adnexal tumors sweat gland origin皮肤附属器肿瘤汗腺起源课件

ABCofSweatGlandTumors DebaPSarma MDLakesideHospital Omaha NE Sweatglandanatomy Duct Gland Duct PoreAcrosyringiumSyringiumStraightpartCylinderSpiralpart Gland Coiledglands Duct Pore OpeningthroughepidermisAcrosyringium Acro endortop syringium tubeorduct Syringium TubeorductStraight Cylinder partoftheductSpiralpartoftheductGland Coiledglands Duct Pore PoromaAcrosyringium SyringocystadenomapapilliferumSyringium SyringomaStraightpartoftheduct CylindromaSpiralpartoftheduct SpiradenomaGland Hidradenoma Sweatglandtumors Benign AdenomaDuctalGlandularMixedMalignant AdenocarcinomaDuctalGlandularMixed Sweatglandtumors Benign Ductal SyringocystadenomapapilliferumSyringomaHidrocystomaPoromaCylindromaSpiradenomaGlandular HidradenomaMalignant Adenocarcinoma Syringocystadenomapapilliferum Epidermisshowsacanthosisandpapillomatosis Cysticinvaginationswithpapillaryprojectionsextenddownwardfromtheepidermis Thepapillaryprojectionsarelinedbytwolayersofcuboidalandcolumnarepithelialcells Thestromaisinfiltratedbyanumerousplasmacells Syringocystadenomapapilliferum Syringocystadenomapapilliferum SP isabenignadnexaltumor mostcommonlylocatedonthescalporface whichfrequentlyarisesfromanevussebaceus NS Epidermisshowsacanthosisandpapillomatosis Cysticinvaginationswithpapillaryprojectionsextenddownwardfromtheepidermis Thepapillaryprojectionsarelinedbytwolayersofcuboidalandcolumnarepithelialcells Luminalcellsmayshowdecapitationsecretion Thestromaisinfiltratedbyanumerousplasmacells Malformedsebaceousglandsandhairstructuresmaybepresent Syringoma Epidermisisnormal Upperdermisshowsnumeroussmallepithelialductsembeddedinscleroticstroma Thewallsoftheductsarelinedbytwolayersofcuboidalorflatepithelialcells Ductallumencontainseosinophilic amorphousdebris Someductshaveelongatedtailsofepithelialcellsthatproduceacomma shapedortadpoleappearance Syringomaisabenignadnexalneoplasmformedbywell differentiatedductalelementsofsweatgland Fourvariantsofsyringoma 1 localizedform 2 associatedwithDownsyndrome 3 generalizedmultipleanderuptivesyringomas and 4 familial Syringomasarecommonlesions mostlyinfemale appearingatpubertyassymmetricalmultiple1 3mmclusteredlesionsintheuppercheeksandlowereyelids Othersitesincludeaxilla chest abdomen genitalskin EruptivesyringomasaremorecommoninAfricanAmericansandAsians Pathology Epidermisisnormal Upperdermisshowsnumeroussmallepithelialductsembeddedinscleroticstroma Thewallsoftheductsarelinedbytwolayersofcuboidalorflatepithelialcells Ductallumencontainseosinophilic amorphousdebris Someductshaveelongatedtailsofepithelialcellsthatproduceacomma shapedortadpoleappearance Keratinouscystsarecommonlyseeninthesubepidermallocation Tumordoesnotextendintosubcutis Syringoma Poroma Poromashowsintraepidermalnestsofsmallmonotonouspolygonalcellswithlowmitoticactivity Thetumorcellsgenerallydemonstratedirectdownwardgrowthintothedermisasinterconnectedbasaloidproliferations Theintraepidermalnestsofbasaloidcellsaresmallerthantheadjacentkeratinocytesandshowintercellularbridges Therearefociofmaturationtowardsductscharacterizedbylumenformationsurroundedbyeosinophilicmaterialoversmallepithelialcells Poroma Poromaisabenignadnexaltumorarisingfromsweatgland eccrineandapocrine duct Location Mostlyfootandhand Maybepainful Poromaarethreetypes A Intraepidermalporoma Hidroacanthomasimplex B Intradermalporoma Dermalducttumor C