sweat gland cancer
Introduction
Introduction to sweat gland cancer Syringocarcinoma (syringocarcinoma) is a malignant tumor that mainly occurs in the apocrine glands and has invasive and metastatic disease. It is a rare skin malignant tumor, accounting for 2.2% to 8.4% of skin malignant tumors. It occurs in 40 to 60 years old, and women are more common than men. Most occur in the scalp, face, underarms, chest wall, scrotum and around the anus, and can be single or multiple. basic knowledge The proportion of illness: 0.001% Susceptible people: good for women aged 40 to 60 Mode of infection: non-infectious complication:
Cause
Causes of sweat gland cancer
The cause is not clear. According to the location of the tumor cells in the sweat glands, there are points of apocrine adenocarcinoma and small sweat gland cancer.
1. The carcinoma of large sweat gland occurs in the apocrine glands, often a substantial, invasive and metastatic malignant tumor, classified into 5 types according to histopathological features:
(1) Undifferentiated type: There are two kinds of cancer cells, one kind of cytoplasm is transparent or dyed with red and red, which is small polygon or oval; the other kind of cytoplasm is dark red, fusiform, and the cancer cells are obvious. Shaped, arranged in a strip or plaque, with a tendency to form glands, no PAS staining positive substances (Figure 1).
(2) Differentiation type: There are also two types, which are the same as undifferentiated type, but the cytoplasm is lightly stained, and the cells are large polygons or cuboids. The cancer cells are intertwined and arranged in a nodular shape, which tends to form glandular cavity or In the cyst, some cancer cells contain PAS-positive substances.
(3) gland type: composed of cuboidal or columnar epithelial cells, forming glandular cavity, PAS staining positive substance in glandular epithelial cells and glandular cavity.
(4) Mucous epidermis: it consists of atypical squamous cell nests and columnar cells containing transparent mucus or granules.
(5) Eczema-like cancer type: cancer cells invade the local epidermis.
2. The carcinoma of eccrine gland (carcinoma of eccrine gland) occurs in the small sweat glands, often a substantial, invasive malignant tumor, according to its histopathological features are divided into four types:
(1) syringoid eccrine carcinoma: the tumor cells involve the entire dermis and even the subcutaneous tissue, and there is an enlarged catheter lumen opening to the skin surface, which is connected with the epidermis of the arachnoid hypertrophy or verrucous hyperplasia. Adenoid cystic structures connected to each other, and keratinous cysts can be seen. The size of the tumor cells is different, the nucleus is deeply stained, the division is easy to see, the interstitial blood vessels are rich or fibrotic or even cartilage-like, and the electron microscopy shows the inside of the glandular cavity. The lining epithelium may have keratinized or ductal cells, see also secretory cells.
(2) clear cell eccrine gland carcinoma: also known as malignant clear cell hidroadenoma, clear cell hidroadenocarcinoma, malignant terminal cell Clear cell hidroadenoma), which is metaplasticized from benign and transparent sweat gland cells. Histopathology shows that its tumor cells invade the surrounding tissues, the boundaries are unclear, and the tumors are substantially visible. Adenoid and ductal cystic regions and tumor clear cells and atypical cells (figure 2).
(3) mucinous eccrine carcinoma: the tumor parenchyma is a small nest or adenoid structure composed of small basal-like cells. The duct and microcyst structure are small and sweaty, and the cells are obvious except for the size and shape. Atypical, they are fused together or separated by hardened collagen, the nucleus is deeply stained, occasionally mitotic figures, and the interstitial has obvious mucus pits.
(4) eccrine adenocarcinoma (eccrine adenocarcinoma): a typical small sweat gland cancer, rapid growth, high metastasis, histopathology shows the same tumor in addition to the substantial, catheter, basal-like cells and squamous cell-like masses, mainly For glandular cystic structures, tumor cells, especially transparent cells, have small sweat gland enzymes and glycogen. Therefore, PAS staining can help distinguish between cell-rich small sweat gland cancer and metastatic adenocarcinoma.
Prevention
Sweat adenocarcinoma prevention
1. For precancerous lesions of the skin such as albinism, pigmented dry disease, X-ray and laser dermatitis ulcers, should be vigilant to prevent the occurrence of this disease, if necessary, for histopathological examination.
2. Avoid excessive sun exposure, avoid long-term contact with various rays and chemical poisons, and pay attention to timely diagnosis and treatment of chronic inflammatory or ulcerative skin lesions.
3. The prognosis of skin cancer is good, especially basal cell carcinoma, which can be combined with comprehensive treatment. For the second treatment, it must not be considered as palliative treatment.
4. Diet should be rich in vitamin A and vitamin C, eat ginger, raw onions, garlic, pepper and other irritating foods, quit smoking and alcohol.
5. Keep the area clean and prevent infection.
Complication
Sweat adenocarcinoma complications Complication
Metastasis can occur, with local lymph nodes and visceral metastases being the most common.
