Apocrine nevus

Abstract: We report an apocrine adenocarcinoma of the left axilla associated with hamartomatous apocrine gland hyperplasia of both axillae. The patient, a 69-year-old man, presented with no symptoms or complaints other than an oval mass felt in the left axilla. The mass was resected and histopathological examination revealed a papillary apocrine adenocarcinoma located within hyperplastic apocrine glands. Because gallium scintigraphy performed after the operation still showed bilateral abnormal uptakes, skin and subcutaneous tissues of the bilateral axillary areas were resected. Histological examination demonstrated marked multilobular hyperplasia of the apocrine glands. These hyperplastic glands did not show distinct atypia, and there was no evidence of tumor remnants in the left axilla. The patient has shown no signs of local recurrence or metastasis at 20 months' follow-up. To our knowledge, this is the first case of malignant transformation of hamartomatous apocrine gland hyperplasia (apocrine gland organic hamartoma or apocrine nevus).

Abstract: The case of a 59-year-old woman with a history of an organoid nevus of the scalp is reported. Histologic examination revealed multiple secondary tumors including a tumor of the follicular infundibulum, an apocrine nevus, a syringocystadenoma papilliferum, an apocrine adenoma, and a piloleiomyoma occurring in the absence of sebaceous glands. The types of secondary tumors which may develop within organoid nevi are reviewed. The terminology and pathogenesis of this hamartoma are discussed.

Abstract: Case 1 A 6-month-old boy presented to our clinic with a scalp lesion dating since birth (Fig. 1). The lesion was in the form of an erythematous, dome-shaped nodule, measuring around 1.5 cm in diameter and having a slightly irregular surface. The lesion was nonitchy, nontender, and showed limited mobility. Our clinical differential diagnosis included: meningocele, hemangioma, dermoid cyst, and apocrine nevus. A computed tomography (CT) scan was performed to exclude possible intracranial connection, and the lesion was surgically excised. Figure 1. Case 1: erythematous nodule on the occipital area of a 6-month-old boy. The lesion was clinically suggestive of apocrine nevus, dermoid cyst, or meningocele Download figure to PowerPoint Histopathologic examination (Fig. 2) revealed a markedly dilated follicular cystic structure, with numerous sebaceous lobules arising from its wall. Other cystic structures containing keratin, but no hair, were also seen. There were numerous sebaceous lobules, excess fibrous tissue (showing a lamellar pattern around the cystic structures and sebaceous lobules), and excess fatty tissue, but no muscles of hair erection were found in the lesion. Clefts were seen separating the pericystic fibrous tissue from the rest of the dermis. Collections of blood vessels were detected in the lower part of the lesion. These features are characteristic and seen only in folliculo-sebaceous cystic hamartoma. Figure 2. large infundibular cystic structure with numerous sebaceous lobules and rudimentary follicles arising from its wall. Individual sebaceous lobules are seen surrounding the cyst. Lamellar fibrous tissue is seen around the cyst and separated from the surrounding stroma by clear clefts. Numerous blood vessels, muscle fibers, and adipose tissue are seen in the lower part (× 100) Download figure to PowerPoint Case 2 A 55-year-old woman presented with two erythematous, dome-shaped nodules on the scalp of more than 10 years' duration (Fig. 3). Each lesion measured about 1 cm in diameter, exhibited soft consistency, and showed limited mobility. Apart from the unsightly appearance, the lesions were symptomless. The clinical differential diagnosis included: intradermal nevus, apocrine nevus, nevus sebaceous, and syringocystadenoma papilliferum. Figure 3. Case 2: skin-colored nodules on the back of the scalp of a 55-year-old woman Download figure to PowerPoint Microscopic examination (Fig. 4) revealed a mid-dermal cystic structure lined by follicular epithelium with numerous rudimentary hair follicles and sebaceous lobules arising from its wall. There were also numerous sebaceous lobules, as well as excess fibrous and fatty tissue. Clefts were seen separating the lamellar pericystic fibrous tissue from the rest of the dermis. These features are diagnostic of folliculo-sebaceous cystic hamartoma. Figure 4. Infundibular cystic structure not connected to the overlying epidermis showing the same features as in Fig. 2, with a large number of isolated sebaceous lobules. There is pericystic compact lamellar fibrous tissue separated from the surrounding stroma by clear clefts (× 100) Download figure to PowerPoint

Abstract: Syringocystadenoma papilliferum (SCAP) is an uncommon benign adnexal tumor of the skin. It is frequently seen in association with other benign adnexal lesions, such as nevus sebaceous, apocrine nevus, tubular apocrine adenoma, apocrine hidrocystoma, apocrine cystadenoma, and clear cell syringoma. The unusual reported locations of SCAP include the head and neck, the buttock, the vulva, the scrotum, the pinna, the eyelid, the outer ear canal, the forehead, the back, the scalp, the thigh, the nipple, the axilla, and the postoperative scar. The occurrence of SCAP in the right lower abdomen is distinctly uncommon. Herein, we report an unusual case of a 41-year-old man with SCAP occurring in the right lower abdomen that did not develop malignancy, despite a long disease course and an absence of medical treatment. The clinical and histopathologic features and the differential diagnosis of SCAP are also discussed.