Poroma Compoundporoma themostcommontype Histology Poromashowsintraepidermalnestsofsmallmonotonouspolygonalcellswithlowmitoticactivity Thetumorcellsgenerallydemonstratedirectdownwardgrowthintothedermisasinterconnectedbasaloidproliferations Theintraepidermalnestsofbasaloidcellsaresmallerthantheadjacentkeratinocytesandshowintercellularbridges Therearefociofmaturationtowardsductscharacterizedbylumenformationsurroundedbyeosinophilicmaterialoversmallepithelialcells Differentialdiagnosis Basalcellcarcinoma tricholemmoma seborrheickeratosis Mostlyintheeyelids Dermalcystlinedbycuboidalductalepitheliumofsweatglandcontainingfluid notkeratin Eccrineorapocrinetypeepithelialcellsmaysuggesttheorigin Hidrocystoma Cylindroma Lobulesofepithelialcellsarrangedinajigsawormosaicpattern Prominentredbasementmembrane likestructureencirclesthetumorlobules Eachlobuleshowsaperipheralliningbydarkbasaloidcellsandaninnerlargerandpalerzoneofcells Cylindroma Clinical Sex mostlyfemale Location mostlyscalp Slow growing sometimespainfulsolitarypinkorreddermalnoduleaveraging1cminsize Familialcasesareassociatedwithmultipletumors Suchcasesmayalsobeassociatedwithfacialtrichoepitheliomas andeccrinespiradenomas calledautosomaldominantBrooke Spieglersyndrome familialcylindromatosisorturbantumorsyndrome Pathologicfeatures Presenceofnumerousscalplesionsiscalled turbantumor Non encapsulateddermaltumornotconnectedtotheoverlyingepidermis Composedofnumerouslobulesofepithelialcellsarrangedinajigsawormosaicpattern Prominentredbasementmembrane likestructureencirclesthetumorlobules Eachlobuleshowsaperipheralliningbydarkbasaloidcellsandaninnerlargerandpalerzoneofcells Nodulardepositsofredmaterialwithinthelobulesaswellasfocalwell formedducts Thisisacommonadnexaltumorofeccrineorigin Spiradenoma Well circumscribedorencapsulateddermalnodulecomposedofsmalldarkbasaloidandlargepaleepithelialcellswithinavascularstroma Low powerviewresemblesalymphnode Stromacontainsappreciablenumberoflymphocytes Cuboidalepithelialcellsformcompactedcordswithoccasionalductallumenformationwitheosinophiliccuticle Hyalinizedmatrixaroundtheepithelialcordsmayresemblethatofcylindroma Spiradenoma Clinical Painful solitarydermaltumorintheskinofupperhalfofthebodyduring2ndto4thdecade MultipletumorsmaybepartofBrooke Spieglersyndrome Pathology Well circumscribedorencapsulateddermalnodulecomposedofsmalldarkbasaloidandlargepaleepithelialcellswithinavascularstroma Low powerviewresemblesalymphnode Stromacontainsappreciablenumberoflymphocytes Cuboidalepithelialcellsformcompactedcordswithoccasionalductallumenformationwitheosinophiliccuticle Hyalinizedmatrixaroundtheepithelialcordsmayresemblethatofcylindroma Hidradenoma Wellcircumscribed un encapsulatedsolidandcysticlobulardermaltumor 50 connectedtotheepidermis Biphasiccellularpattern areasofround fusiform polygonalsquamoidcellswitheosinophiliccytoplasmandcellswithclearcytoplasm Duct likestructures cysticchange focalapocrinechange squamouseddies gobletcellsetcmaybepresent Hidradenoma Location mostlyheadandneck limbs oranysite Middleageandelderly F M Solitary slow growingsolidorcysticdermalnodule 1 2cm Wellcircumscribed un encapsulatedsolidandcysticlobulardermaltumor 50 connectedtotheepidermis Biphasiccellularpattern areasofround fusiform polygonalsquamoidcellswitheosinophiliccytoplasmandcellswithclearcytoplasm Duct likestructures cysticchange focalapocrinechange squamouse