Symptom
Sweat gland cancer symptoms common symptoms nodular skin adhesion skin metastasis
1. Apocalyptic adenocarcinoma: both men and women can be sick, more common in the armpits, areola and perineum, male breasts, scalp, eyelids and other parts can also occur, often single, even or multiple, hard, more than 2cm in diameter , up to 20cm or more, often adhere to the surface of the skin, the surface of the skin is normal or slightly red, sometimes with telangiectasia, can be broken into cauliflower-like, slow growth, but can suddenly increase, easy to relapse after resection, often Regional lymph node metastasis.
2. Small sweat gland cancer: occurs in the scalp and face (such as eyelids), limbs (such as hands, feet), often a single, manifested as invasive plaque, can cause alopecia in the scalp, in addition to mucinous small sweat gland cancer In addition, all other types grow fast and are highly transferable.
Examine
Examination of sweat gland cancer
Mainly rely on histopathological examination. Pathologically, according to the source of tumor cells, there are points of apocrine adenocarcinoma and small sweat gland cancer. Apocalyptic adenocarcinoma can be divided into 5 types, and small sweat adenocarcinoma can be divided into 4 types, as follows:
Apocrine adenocarcinoma
It occurs in the apocrine glands and is often a malignant tumor that is substantial, invasive, and metastatic. According to histopathological features, it is divided into 5 types:
(1) There are two kinds of cancer cells in the undifferentiated type, one kind of cytoplasm is transparent or dyed with reddish-yellow, which is small polygon or oval; the other cytoplasm is dark reddish and fusiform. The cancer cells are obviously shaped, arranged in a strip-like or plaque-like tendency to form glands, and there is no positive substance for PAS staining.
(2) There are also two types of different types of differentiation, but the cells with lightly stained cytoplasm are large polygonal or cubic. The cancer cells are intertwined and arranged in a nodular shape, tending to form a glandular cavity or a cystic cavity. Some cancer cells contain PAS-positive substances.
(3) The glandular type consists of cuboidal or columnar epithelial cells, and PAS staining positive substances are found in the glandular gland epithelial cells and glandular cavities.
(4) The mucoepidermoid type consists of atypical squamous cell nests and columnar cells containing transparent mucus or granules.
(5) Eczema-like cancerous cancer cells invade the local epidermis.
2. Small sweat gland cancer
It occurs in the small sweat glands and is often a substantial, invasive malignant tumor. According to its histopathological features are divided into four types:
(1) sweat duct-like small sweat gland adenocarcinoma cells involve the entire dermis and even subcutaneous tissue, and there is an enlarged catheter lumen opening to the skin surface, which is connected with the epidermis of the acanthosis hypertrophy or verrucous hyperplasia. There are ductal adenoid vesicular structures connected to each other and keratinous cysts are visible. Tumor cells are not so large in size. The split is easy to see. The interstitial blood vessels are rich or fibrotic and even cartilage-like. Electron microscopy showed that the lining epithelium of the glandular sac cavity may have keratinized or ductal cells, see also secretory cells.
(2) Clear cells Small sweat gland cancer, also known as malignant transparent cell sweat adenoma, clear cell sweat gland cancer, malignant transparent cell terminal sweat duct tumor, is derived from benign transparent sweat gland cells. Histopathology showed that its tumor cells invaded the surrounding tissues and the boundaries were unclear. Substantial adenoid and ductal cystic areas and neoplastic clear cells and atypical cells are seen in the tumor.
(3) Mucinous apocrine adenocarcinoma is a small nest or adenoid structure composed of small basal-like cells. Catheters and microcapsules resemble small sweat glands, except for their size and shape. The cells are clearly atypical, fused to each other or separated by sclerosing collagen. Deep smear of the nucleus, occasionally, the mitotic interstitial has obvious mucus pits.
(4) Small sweat gland adenocarcinoma is a typical small sweat gland cancer with rapid growth and high metastasis. Histopathology showed that in the same tumor, except for the substantial, ductal, basal-like cells and squamous cell-like masses, mainly glandular cystic tumor cells, especially transparent cells, had small sweat gland enzymes and glycogen. Therefore, PAS staining can help distinguish between eutrophic small sweat gland cancer and metastatic adenocarcinoma.
Diagnosis
Diagnosis and identification of sweat adenocarcinoma
Diagnostic criteria
1. History: In the upper 40 years old, the old people have nodules or ulcers.
2. Clinical features
(1) apocrine adenocarcinoma: nodules occur in the abundance of sweat glands such as underarms. They are exogenous and solid, red or purple, with toughness and no symptoms. Even rupture is cauliflower-like and painful.
(2) Small sweat gland cancer: a rapidly growing infiltrating plaque that occurs on the head, face or limbs.
3. Pathological diagnosis
To diagnose this cancer, we must first rule out metastatic adenocarcinoma of the skin, especially those with enlarged lymph nodes.
Differential diagnosis
The disease is sometimes differentiated from fibrosarcoma, malignant neurofibroma or dermatofibrosarcoma and synovial sarcoma, but histopathological examination can confirm the diagnosis.
