Case Report: Dermoscopic, High-Frequency Ultrasound, Contrast-Enhanced Ultrasound Appearances and Special Treatment of a Patient With Syringoid Eccrine Carcinoma on the Chest

This article aims to explain the use of a variety of noninvasive of minimally invasive examinations to obtain reliable diagnostic clues. The choice of treatment methods and repair techniques for wound defects are also critical in terms of the prognosis. Here, we describe the case of a 53-year-old male patient who visited our dermatology clinic due to a red plaque on the inner side of his left nipple without any symptoms for more than 30 years. He was given dermoscopy, high-frequency ultrasound (HFUS), Color Doppler flow imaging (CDFI), and contrast-enhanced ultrasound (CEUS) examinations. Currently, there are no literatures on these auxiliary examinations for this disease. Dermoscopy revealed that there were abundant blood vessels on the periphery of the skin lesion with obvious dilation. HFUS revealed an inhomegeneous hypoechoic solid mass in the dermis with clear borders and irregular shape. CDFI indicated that there are abundant blood flow signals in the periphery and central of the tumor. CEUS showed a mixed inhomogeneous, grid-like high-enhancement pattern. Based on the above auxiliary findings, the possibility of malignant lesion was suspected. Therefore, the patient was given a pathological examination, which showed that many luminal structures of the dermis layer were embedded in the hyperplastic fibrous tissue. The atypical cells were not obvious but showed an infiltrating growth pattern. Immunohistochemistry showed positive reaction for cytokeratin 7 (CK7), epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA) and a weak positive results was obtained for S-100. There was also a negative result for CK20, gross cystic disease fluid protein 15 (GCDFP-15), and P63. As a result, the patient was diagnosed with “syringoid eccrine carcinoma.” The treatment was surgical excision. Mohs microsurgery was combined with the looped, broad, and deep-buried suturing technique (LBD tension-reduced suturing technique). This technique directly sutures the wound instead of carrying out traditional skin grafting or flap transfer. The postoperative follow-up results were satisfactory as no obvious keloid formed on the wound during the follow-ups. In conclusion, ultrasound is greatly advantageous in tumor morphology and hemodynamics. It orients the therapeutic management and assesses the therapeutic efficacy and the tumoral prognosis. In surgical treatments, a less-traumatic operation should be selected to reduce the patient’s pain.

Primary Cutaneous Mucinous Carcinoma Presenting as an Unusually Large Lesion - A Rare Case Report

Primary cutaneous mucinous carcinoma (PCMC) also known as primary mucinous carcinoma of the skin (PMCS) or primary mucinous eccrine carcinoma (PMEC) is a rare malignant adnexal tumour of eccrine origin. Many visceral mucinous carcinomas especially of the breast and gastrointestinal tract can metastasize to the skin mimicking PCMC. Hence it is very important to rule out metastatic mucinous carcinomas before making a diagnosis of PCMC. Usually, PCMC presents as a slowgrowing tumour of considerably smaller size compared to our case. The large size and shorter duration are the key features of this case report. Here we report an unusually large-sized rare malignant tumour of skin appendage. Our patient was a 54-year-old lady who presented with progressive swelling of one year duration in the right frontoparietal area. Ultrasonography showed an ill-defined lesion in the subcutaneous plane with multiple cystic spaces within it. No bone involvement was noted. The excised lesion measured 13 x 7 x 2 cms and was diagnosed as primary cutaneous mucinous carcinoma on histopathological examination. The possibility of cutaneous secondaries from elsewhere was ruled out by detailed clinical and radiological investigations. The case is reported considering the unusually bigger size and shorter duration of this rare entity.

Eccrine and Apocrine Carcinoma in Dogs

Background: Sweat gland carcinomas divide into eccrine, apocrine, mixed origin (eccrine and apocrine). Eccrine carcinoma (EC) is a rare malignant neoplasm of the sweat glands that can affect dogs, cats, and humans. EC can present itself as a solitary swelling in the pads, digits, or distal limbs. EC is more common in elder animals, and exhibits no predisposition according to breed. In humans, EC is more frequent in the head and neck, and is more likely to occur in mid-aged people; metastases can develop in any site of the body. A diagnosis of this type of tumor can be determined by histopathological examination. Apocrine carcinomas occur most frequently in the axillary areas even though they may occur in other regions of the body, and affect mainly elder animals.Case: A 13-year-old male mongrel dog with a history of presence of smooth reddish infiltrative nodule in the skin of the thorax, but with no history of progression, was examined. After running complementary tests, a fragment of the skin on the thorax was taken for biopsy. The second animal was an 8-year-old female Golden Retriever, which was presented with a history of presence of a nodule on the right digital pad. After running complementary tests, a fragment of this nodule was collected. In both cases, the excised fragments were placed in 10% buffered formalin and routinely processed for the preparation of histological slides, which were stained with hematoxylin and eosin, and subjected to histopathological evaluation. Light microscopy analysis revealed, in both cases, the presence of a poorly delimited, non-encapsulated mass infiltrating the muscle and adipose tissue. Necrotic areas, and presence of eosinophilic material in the nucleus were observed. Additionally, the samples from both cases were subjected to immunohistochemical staining for cytokeratin (CK Pan).Discussion: A definitive diagnosis of sweat gland carcinoma was achieved by means of the histopathological analysis. Sweat gland neoplasms are uncommon and difficult to diagnose; distinguishing eccrine carcinoma from apocrine carcinoma requires knowledge on the site of origin of the tumor. Some authors assert that, in spite the growing number of reports on tumors of cutaneous glands in dogs, there are only few immunohistochemical studies on cutaneous gland neoplasms in these animals. There is no specific immunohistochemical marker to distinguish eccrine carcinoma from apocrine carcinoma. Consequently, investigation on the anatomical origin of the tumor is important. In the cases describe herein, involvement of the thorax (apocrine) and digital pad (eccrine) are reported. However, there are accounts of the occurrence of sweat gland tumors in axillary and inguinal regions, as well as in the limbs. Both biopsy samples tested positive for cytokeratin (CK) after immunohistochemical examination. This marker is specific for simple epithelium and, according to some authors, can distinguish an eccrine carcinoma from basal cell carcinoma. The antibody used did not stain the innermost are of the tumor, where cells may be negative for CK. Some tumors may not have specific markers, which makes a combination of clinical data and complementary histopathological and immunohistochemical exams necessary for the determination of a diagnosis, as is the case for eccrine and apocrine carcinomas. In view of the scarcity of reports on eccrine carcinoma in the literature, and considering the small number of immunohistochemical studies on cutaneous gland tumors in dogs and cats, this work can help the determination of the diagnosis of cutaneous neoplasms, which are frequently observed in the clinical routine.