Case Number : 85 Posted By: Guest

Richard Carr - Warwick (UK) Wrote:

To answer a couple of the questions below (hope it is not too late). I don't think the apparent multinucleate cells in the upper field are giant cells but in fact these are entrapped coil ducts. We often see them trapped in tumours at the levels of the sweat gland coil. The lumina on the left lower field would need confirming with immunostains if you are in any doubt but all I can say is they are very punch out and round to quite suggestive. This tumour is quite poroid (Eduardo Calonje teaches that these cells are "mini-squames" i.e. not quite basaloid not quite squamoid but half-way between the two. This lesion is only mildly pleomorphic and retains some of the poroid appearances. The pavementing fo the cells (close adhesion and slight angulation is also typical). We often see squamous cuticular and squamous morular (rounded squamoid foci) in porocarcinomas so seeing dyskeratotic cells in no surprise. When tumours lose there poroid nature and have prominent squamous differentiation and waste basket term like "adenosquamous carcinoma" could be applied. Finally the epithelial tumour cells in the infiltrative border are becomming spindly and we can of course see examples of carcinoma-sarcoma but in this case the acutal stroma appears to me to be "benign". Regards to all. Richard

Submitted on 07/10/2010 09:17
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Iskander Chaudhry - Manchester Royal Infirmary (Manchester, UK) Wrote:

The final diagnosis everyone is: Perineural infiltration in porocarcinoma. See you tomorrow.

Submitted on 06/10/2010 23:16
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Iskander Chaudhry - Manchester Royal Infirmary (Manchester, UK) Wrote:

Very interesting discussion. This is a primary cutaneous tumour with perineural invasion. Some of you are 'spot' on! I will give the diagnosis later during Phillip's absence.

Submitted on 06/10/2010 19:57
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Wayne Grayson - (Johannesburg, South Africa) Wrote:

I think we are seeing the advancing front of an invasive carcinomatous lesion, suspect for a porocarcinoma. The vacuolated cells at the lower left of the field might very contain intracytoplamsmic lumina; obviously, EMA and CEA immunostains would be valuable in this context.

Submitted on 06/10/2010 18:22
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Marcela Saeb Lima - Instituto Nacional de Ciencia Médicas y Nutrición Salvador Zubirán (Mexico City) Wrote:

Porocarcinoma is my diagnosis

Submitted on 06/10/2010 16:18
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Dear Dr Carr, May I ask u a question. Being so junior, I always tend to overdiagnose the glandualr lumina, so today I did not focus on them and they did not alert me to a sweat gland origin although I know think that this is very possible. Can u give us an educational comment about the glandular lumina, should we stick to finding an esinophilic cuticle??. Besides does these cells today look poroid or in porocarcinoma the poroid appearence is lost?. Also I liked the comment of an entrapped sweat gland coil. Is it entrapped by stromal cells? Are there atypical spindle cells in the stroma. I feel that the stroma is full of atypical spindle cells?? Thank u very much. I am learning new things everyday from this valuable site.

Submitted on 06/10/2010 15:53
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Thanks Dr Carr for the informative precious comment.I would like to ask about the giant cells in the left upper part of the picture.What is their significance?

Submitted on 06/10/2010 15:47
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Richard Carr - Warwick (UK) Wrote:

CK5 and p63 are usually positive in primary cutaneous adenocarcinomas and usually negative in visceral adenocarcinomas (I can't remember the exact sensitivies and specificities and I think the apocrine tumours tend to by p63 negative.

Submitted on 06/10/2010 14:26
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Porocarcinoma... Thank your very much Dr Carr for your didactic comments. Will please explain us why, in this case, CK5 and p63 would help us ruling out metastasis?

Submitted on 06/10/2010 14:18
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Richard Carr - Wawrick (UK) Wrote:

Glad Phillip is away as this could get embarasing! We have a deep tumour (muscular vessel and entrapped sweat gland coil). Surely these are true glandular lumen in the bottom left so I would have to go for either porocarcinoma, hidradenocarcinoma or "adenosquamous carcinoma". Favoured carcinoma based on the dyskeratotic cells and mitotic figures and slightly infiltrative border. Adenosquamous carcinoma can cover a multitude of sins! We must not forget a metastasis (CK5 and p63) but probably this is cutaneous. BerEP4, EMA, CEA to confirm glands.

Submitted on 06/10/2010 12:19
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I think this could be spindle cell variant of SCC or undifferentiated SCC with osteoclast like giant cells.

Submitted on 06/10/2010 08:41
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

First impression, SCC; spindle cell variant.

Submitted on 06/10/2010 08:24
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Miguel Sanz - UAH (Spain) Wrote:

sebaceous carcinoma or perhaps metatypical carcinoma

Submitted on 05/10/2010 23:24
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