ABSTRACT: Background: Skin adenexal tumors are large and diverse group of skin tumors that are classified according to embryologic and histologic features into sweat gland tumors (eccrine, apocrine), follicular and sebaceous. Usually they are rare tumors, clinically misdiagnosed, histology helps in establishing the diagnosis .
Aim: To study histopathology of skin adnexal neoplasms and to correlate with the clinical profile. Materials and Methods: Prospective & retrospective study was conducted in the Department of Pathology MKCG Medical College over a period of 5 years. Total 31 cases were included, diagnosed to have Skin adnexal neoplasm and confirmed by histopathology. All the specimens were formalin fixed, processed and stained with H&E and special stains wherever necessary. Tumors with follicular differentiation constituted the maximum number, 15 cases(48.
4%) followed by eccrine tumor 13cases(42%);tumours of apocrine differentiation 3 cases(9.6%). Conclusion: Cutaneous adnexal neoplasms are relatively uncommon neoplasm with distinct histological features, commonly distributed in head and neck region, with slight male predominance in our study.Keywords:Cutaneous adnexal tumor, Histopathology, SAT (Skin adnexal tumor).INTRODUCTION: Cutaneous adnexal neoplasms are a large and varied group of neoplasms which differentiate towards pilosebaceous apparatus, apocrine and eccrine sweat glands 1–3.
However, the apparent differentiation is not always distinct and some tumors can display elements of mixed differentiation. These divergences can be due to their origin from pluripotent stem cells 1–4. Usually SATs present as papules and nodules usually solitary lesion, but have distinct histological features 1–5. Most SATs are benign. However, diagnosing them may have important implications as they might be markers for syndromes associated with internal malignancies, such as trichilemmomas in Cowden’s disease and sebaceous tumours in Muir –Torre syndrome 1–3. Malignant tumors are rare, aggressive, have the potential for nodal involvement and distant metastasis with a poor clinical outcome 1–4. Therefore, establishing the diagnosis of malignancy in SATs is important for therapeutic and prognostic purposes.
In this study we have analysed the frequency, clinical features, gross and microscopic features and the differentiating features between benign and malignant SATs. This study was undertaken to analyze the morphological ,clinical & histological features of Skin adenexal tumor at our center over a period of five years. MATERIALS AND METHODS:A combined prospective & retrospective study was done. Review of all skin adnexal neoplasms reported in the Department of Pathology, MKCG Medical College during the period January2013toDecember2017was done.
31 cases were there in total. Clinical detail of patients’ were documented including age, sex, clinical diagnosis & gross examination. The histopathological examination was done on formalin fixed tissues and paraffin embedded blocks. Haematoxylin &Eosin stained sections were examined and few special stains like PAS & reticulin were performed wherever required. All the slides were reviewed.
The concordance of clinical and histopathological diagnosis was all so assessed.RESULTS: In the present study total 31 cases were found as skin adenexal tumor over a period of 5years. Majority of tumors were benign adnexal tumors, constituted 93.
5% (29/31) cases and minority were malignant adnexal tumors, constituted 6.5% (2/31) cases ( Fig-1). The hair follicle tumors constituted the largest group involving 48.4% (15/31) cases followed by the sweat gland tumors 42 % (14/31) cases (Table 1). The hair follicle tumors are comprised of 10 proliferating trichilemmal cysts, 3cases of pilomatrixoma, trichoepithelioma 1 case, trichofolliculoma1case. The sweat glands tumors are comprised of nodular clear cell hidradenoma 7 cases, chondroidsyringoma 4 cases, apocrine hidrocystoma 2 cases, and syringocystadenomapapilliferum one case.. Amongst the benign tumors; proliferating trichilemal cyst (32.
3%, 10/31) and clear cell hidradenoma(22.6%,7/ 31) were the most common tumors. Amongst the malignant tumors,malignant hydradenoma and malignant poroma were the only malignant tumors observed with one case each. The frequency distribution of various lesion is shown inTable-1.The head and neck region was the most common site affected (77.4 %, 16/31) followed by extrimities.(Table-2).The age of patients’ varied from 8years to 79 years.
However, the highest incidence was observed in the age group of 41-50 years (25.8%, 8/31) (Fig-2). Considering sex , male preponderance was seen.
The male -to- female ratio was 1.07:1 .