year follow-up period all are symptom free. None of these tumours showed any evidence of distant spread.
微囊性附属器癌是一种罕见的附属器肿瘤。它在局部具有高度侵袭性，其重要性在于它很容易与良性附属器肿瘤混淆，尤其是促结缔组织增生性毛发上皮瘤、毛发腺瘤和汗管瘤。我们报告3例皮肤微囊性附属器癌，均位于面部：2例在唇部，1例在左眉部。临床上，这些肿瘤为生长缓慢的硬结性结节或斑块。其中2例在初次活检时表现为良性特征，在那个阶段无法确定其恶性潜能。在随后的复查中，这3个肿瘤均表现出Goldstein等人以及弗吉尼亚大学研究所描述的微囊性附属器癌的所有特征性表现。所有3例患者均接受了广泛切除的手术治疗。它们表现出高度的局部恶性行为，尽管在临床可评估边缘周围切缘足够，但仍有2个病灶切除不完全。另1例尽管组织学证实切除完整，但3年后复发。其中2个肿瘤显示浸润至下方肌肉并伴有神经周围扩散。下一阶段进行更广泛的切除并进行冰冻切片控制，获得了良好的切缘，经过5年的随访期，所有患者均无症状。这些肿瘤均未显示任何远处转移的证据。
