Mucinous carcinoma of the skin
Long-standing translucent tumor on the groin.
García-Doval I, De la Torre C, Losada A, Toribio J, Cruces-Prado MJ.
Hospital Provincial de Pontevedra. Spain.
Discussion
Mucinous carcinoma of the skin is a rare cutaneous neoplasm.[1-3] The following are its main characteristics:
Main clinical features:[2,3]
- 800cated on the head.
- Slowly growing: described as dome shaped with a translucent hue or subcutaneous mass.
- Recurs locally: metastases infrequent.[4]
- Treatment of choice: surgery. Moh's surgery has been effectively used.[5,6]
- Must be distinguished from metastatic visceral mucinous carcinoma (breast, colon, stomach, lung, ovary or pancreas). There
should be no evidence of primary tumor at these sites.
Main histopathological features:[2,3,7]
- Dermal pools of pale-staining sialomucin separated by thin fibrous septa. Small cellular islands "float in the pools".
- Round or cuboidal cells, with a high nuclear:cytoplasmatic ratio. Some of them have vacuolated cytoplasm forming ductal lumina.
- Inflamation or atypia nearly absent.
Our case shows some peculiarities. It is in an infrequent location (10f mucinous carcinomas are in the inguinal region). It
was associated with multiple basal cell carcinomas and Bowen's disease, without clinical or laboratory signs of arsenicism,
nevoid basal cell carcinoma syndrome or xeroderma pigmentosum. Another outstanding feature is the evolution over thirty-five
years, which speaks in favor of a benign prognosis. A trend for local recurrence has been noted.
Histogenesis:[1]
The histogenenesis of mucinous carcinoma of the skin is debated. An apocrine origin seems more likely. Various arguments that
favor an apocrine or ecrine origin, are summarized:
Apocrine origin:[7]
- Decapitation secretion present in luminal cells, a typical feature of apocrine secretion.
- Histologically indistinguishable from breast colloid carcinoma. As the breast is considered to be a modified apocrine gland,
breast colloid carcinoma has an apocrine origin.
- Cells similar to neoplastic cells of pale-cell hidradenoma, a neoplasm of apocrine origin.[8]
- Plasmocytoid cells float in the lakes of mucin, an alleged apocrine feature.
- Positive staining for lactalbumin and gross cystic disease fluid protein-15.[9]
Ecrine origin:
- Admixture of dark and light cells, like the secretory portion of the ecrine coil.[10]
- Enzyme histochemistry similar to that found in ecrine secretory epithelium: positive reactions with succinate dehydrogenase
and phosphorylase.[10]
- Immunohistochemical reaction against anti-CEA as other ecrine tumors.[11] Co-expression of cytokeratin and vimentin as fetal
secretory cells of the ecrine sweat glands.[12]
- Secretion similar to that of the dark, mucinous, cell of the ecrine coil by electron microscopy.[10] The findings of extracellular
mucin and accumulation of it to form intercellular canaliculi have also been considered to favor ecrine origin.[4]
References
1. Lennox B, Pearse AGE, Richards HGH. Mucin-secreting tumors of the skin: with special reference to the so-called mixed-salivary
tumour of the skin and its relation to hidradenoma. J Pathol Bacteriol 1952; 64: 865-80.
2. Karimipour DJ, Johnson TM, Kang S, Wang TS, Lowe L. Mucinous carcinoma of the skin. J Am Acad Dermatol 1996; 34: 323-6.
3. González-Vela MC, Mira Soto MC, Val-Bernal JF. [Mucinous carcinoma of the scalp. Immunohistochemical study and review of
the literature]. Actas Dermosifiliogr. 1997; 88: 270-5.
4. Pilgrim JP, Wolfish PS, Kloss SG, Heng MCY. Primary mucinous carcinoma of the skin with metastases to the lymph nodes.
Am J Dermatopathol 1985; 7: 461-9.
5. Snow SN, Reizner GT. Mucinous eccrine carcinoma of the eyelid. Cancer 1992; 70: 2099-104.
6. Weber PJ, Hevia O, Gretzula JC, Rabinovitz HC. Primary mucinous carcinoma. J Dermatol Surg Oncol 1998; 14: 170-2.
7. Requena L, Kiryu H, Ackerman AB. Ackerman´s Histopathologic diagnosis of Neoplastic Skin Diseases. Neoplasms with Apocrine
Differentiation. Philadelphia: Lippincott-Raven Publishers, 1998: 907-47.
8. Santa Cruz DJ, Meyers J, Gnepp DR, Pérez B. Primary mucinous carcinoma of the skin. Br J Dermatol 1978; 98: 645-53.
9. Carson HJ, Gattuso P, Raslan WF, Reddy V. Mucinous carcinoma of the eyelid. An immunohistochemical study. Am J Dermatopathol
1995; 17: 494-8.
10. Headington JT. Primary mucinous carcinoma of the skin: histochemistry and electron microscopy. Cancer 1977; 39:1055-63.
11. Fukamizu H, Tomita K, Inoue K, Takigawa M. Primary mucinous carcinoma of the skin. J Dermatol Surg Oncol 1993; 19: 625-8.
12. Muramatsu T, Takagi K, Yashiki A, Sakurai S, Honoki K, Shirai T. Mucinous carcinoma of the skin. Br J Dermatol 1995; 133:
820-1.