Case Number : Case 80 Posted By: Guest

Phillip McKee - Overseas Consultations (Arizona, USA) Wrote:

The diagnosis was mucoepidermoid carcinoma and it was related to salivary gland tissue. Well done to all the contributors especially my dear friend Richard.

Submitted on 30/09/2010 00:25
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

So, I must have followed the lesson previously given to us by Dr McKee; Always follow ur first impression. MEC was my first impression, I did not c except very very few clear cells and since I am a very Junior Dermatopathologist and I never saw this MEC before and only read about it a very small paragraph in my text book, I have to admit that I was hesitant to write it as a first possibility. I kept wandering all the day and looking to the section and thinking that the large island on the lower right could not be neither metastatic adenocarcinoma nor mucinous metaplasia. It fits only with MEC. So, My Final diagnosis of the day will be my first morning impression that I did not follow: MUCOEPIDERMOID CARCINOMA. I also agree with Dr Carr that it must be a secondary cutaneous affection from a salivary gland. I have learned my lesson Dr McKee!!! Thank u very much for giving us such an opportunity to c such rare things. I just feel blessed.

Submitted on 29/09/2010 18:26
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Richard A. Carr - Warwick (UK) Wrote:

My diagnosis this morning was MEC and I have not changed my mind as the day has gone on. The reasons are outlined by Dr Garces. We have seen mucinous metaplasia in hidradenoma (and even reported a small series with Dr Calonje) so that is a good suggestion. I suppose a metastatic MEC (or extension from the underlying salivary gland is a strong possibility as cutaneous MEC is exceedingly rare.

Submitted on 29/09/2010 18:06
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Phillip McKee - Overseas Consultations (Arizona, USA) Wrote:

This has got you thinking!! The clue is in the 3 cellular components. All to be revealled later.

Submitted on 29/09/2010 18:03
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Nice explanation of the stroma Dr Carlos. Well my first impression was mucoepidermoid carcinoma, but I know from my readings that it contains also a 3rd type of cells, Clear cells. Did not see it before and could not find except very few clear cells. This is why I put it second possibility.

Submitted on 29/09/2010 17:27
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Good morning everyone. Mi diagnosis is mucoepidermoide carcinoma. The stroma is desmoplastic, denoting an invasiv process. I dont think that this is a metastatic adenocarcinoma because I see clearly two cell population,sguamoid cells and abrupt transition to globet cells.

Submitted on 29/09/2010 17:03
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Mucinous metaplasia of eccrine glands.

Submitted on 29/09/2010 16:59
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Hi, all. I would like to re-arrange my DDx. I think there is a solid strand of cells in the right part of the field. I will put metastatic adenocarcinoma first, followed by mucoepidermoid carcinoma and then mucinous eccrine metaplasia. I am not comfortable with the stroma.

Submitted on 29/09/2010 16:50
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Mo - (India) Wrote:

I wondered about a metastatic gastric carcinoma

Submitted on 29/09/2010 16:36
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Jonathon Shelton - UK () Wrote:

Very difficult case - unsure of diagnosis but would consider mucoepidermoid carcinoma

Submitted on 29/09/2010 16:35
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Amira Tawdy - Cairo University (Egypt) Wrote:

I think it might be atypical eccrine hidradenoma with mucinous metaplasia

Submitted on 29/09/2010 11:35
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Marwa Fawzi - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

It may be an invasive microacinar adenocarcinoma or unusual varient of anogenital paget's disease with dermal mucinous carcinoma [eccrine duct spread of paget's disease ] or i am totally wrong ??????

Submitted on 29/09/2010 10:26
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I think that this lesion which is full of mucous secreting goblet cells could be one of the mucinous eccrine metaplasias. Either: Mucinous Metaplasia of Eccrine Secretory Coils or Mucinous Syringometaplasia extending to involve sweat glands in deep dermis. The DDx: Mucoepidermoid carcinoma or Less Likely Metastatic Adenocarcinoma.

Submitted on 29/09/2010 08:25
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