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Case Report DOI: 10.7241/ourd.20132.54 SYRINGOCYSTADENOCARCINOMA PAPILLIFERUM: A CASE REPORT OF A RARE SKIN ADNEXAL TUMOUR Chidambharam Choccalingam 1 , Premila Samuel 1 , Deepak Subramaniam 2 , Faizal Hammed 2 , PurushothamanV 2 , Rajiv Joshi 3 Source of Support: Nil Competing Interests: None 1 Department of Pathology, SRL Ltd, Chennai, India 2 Department of Surgery and Plastic Surgery, Fortis Malar, Chennai, India 3 Department of Dermatology, SRL Ltd, Mumbai, India Corresponding author: Dr Chidambharam Choccalingam Chidambharam@gmail.com Our Dermatol Online. 2013; 4(2): 221-223 Date of submission: 26.02.2013 / acceptance: 20.03.2013 Abstract Syringocystadenocarcinoma papilliferum (SCACP), a rare skin adnexal carcinoma with apocrine differentiation is the malignant counterpart of syringocystadenoma papilliferum (SCAAP). It usually occurs in the head and neck region of elderly individuals. We describe a 46 year old south Indian female with a lesion in the scalp. Morphologically the tumour had the characteristic features of SCAAP along with frank invasion into deep dermis and malignant cytologic features. Immunohistochemically, the tumour cells stained strongly with cytokeratin (CK) 7, carcinoembryonic antigen (CEA), gross cystic disease fluid protein-15 (GCDFP-15), We made a diagnosis of SCACP in the patient, and a wide excision with skin grafting was performed on the patient. Key words: syringocystadenocarcinoma papilliferum; adnexal neoplasm; apocrine differentiation Cite this article: Chidambharam Choccalingam, Premila Samuel, Deepak Subramaniam, Faizal Hammed, Purushothaman V, Rajiv Joshi: Syringocystadenocarcinoma Papilliferum: A case report of a rare skin adnexal tumour. Our Dermatol Online. 2013; 4(2): 221-223. Introduction Syringocystadenocarcinoma papilliferum (SCACP) is a rare skin adnexal carcinoma, considered to be a malignant counterpart of syringocystadenoma papilliferum (SCAAP) by the World Health Organization [1,2]. Adnexal tumours are skin tumours whose differentiation is towards one or more of the cutaneous adnexal structures (apocrine, follicular, and sebaceous) of the skin. SCACP is a malignant adnexal neoplasm that shows predominantly apocrine differentiation [3]. It is an extremely rare cutaneous neoplasm with only 13 reported cases, to our knowledge until 2012, since it was first reported in 1980 [2,4]. Most of the SCACP’s is preceded by long standing SCAAP. The malignant tumour has a predilection for the head and neck region and commonly affects older people in the 5 th to 7 th decade [3,4]. To our knowledge, only one case of SCACP has been reported from India [4]. Herein we report a case of SCACP occurring on the right scalp of 46 year old South Indian female patient. Case Report A 48 year old south Indian woman presented with an ulcerative growth over the scalp for duration of 1 year (Fig. 1). Since the clinical diagnosis was in favour of squamous cell carcinoma, a needle core biopsy was performed. Histopathologic examination revealed cystic invaginations and papillomatous downgrowths extending up to the deep dermis. The cystic invaginations and papillomatous downgrowths were lined by luminal high columnar cells, with few showing decapitation secretion and outer cuboidal cells (Fig. 2a). The cells show moderate to severe atypia with increased mitotic activity (Fig. 2b). There was a dense infiltration of abundant plasma cells and lymphocytes in the stroma of the tumour. In few loci, frank invasion of the stroma by the tumour was seen. Based on these histopathological findings, the diagnosis of SCACP was made. Wide excisional surgery with split skin graft was performed to remove the tumour. There were no signs of lymph node involvement ultrasonographically and clinically. The patient had no clinical or radiographic evidence of any primary tumour elsewhere. Gross pathology of the whole specimen revealed a skin ellipse with a large asymmetric ulcerative growth measuring 6 * 5 * 2 cms. The growth was poorly circumscribed and seen extending up to the dermis. The histopathological examination of the whole growth revealed the same, with stromal invasion being prominent. www.odermatol.com © Our Dermatol Online 2.2013 221
