Eccrine porocarcinoma Case for discussion.pptx

Eccrine porocarcinoma

1. MAPCON 2017 Slide Seminar – Case no. 115 Department of Pathology ACPM Medical College, Dhule

2. History 65 years male patient presented with non healing ulcer on anterolateral aspect of right thigh since 6 months. Gradual increase in size was noted. Wide local surgical excision done. Mass measuring 3 cm in diameter & surgical resection of 16x6x2 cm. received.  

3. Ulceroproliferative mass of 3 cm in diameter. In a surgical resection of 16x6x2 cm.

4. C/S - Mass 3 x 3 x 0.5 cm whitish in colour with cystic lumina seen in the tumour

5. Infiltration seen upto subcutaneous fat

6. Atypical poroid cells infiltrating into dermis as anastomosing bands and dermal tumor islands

7. Dermal tumour islands

8. Eccrine differentiation was indicated by spiraling ductular structures

9. Cells reveal- Pleomorphism, hyperchromatic nuclei with prominent nucleoli & moderate cytoplasm.

10. Nuclear pleomorphism, Mitotic index >14

11. Immunohistochemistry CK 15 CK 7

12. Immunohistochemistry EMA Estrogen

13. Immunohistochemistry The tumour was positive for EMA, CK7, CK15, Estrogen receptor Immuno -negative for CK20 , D240, CEA, BerFP4, CD10, GCDFP-15 . CK20(), D240(), CEA(), BerFP4(), CD10(), GCDFP-15().

14. Final Diagnosis ECCRINE POROCARCINOMA

15. Discussion Eccrine porocarcinoma (EPC) represents 0.005% of all malignant epithelial neoplasms . Majority patients older, peak incidence 67 yrs. M=F, a slight predominance in women. 20 % of EPC recur after excision, 20 % have nodal metastasis, 12 % develop distant metastasis. Patients with metastasis have a high mortality rate

16. Histogenesis Forms in the intraepidermic ductal portion of the sweat gland. Etiology remains unknown (EPC arises from malignant transformation of Eccrine Poroma ). Diagnosis of EPC requires clinical, histopathological and IHC characterization.

17. Prognosis Histological findings that predict the worse prognosis are - lymphovascular invasion, - mitotic index of >14 mitotic cells/ hpf - tumoral depth of more than 7 mm. No standard therapeutic protocol for EPC. Wide excision with clear margins (HPE) is treatment of choice. Infiltrative tumour margin has influence on local recurrence.

18. References 1. Murilo de Almeida Luz,I Daniel Cury Ogata,II Marcos Flávio Gomes Montenegro eccrine porocarcinoma (malignant eccrine poroma ): a series of eight challenging cases CLINICS 2010;65(7):739-42 2. Ugo Marone, Corrado Caracò, Anna Maria Anniciello, Gianluca Di Monta Metastatic eccrine porocarcinoma : report of a case and review of the literature Marone et al. World Journal of Surgical Oncology 2011, 9:32 3. Harish S. Permi & Shubha P. Bhat Kishan Prasad H. L. Eccrine Porocarcinoma of Scalp: An Uncommon Tumor at an Unusual Site Indian J Surg Oncol (April–June 2011) 2(2):145–147