Case Number : Case 1142 - 7th November Posted By: Guest

Looks very interesting and I am sure it will turn out to be something very unusual as we are used to with Dr Carr cases !!!
My theories are:
BCC with extensive apocrine differentiation.
Apocrine carcinoma (ceruminous gland carcinoma) of the ear.
Waiting for the immunos !!!!
Looking forward to read others' suggestions.
I do not think I should think of a metastatic lesion here because the third image shows a point of connection of the tumor with the epidermis rather than the appearence of a metastatic lesion with epidermotropism.

Agree with BCC with extensive apocrine differentiation.

BCC with apocrine differentiation.

Agree with apocrine carcinoma, with pagetoid spread into epidermis/adnexa.

I would favor apocrine carcinoma, too.

This was from external ear. I reported this as an apocrine carcinoma (highly cystic, focally cribriform but quite high grade, with almost bowenoid-like superficial basaloid areas). I guess this is not our normal picture of an apocrine carcinoma (i.e. a pink predominantly tublar tumour) but I don't see what else to call it. I did a few immunos and duct lining cells were positive for Cam5.2, CK7 (patchy), BerEP4 (patchy in gland lining cells therefore not BCC), EMA (more diffusely in basaloid/bowenoid areas, again excluding BCC). CK5 fairly diffuse and p63 diffuse but negative in mature duct lining cells. Oestrogen receptor widely positive. I did not do an neuroendocrine markers. IHC was mean't to appear at 4pm - I have asked the team to post them now. Apologies I was attending the UK National Skin EQA on friday.
Hope you enjoyed your weekends.

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1142_RAC6924x10_p63_IHC_4pm.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1142_RAC6925x10_CK7_IHC_4pm.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1142_RAC6925x10_Cam52_IHC_4pm.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1142_RAC6925x10_ER_IHC_4pm.jpg[/img]

Lovely case :-)