Hidradenocarcinoma

 Local recurrences


image Metastases





Microscopic




• Epithelial islands with interspersed glands/ducts
• Cells composing islands are variable

image Clear

image Poroid

image Squamoid (less common)

image Rarely mucinous

• Hyalinized stroma
image Similar to hidradenoma

• Infiltrative growth pattern
image Not well circumscribed, unlike hidradenoma

• Deep extension

• Perineural or vascular invasion may be present

• Ki-67 generally shows high proliferative index


Top Differential Diagnoses




• Hidradenoma

• Porocarcinoma

• Metastatic renal cell carcinoma

• Clear cell squamous cell carcinoma

• Clear cell basal cell carcinoma

• Sebaceous carcinoma

image
Hidradenocarcinoma: Low Magnification
Low magnification of a hidradenocarcinoma shows a dermal-based, atypical, multilobular neoplasm with clear cell features image and cystic spaces image containing mucinous material and cellular debris.


image
Hidradenocarcinoma: Areas of Necrosis
Areas of squamous differentiation image and prominent tumoral cell necrosis image are present in this example of hidradenocarcinoma. Squamous differentiation is much less common than in porocarcinoma.

image
Hidradenocarcinoma: Atypia and Mitoses
Infiltrative islands of tumor cells in hidradenocarcinoma show cellular atypia, with enlarged nuclei and prominent nucleoli. There is also an atypical mitosis image present.

image
Hidradenocarcinoma: CEA Positivity
CEA highlights numerous small ductal lumina image and their contents in this example of an infiltrative hidradenocarcinoma.


TERMINOLOGY


Synonyms




• Malignant acrospiroma, malignant hidradenoma


Definitions




• Malignant adnexal tumor arising from, or showing areas similar to, hidradenoma


CLINICAL ISSUES


Site




• Most frequently in head and neck region


Presentation




• Nodule or mass


Treatment




• Surgical approaches
image Wide, local excision of tumor

image Mohs micrographic surgery may be best option to ensure clear margins

• Drugs
image For metastatic hidradenocarcinoma, if surgery is not option
– Various chemotherapeutic regimens reported

– Case reports of sunitinib and capecitabine treatment

• Radiation
image Variable response


Prognosis




• Excision may be curative
• Course can be aggressive

image Local recurrences, metastatic disease (to lymph nodes, distant skin, internal organs)


MICROSCOPIC


Histologic Features




• Epithelial islands with interspersed glands/ducts
• Architecture may be predominantly solid islands; sometimes cystic areas present

image Cells composing islands are variable

– Clear, poroid, less commonly squamoid; rarely mucinous

• Hyalinized stroma

• Infiltrative growth pattern; not well-circumscribed

• Deep extension

• Necrosis may be evident

• Nuclear pleomorphism may be present

Apr 24, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Hidradenocarcinoma
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