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.

Pilomatrixcarcinoma of the Foot: A New Localization of an Extremely Rare Adnexal Tumour

Pilomatrixcarcinoma is a very rare follicular neoplasm that shows matrical differentiation. The majority of these lesions originate de novo, while only a few cases of transformation of pilomatricoma (calcifying epithelioma of Malherbe) have been described in the literature. The neoplasm affects mostly middle-aged males with a male-to-female ratio of 3–4:1. The most common localizations are the face, head, trunk and extremites, though there are a few reports of pilomatrixcarcinoma of the eyelid, eyebrow, axilla and clitorid. Here, we describe the first case of a pilomatrixcarcinoma on the anterolateral surface of the first toe of the left foot of an 83-year-old patient, which developed in less than six months and led to amputation of the distal phalanx. We report a brief review of the current literature with particular emphasis on histopathological features useful for diagnosis.

Recurrent Cutaneous Adenoid Cystic Carcinoma of Forehead

Adenoid Cystic Carcinoma (ACC) is a malignant tumour more commonly seen in salivary glands and rarely arises from the skin as adnexal tumour. Cutaneous ACC is a rare malignant adnexal tumour of eccrine origin. It has an indolent course and rarely metastasizes. Hereby, authors report a case of 48-year-old male with complaints of swelling on right forehead present for the past four years. Clinical diagnosis of infected sebaceous cyst was made and excised with simple excision. The swelling reappeared within 15 days of first surgery. The cytological examination of the swelling revealed abundant cellularity with predominantly cohesive clusters of monomorphic population of cells centered around eosinophilic hyaline globules suggestive of ACC. Retrieval of previous biopsy report revealed diagnosis of ACC reaching the margins of excision, the report of which was neither collected by either operating surgeon nor by the patient. Histopathological examination revealed classical cribriform pattern of arrangement of tumour cells with perineural infiltration by tumour cells. Immunohistochemistry further confirmed the diagnosis. The present case report brings out the importance of clearance of surgical margins in malignant tumours, including skin adnexal tumours. It also highlights the importance of histopathological examination of benign looking skin adnexal tumours.

Female Adnexal Tumour of Wolffian Origin: A Rare Case Report

Female Adnexal Tumour of Wolffian Origin (FATWO) is a rare tumour occurring in adnexal region, arising from the remnants of the mesonephric duct, in places like the broad ligament, fallopian tube, ovarian hilum, peritoneum. Here the authors have reported a case of FATWO in a 47-year-old woman occurring in the wall of fallopian tube and confirmed with immunohistochemistry. Most of these tumours behave in a benign fashion but certain histological features like hypercellularity, cellular pleomorphism and nuclear atypia cause significant confusion in histopathological diagnosis. Multiple differential diagnoses were considered. After careful histopathological examination and thorough investigation with multiple immunohistochemical stains, the diagnosis was ultimately established.

Multiple Trichoepithelioma

Multiple non-familial Trichoepithelioma is a rare benign adnexal tumour that originates from pilosebaceous follicle. The incidence is predominantly at puberty or early part of childhood. The common sites of occurance of trichoepithelioma are upper lip, forehead, scalp and nose. Trichoepithelioma in young women may lead to cosmetic disfigurement. We report a case of multiple non-familial trichoepithelioma who presented with complaints of multiple skin coloured raised lesions on her face since the age of 15 years. Keywords: Benign adnexal tumour; horn cyst; multiple non-familial trichoepithelioma.

Eccrine spiradenoma: a rare adnexal tumour with atypical presentation, a case report

First described in 1934, eccrine spiradenoma (ES) is a rare, benign adnexal tumour arising from eccrine sweat glands. It commonly presents as a slow-growing nodule on the upper trunk, and head and neck region, mostly in the age bracket of 15-35 years, with no gender preference. While no established guidelines exist for optimal management of malignant ES, some therapies have been studied. The diagnosis of this entity is extremely important as it can harbour a malignant component with disastrous outcomes which may be missed due to its strong resemblance to benign lesions, such as a papilloma. Here, we present the case of a 35-year-old lady who presented with a papilloma-like growth on the upper medial aspect of the thigh which was diagnosed as eccrine spiradenoma upon excision. Keywords: Eccrine Spiradenoma, adnexal tumour, dermal lesion, case report. Continuous...

Risk of Malignancy Index 4 (RMI4) and Risk of Malignancy Index 3 (RMI3) as Diagnostic Tests for Adnexal Tumor

Objective: Comparing scoring with RMI3 and RMI4 in establishing the diagnosis of adnexal tumour in RSUD Dr. Saiful Anwar Malang.Methods: Prospective cohort study with samples of all patients suspected of having an adnexal tumour diagnosed in gynecology policlinic using gynecological oncology policlinic medical records at RSUD Dr. Saiful Anwar in the form of age, demographics, menopause status, Ca125, ultrasound results.Results: Between the RMI3 results and the results of histopathology, a contingency coeffi cient of 0.596 was obtained with a p-value of 0.000015 (p <0.05), with a PPV of 83%, an NPV of 91%. Between the RMI4 results and the histopathology results, a contingency coeffi cient of 0.657 with a p-value of 0.0000004 (p <0.05) was obtained, with a PPV of 92%, NPV of 95%. On the ROC curve, the area of the predicted results using the RMI4 score is higher than the RMI3 score.Conclusions: Using the RMI4 score results in more accurate predictions than the RMI3 score in detecting adnexal tumour malignancies.Keywords: adnexal tumours, diagnostic tests, ovarian tumours, risk of malignancy index, ultrasound. Abstrak Tujuan: Membandingkan Skoring RMI3 dan RMI4 dalam menegakkan diagnosis tumor adneksa di RSUD dr. Saiful Anwar Malang.Metode: penelitian kohort prospective dengan sampel semua pasien yang dicurigai menderita tumor adneksa yang didiagnosis di poli Ginekologi menggunakan data rekam medis poli Ginekologi Onkologi RSUD dr. Saiful Anwar berupa usia, demografi , status menopause, Ca125, hasil USG.Hasil: Antara hasil RMI3 dengan hasil hispatologi, didapatkan koefi sien kontingensi sebesar 0,596 dengan p-value 0,000015 (p<0,05), dengan PPV 83%, NPV 91%. Antara hasil RMI4 dengan hasil histopatologi, didapatkan koefisien kontingensi sebesar 0,657 dengan p-value 0,0000004 (p<0,05), dengan PPV 92%, NPV 95%. Pada kurva ROC, luas area hasil prediksi dengan menggunakan skor RMI4 lebih tinggi daripada skor RMI3.Kesimpulan: Menggunakan skor RMI4 menghasilkan prediksi yang lebih tepat daripada skor RMI3 dalam mendeteksi keganasan tumor adneksa.Kata kunci: risk of malignancy index, tumor adneksa, tumor ovarium, uji diagnostik, USG.