© Angel Fernandez Flores, MD, PhD Apocrine carcinoma

 

Apocrine carcinoma

 

Clinical presentation

A tumor in apocrine areas, such as axilla, scalp, eyelid (Moll´s gland carcinoma), ear (ceruminous gland carcinoma), anogenital area chest or lip.

 

Morphology

Malignant infiltrative ireegular pattern, frequently involving the dermis and hypodermis.

 

 

Atypical cells, with abundant eosinophilic cytoplasm and decapitation secretion.

Nuclei are round with prominent nucleoli.

Atypical mitoses can be found.

 

 

Variants

Cribriform variant.

In situ cutaneous apocrine carcinoma

 

Main differentials:

The differential diagnosis between primmary cutaneous apocrine carcinoma and a mestastasis of a breast carcinoma into the skin, is one of the most difficult and elusive areas in dermatopathology.

Recently, we examined a series of cases, and concluded that the following panel was usefull in such differential (Rom J Morphol Embryol 53(4), Dec 2012, free access in PubMed):

Primmary CAC:

ER-, PR-, CK5/6+, mammaglobin- (or positive in scattered cells), D2-40 is either negative or positive with a basilar pattern.(Cesk Patol 2009;45:108-112) (Appl Immunohistochem Mol Morphol 2010;18:573-574)

Metastasis

ER+/-, PR+/-, CK5/6-, mammaglobin+ (more than 10 % of the cells), D2-40+ (luminal reinforcement).

 

Additional comments

If the "immunohistochemical" apocrine status of the cutaneous carcinoma is demonstrated (AR+, ER-, PR-), p63 might be useful as an additional tool (positive in primary cutaneous, versus negative in metastasis).

A negative D2-40 immunostaining does not favor any of the two options.

 

© Angel Fernandez Flores, MD, PhD