Case Number : Case 73 Posted By: Guest

Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Thank u Dr McKee for this nice case. This case and the reading that it has provoked helped me to solidify very important points about clear cell hidradenoma and sebaceous carcinoma. I just believe that without my mistakable diagnosis I would have had forever misperceptions about these two neoplasms in my mind. Thank u very much Sir!!!

Submitted on 20/09/2010 21:13
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Phillip Mckee - Overseas consultations (Arizona, USA) Wrote:

Thank you for all your contributions. The diagnosis is clear cell hidradenoma with cystic change. Many of you thought this and then wandered off to think of all sorts of differential diagnoses. One of the things I always tried to impress upon my residents and fellows is that your first impression is generally the correct one. It is rather like filling in a multiple choice questionnaire. If you go over it a second time you will invariably change correct answers into wrong ones! Mind you PEComa was an interesting diagnosis. I will put in an example some time in the future and see how you all do.

Submitted on 20/09/2010 20:20
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ANDREW DANCKWERTS - WITS UNIVERSITY (JOHANNESBURG, RSA) Wrote:

CLEAR CELL NEOPLASM. UNCERTAIN OF MALIGNANT POTENTIAL. DIFFERENTIAL DIAGNOSIS: IF MALIGNANT THINK- CLEAR CELL MELANOMA, SEBACEOUS CARCINOMA, METASTATIC RENAL CELL CARCINOMA,OTHER...IF BENIGN, THICK- CLEAR CELL HIDROADENOMA.

Submitted on 20/09/2010 17:46
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Marcela Saeb Lima - MSLDermatopato (Mexico City) Wrote:

Very interesting case: It is a clear cell neoplasm, which can go from malignant like sebaceous or hidradenoma to decidual reaction

Submitted on 20/09/2010 17:20
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Phillip Mckee - Overseas consultations (Arizona, USA) Wrote:

Good morning from Sedona. I hope that you all had a great weekend. It was in the middle 90's F. A perfect time of the year. This case is certainly resulting in a lot of controversy with sme very interesting differential diagnoses. More later.

Submitted on 20/09/2010 17:19
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

The cells in sebaceous carcinoma are finely vaculated or foamy rather than clear (the cells here are rather clear). The clear cells of the clear cell neoplasms, such as clear cell hidradenoma or metastatic RCC(due to accumelation of glycogen) have eccentric nulclei, while in sebaceous carcinoma the clear cells filled with lipids have central nulei.Cystic spaces chracterise clear cell hidradenoma not sebaceous carcinoma. So on further reading, favor clear cell hidradenoma or metastatic RCC. Challenging case.

Submitted on 20/09/2010 16:57
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Dear all, I want to correct an information that I said earlier that the cystic structures in clear cell hidradenoma are lined by col. or cuboidal cells. Actually, I read again hidradenoma and the correct is that the ductal (tubular) structures are those which are lined by col. secretory or cuboidal ductal epith. The cystic spsces which may be widely dilated are only rarely lined by a single layer of luminal cells, more frequently they are bordered by tumor cells showing no particular orientation in addition to degenerative changes, suggesting that they may result from tumor cell degeneration. Thank u.

Submitted on 20/09/2010 16:53
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Miguel Sanz - UAH (Spain) Wrote:

I would look for blood inside the clear cell nests in favour of metastatic renal cell carcinoma.

Submitted on 20/09/2010 16:03
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Wayne Grayson - (Johannesburg, South Africa) Wrote:

Cutaneous clear cell neoplasm. Although I favour a clear cell hidradenoma, a mild degree of atypia is present. Consequently, I would also consider a well-differentiated hidradenocarcinoma or a metastatic renal cell carcinoma.

Submitted on 20/09/2010 15:26
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Rodrigo Restrepo - UPB/CES (Mdlln/Col) Wrote:

Clear cell hidradenoma

Submitted on 20/09/2010 15:19
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Richard Carr - Warick Hospital (UK) Wrote:

My Favoured Diagnosis: Clear cell hidradenoma. I think focally some of the spaces are lined by the epithelial cells forming cystic spaces (but not typical holocrine - that is mushy bubbly darker pink). We would like to see the border to assess for malignancy as cytology and mitotic figures are not overly helpful although this case looks benign to me cytologically. We would also like to see the nice amorphous/hyaline collagen typical of hidradenoma. Sebaceoma is a basaloid tumour with

Submitted on 20/09/2010 11:18
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galal el enany - cairo university (faculty of medicine) Wrote:

distinct sebaceous cells are present.many other cells are undifferentiated.some sebaceous and undifferentiated cells look atypical.I think fat stains should be used to confirm the diagnosis.SEBACEOUS CARCINOMA

Submitted on 20/09/2010 10:42
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Yvonne Bury - (UK) Wrote:

What about clear cell sarcoma of soft tissue or ballon cell melanoma. I like the idea of met RCC, but do not think the lesion is vascular enough.

Submitted on 20/09/2010 07:46
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Well, cystic spaces in clear cell hidradenoma are lined by either columner secretory cells or cuboidal ductal cells. The cystic spaces here to me are foci of necrosis. Or holocrine degeneration of sebaceous origin. I would like also to comment on the idea of sebaceoma raised by Dr. Marwa and Dr. Lushen, I think in sebaceoma one see an admixture of basaloid cellsa nd mature sebocytes with the basaloid cell population far exceeding the mature sebocytes. I think here we are seeing immature sebocytes (Foamy cells, vacuolated cells). The basaloid cell poulation here is not that prominent. After all, I might all be wrong. Nice case, let's wait and c!!!!!!

Submitted on 20/09/2010 06:57
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil, Ecuador) Wrote:

You are so right Mona... Perhaps we have to consider the diagnosis of Clear cell hidradenoma ( cystic spaces, two cell population ).

Submitted on 20/09/2010 05:47
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Dear Dr Calos, The ideas of PEcoma and metastatic renal cell carcinoma are so interesting, but I have few questions: do we have 2 cell populations in met renal cell carcinoma? In this section there are ? squamoid/? basaloid cells besides the clear cells and I can not see the highly vascular stroma characteristic of met. renal cell carcinoma with extravasated RBC and hemosiderin? The same issue of the 2 cell population applies to PEcoma, as much as I know in PEcoma one c mainly epithelioid, occassionally spindle shaped cells with clear to granular cytoplasm with often MNGCs? Any Explanations??

Submitted on 20/09/2010 04:38
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Besides Pecoma I want to add Metastatic renal cell carcinoma... The cells dont look sebaceous to me..

Submitted on 20/09/2010 00:45
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Good evening... PEComa?

Submitted on 20/09/2010 00:43
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Marwa Fawzi - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Sebaceoma with cysts containing holocrine debris vs Sebaceous Carcinoma.

Submitted on 19/09/2010 23:01
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

My openion is sebaceous carcinoma.

Submitted on 19/09/2010 21:49
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Lushen Pillay - Wits Dermatology, South Africa (South Africa) Wrote:

Definitely looks non-benign. I would go for a Sebaceoma. (sebacious EpFithelioma) with a Differential of Sebaceous Carcinoma.

Submitted on 19/09/2010 21:16
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Sheets of cells with some lobular architecture. The cells include foamy cells, vacuolated cells, clear cells. Also there are small basaloid and squamoid cells. Foci of necrosis. Cells look atypical. My diagnosis is Sebaceous Carcinoma.

Submitted on 19/09/2010 20:48
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