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Review
. 2023 Aug 16;59(8):1465.
doi: 10.3390/medicina59081465.

Mixed Eccrine Cutaneous Tumor with Folliculo-Sebaceous Differentiation: Case Report and Literature Review

Dimitrinka Kisova  1 , Tihomir Dikov  1 , Vesela Ivanova  1 , Hristo Stoyanov  2 , Greta Yordanova  3
Affiliations
Review

Mixed Eccrine Cutaneous Tumor with Folliculo-Sebaceous Differentiation: Case Report and Literature Review

Dimitrinka Kisova et al. Medicina (Kaunas). .

Abstract

Background/Introduction: Cutaneous mixed tumor is a rare benign neoplasm that exhibits a wide range of metaplastic changes and differentiation in the epithelial, myoepithelial, and stromal components, which is often confused with various other skin lesions. Case report: We present an unusual case of a 58-year-old woman with a mixed tumor of the upper lip, previously misdiagnosed as adnexal carcinoma on a preoperative biopsy. The excision biopsy shows a well-circumscribed lesion composed of various cells and structures featuring folliculo-sebaceous differentiation embedded in a prominent chondromyxoid stroma. The immunohistochemical study proves the various lineages of differentiation and classifies the neoplasm as the less common eccrine subtype of cutaneous mixed tumor. Discussion: The common embryologic origin of the folliculo-sebaceous apocrine complex leads to a great histological variety of cellular components of mixed tumors and the formation of structures that resemble established types of adnexal neoplasms, which could be a diagnostic pitfall, especially on a small incision biopsy.

Keywords: adnexal; eccrine mixed tumor; histopathology; skin; tumors.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A firm nodule on the upper lip area.
Figure 2
Figure 2
Well circumscribed subcutaneous tan lesion.
Figure 3
Figure 3
Two weeks after surgery.
Figure 4
Figure 4
(A) Tubular structures and solid areas in a mixochondroid background. (B) Infundibular cysts in various sizes with corneocytes in lamellar pattern. (C) Follicular germlike structures, (small aggregations of germinative cells with peripheral palisading, with or without associated whorls of delicate collagen bundles and thin fibroblasts). (D) Comma/tadpole shaped ducts; syringoma like eccrine structures. (E) Cells resembling those of the internal epithelial sheath (trichohyalin granules).
Figure 5
Figure 5
(A) Sebaceous gland elements (black arrows). (B) Shadow cells (red arrow). (C) Lipomatous metaplasia—mature adipocytes with intranuclear inclusions—Lochkern. (D) Physaliphorous-like cells. (E) Intracytoplasmic vacuoles.
Figure 6
Figure 6
H&E stained slides from the first incisional biopsy of the patient.
Figure 7
Figure 7
(A,B) CEA and EMA, respectively, showing positive staining in the luminal epithelial cells as well as in the secretory material but overall negativity in the neoplastic cells. (C) Positive expression of CK14/5 in the epithelial cells. (D) GCDFP15 positivity is a single neoplastic tubule. (E) BerEP4 positivity in a portion of the neoplastic tubules. (F) p63 positive staining is shown in the outer layer of the neoplastic tubules as part of the myoepithelial component.
See this image and copyright information in PMC

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