Immunohistochemically, the tumour cells stained strongly with cytokeratin (CK) 7, carcinoembryonic antigen (CEA), gross cystic disease fluid protein-15 (GCDFP-15), which further provided support to the apocrine nature of the neoplasm (Fig. 3a, b, c). The margins were found to be free of tumour. Figure 1. Clinical photograph of the ulceroproliferative growth over the right scalp Figure 2. Biopsy from lesion revealed (A) large cystic invaginations and papillomatous downgrowths lined by inner columnar and outer cuboidal cells (Haematoxylin and Eosin X 10); (B) tumour cells with moderate to severe atypia with increased mitotic activity (Haematoxylin and Eosin X 40) Figure 3. Immunohistochemical characterization of tumour shows (A) GCFDP-15 positive staining of tumour cells; (B) CEA positive staining of tumour cells; (C) CK7 positive staining of tumour cells 222 © Our Dermatol Online 2.2013
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Volume 4, Number 2, April 2013 ISSN
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Editorial Board: Abdel-Naser Mohame
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CONTENTS E d i t o r i a l O r i g
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Original Article DOI: 10.7241/ourd.
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Figure 1. Survival time of HIV/TB-
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Figure 3. A. melanocytic naevus on
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82% of the children belonged to the
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Comment to the article DOI: 10.7241
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The skin around body openings such
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Figure 1. Finger nail dystrophy in
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Comment to the article DOI: 10.7241
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Similar type of rash was also prese
Page 30 and 31: 13. Mastaglia FL, Ojeda VJ: Inflamm
Page 32 and 33: Figure 1. Atrophic areas on left up
Page 34 and 35: 5. Brocard A, Quereux G, Moyse D, D
Page 36 and 37: Figure 1. Macroglossia Figure 2. Ma
Page 38 and 39: Case Report DOI: 10.7241/ourd.20132
Page 40 and 41: Figure 4a, b. Skin biopsy shows hyp
Page 46 and 47: Discussion Poikiloderma of Civatte
Page 50 and 51: Comment to the article DOI: 10.7241
Page 52 and 53: Case Report A 56 year old Caucasian
Page 54 and 55: Using a battery of neurotoxic agent
Page 56 and 57: Figure 1. Multiple lesions on the u
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Page 62 and 63: The patient was put on melanocyl 0.
Page 66 and 67: The type of treatment prescribed by
Page 68 and 69: On the basis of these clinical find
Page 70 and 71: Surgery has been reported to be the
Page 72 and 73: Figure 1. Histological section show
Page 76 and 77: Discussion The breast location of t
Page 78 and 79: Figure 2. The epithelial nests show
Page 82 and 83: Discussion SCACP is one of the cuta
Page 84 and 85: Figure 1. Tumor of the nasal colume
Page 86 and 87: Figure 2. Vesicles and crusts aroun
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Page 90 and 91: Clasificación En base al epitelio
Page 92 and 93: - Microcefalia, hipoplasia mediofac
Page 94 and 95: Caso Nº 3: · Niña, edad desconoc
Page 96 and 97: Clinical Images DOI: 10.7241/ourd.2
Page 98 and 99: Figure 7. Fixed cutaneous sporotric
Page 100 and 101: Letter to the Editor DOI: 10.7241/o
Page 102 and 103: Historical Article DOI: 10.7241/our
Page 104 and 105: Figure 6. Henri Mondor (1885-1962).
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Page 112 and 113: Names of ''Lines'', in dermatology
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Page 116 and 117: THOMAS INMAN English physician, 182
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