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CASE REPORT  
Year : 2013  |  Volume : 56  |  Issue : 3  |  Page : 297-299
Dermal duct tumor with prominent ductal and sebaceous differentiation


Department of Pathology, 251th Hospital of PLA, Zhang Jiakou, Hebei Province 075000, P. R. China

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Date of Web Publication24-Oct-2013
 

   Abstract 

Dermal duct tumor is a rare, benign tumor. Clinically, dermal duct tumor presents as a firm papule, plaque or nodule, particularly on the lower limbs or head and neck region. Dermal duct tumor is been classified as poroma. Poroma can have divergent differentiation, but showing prominent ductal and sebaceous differentiation is rare. We present a case of dermal duct tumor with prominent ductal and sebaceous differentiation arising in the scalp. A 45-year-old man with a painless slow-growing, elevated, brownish nodule on his scalp of 7-year duration was admitted to our hospital. Histopathology revealed dermal duct tumor. The neoplasm also showed prominent ductal and sebaceous differentiation.

Keywords: Ductal, poroma, sebaceous

How to cite this article:
Huang Y. Dermal duct tumor with prominent ductal and sebaceous differentiation . Indian J Pathol Microbiol 2013;56:297-9

How to cite this URL:
Huang Y. Dermal duct tumor with prominent ductal and sebaceous differentiation . Indian J Pathol Microbiol [serial online] 2013 [cited 2020 May 25];56:297-9. Available from: http://www.ijpmonline.org/text.asp?2013/56/3/297/120404



   Introduction Top


Poroma is a benign cutaneous adnexal neoplasm, which has been classified as eccrine or apocrine lineage. If poroid and cuticular cells involving the dermis, the neoplasm would be better classified as dermal duct tumor rather than as classic poroma. Poroid tumors can have divergent differentiation such as sebaceous, follicular and apocrine differentiation. We report herein a rare dermal duct tumor of the scalp with prominent ductal and sebaceous differentiation.


   Case Report Top


A 45-year-old Chinese man was admitted to our hospital with a painless slow-growing, elevated, brownish nodule on his scalp of 7-year duration. The nodule was well-circumscribed, non-ulcerative and 2.5 × 2.3 × 1.5 mm in size. He had no trauma or operation history.

Microscopically, the lesion was mainly located in the dermis and was also attached to the epidermis [Figure 1]. The lesion consisted of well-defined nests of cuboidal poroid cells with lightly basophilic round nuclei and moderate amounts of pale to lightly eosinophilic cytoplasm, which proliferated into the deeper dermis. Many ductal structures, namely as a unique large vacuole among the cells were also observed forming clusters; some were intermingled with the poroma cells [Figure 2] or isolatedly located in the dense stroma [Figure 3]. Within the nests, clusters of mature sebocytes with vacuolated cytoplasm were observed [Figure 4]. Small and big cystic changes were also found in the lesion. Some vacuolated and cuboidal tumor cells were intraepidermally arranged. No nuclear atypia or mitosis was encountered. Based on these findings, a diagnosis of dermal duct tumor with prominent ductal and sebaceous differentiation was made.
Figure 1: The tumor is mainly located in the dermis with areas attached to the epidermis (H and E, original magnification: ×20)

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Figure 2: Unique large vacuole among the cells were also observed forming clusters or intermingled with the poroma cells (H and E, original magnification: 100)

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Figure 3: Aggregations of vacuole cytoplasm isolatedly located in the dense stroma (H and E, original magnification: ×200)

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Figure 4: Within the nests, clusters of mature sebocytes with vacuolated cytoplasm were observed (H and E, original magnification: ×400)

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   Discussion Top


The term dermal duct tumor was coined in 1966. The term eccrine acrospiroma was coined for a morphologically diverse group of tumors, which are thought to differentiate toward the distal part of the sweat duct. Three categories have been proposed: Intraepidermal (hidroacanthoma simplex), juxtaepidermal acrospiroma (poroma) and intradermal (dermal duct tumor) acrospiroma. Reports of poromas with combined sebaceous, follicular and ductal differentiation suggest that some are apocrine origin because of the common embryologic derivation of the folliculosebaceous-apocrine unit. [1],[2],[3],[4],[5],[6],[7] Poroma arising in the scalp is common, but dermal duct tumor with prominent ductal and sebaceous differentiation involving in the scalp just like our case is extremely rare. Our case is unusual in that it was not only predominantly dermal-based, but also intraepidermally arranged. Prominent ductal and sebaceous differentiations were also very notable and unusual.

Reviewing the literature, there have been reports benign poroma-like adnexal neoplasms with divergent differentiation. Hanau et al. [1] proposed using complex poroma-like adenoma and Zaim [2] proposed using sebocrine adenoma for such type differentiation. The folliculocentric nature of poroma with divergent differentiation along with embryologic relationship between follicular and apocrine structure suggest that those neoplasms were "apocrine" rather than eccrine poromas.

Eccrine differentiation of many sweat gland tumors is controversial. They may arise from follicullosebaceous-apocrine germ and therefore show apocrine rather than eccrine differentiation. In our case, ductal and sebaceous differentiation suggested an apocrine lineage, and foci follicular differentiation was also found. Recent studies have demonstrated the existence of apocrine poromas that can be designated as benign skin tumors with sebaceous, follicular and apocrine differentiation. Follicular and/or sebaceous differentiation within a glandular neoplasm can be considered indirect evidence of apocrine differentiation. [8] In our opinion, the degrees and types of differentiation could represent so many entities, just like apocrine poroma, sebocrine adenoma, infundibular adenoma and so on. [2] Our case might be explained by a phenomenon of multidirectional differentiation involving the pluripotential cells with an adnexal structure. [9] These finding are consistent with the theory of a common embryological origin for the three adnexal components as a folliculosebaceous-apocrine unit and eccrine gland from embryonal stratum germinatum.

Although poroma with ductal and sebaceous differentiation was not very frequent, ductal and sebaceous differentiation may be a common feature in skin tumors.

 
   References Top

1.Hanau D, Grosshans E, Laplanche G. A complex poroma-like adnexal adenoma. Am J Dermatopathol 1984;6:567-72.  Back to cited text no. 1
    
2.Zaim MT. Sebocrine adenoma. An adnexal adenoma with sebaceous and apocrine poroma-like differentiation. Am J Dermatopathol 1988;10:311-8.  Back to cited text no. 2
    
3.Kurashige Y, Yamamoto T, Okubo Y, Tsuboi R. Poroma with sebaceous differentiation: Report of three cases. Australas J Dermatol 2010;51:131-4.  Back to cited text no. 3
    
4.Takemoto Y, Ochiai T. Asymptomatic nodule on the left buttock. Am J Dermatopathol 2007;29:593-4, 601.  Back to cited text no. 4
    
5.Kazakov DV, Kutzner H, Spagnolo DV, Kempf W, Zelger B, Mukensnabl P, et al. Sebaceous differentiation in poroid neoplasms: Report of 11 cases, including a case of metaplastic carcinoma associated with apocrine poroma (sarcomatoid apocrine porocarcinoma). Am J Dermatopathol 2008;30:21-6.  Back to cited text no. 5
    
6.Lee NH, Lee SH, Ahn SK. Apocrine poroma with sebaceous differentiation. Am J Dermatopathol 2000;22:261-3.  Back to cited text no. 6
    
7.Misago N, Mihara I, Ansai S, Narisawa Y. Sebaceoma and related neoplasms with sebaceous differentiation: A clinicopathologic study of 30 cases. Am J Dermatopathol 2002;24:294-304.  Back to cited text no. 7
    
8.Abenoya P, Ackerman AB. Neoplasms with Eccrine Differentiation. Philadelphia, PA: Lea & Febiger; 1990. p. 11-42.  Back to cited text no. 8
    
9.Wong TY, Suster S, Cheek RF, Mihm MC Jr. Benign cutaneous adnexal tumors with combined folliculosebaceous, apocrine, and eccrine differentiation. Clinicopathologic and immunohistochemical study of eight cases. Am J Dermatopathol 1996;18:124-36.  Back to cited text no. 9
    

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Correspondence Address:
Yong Huang
Department of Pathology, 251th Hospital of PLA, Zhang Jiakou, Hebei Province 075000, P. R. China

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.120404

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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    Abstract
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