extramammary eczematoid carcinoma
Introduction
Introduction to extramammary eczema-like cancer Extramammary eczema-like carcinoma (extramammaryeczematoidcarcinoma, EMPD) is a malignant tumor originating from the opening cells of the apocrine gland or pluripotent stromal cells differentiated from the epidermis to the apocrine glands. More common in the elderly over the age of 50. Occurs in the perineum and other parts of the apocrine gland. Clinically, eczema-like skin lesions with clear boundaries and long-term unhealed are the main manifestations. Surgical resection is the main treatment, but there may be recurrence. basic knowledge The proportion of illness: 0.005% Susceptible people: more common middle-aged and older people over 50 years old Mode of infection: non-infectious Complications: pruritus
Cause
Extramammary eczema-like cancer
1. Microscopic features
(1) The tumor cells are distributed in a single or cluster in the epidermis, and the epidermal cells around the lesions, especially the basal cells, are obviously compressed, and can be gathered into the glandular cavity in the lower part of the epidermis.
(2) The tumor cells are large and round, with no intercellular bridges, large nuclei, abundant cytoplasm and lightly stained or vacuolated.
(3) The epidermal dermal interface is clear, and the tumor cells can appear in the hair follicle epithelium and sweat gland ducts, but generally do not invade the dermis.
(4) Chronic inflammatory cell infiltration in the superficial dermis.
(5) Sometimes deep sweating or small sweat gland cancer can be seen.
2. Chemical dyeing
(1) PAS staining, partial cytoplasmic positive, and resistant to amylase (containing rogue protein).
(2) Alcian blue staining (PH2.5) was positive for some cells and resistant to hyaluronidase.
(3) Dopa reaction, tumor cells occasionally melanin, but this reaction was negative.
3. Immunohistochemical staining (PAP method) Carcinoembryonic antigen staining, tumor cells were positive, keratinocytes were negative; cytokeratin staining of glandular epithelium, tumor cells were positive.
4. Enzymatic histochemical staining of acid phosphatase, esterase, aminopeptidase and succinate dehydrogenase (apocrine genotype) reaction, tumor cells were positive.
5. Ultrastructural features under electron microscopy:
(1) The cancer cells are large, the cytoplasmic electron density is low, and there is a small amount of tensile fibrils.
(2) There is no desmosome, or there may be a small amount of desmosome between the tumor cells and the keratinocytes between the tumor cells.
(3) The surface of the tumor cells may have a large amount of microvilli or intercellular tubules.
(4) Sometimes several tumor cells can be arranged around a small cavity.
(5) The Golgi complex in some cytoplasm of tumor cells is developed, with a large number of expanded rough endoplasmic reticulum, secretory granules, and intercellular tubules.
Prevention
Extramammary eczema-like cancer prevention
It is mainly aimed at preventing various factors that may lead to extra-emulsion eczema-like cancer. It is currently believed that the loss of normal immune surveillance function, the carcinogenic effects of immunosuppressants, the activity of latent viruses and the long-term application of certain physical (such as radiation), chemical (such as anti-epileptic drugs, adrenocortical hormones) substances may lead to Cancer, therefore, pay attention to personal and environmental hygiene, avoid drug abuse, and pay attention to personal protection when working in a harmful environment.
Complication
Extramammary eczema-like cancer complications Complications pruritus
The skin is mildly erosive and proliferates.
Symptom
Extramammary eczema-like cancer symptoms Common symptoms Mild skin erosion, itching scales, chest acne
The disease occurs in the apocrine glands, such as the external genital area, a few found in the perineum and perianal, even or umbilical fossa, underarm, forearm, neck, parotid gland distribution (outer ear canal) and Moll gland distribution (eyelid).
Most of the lesions are single-shot, a few are multiple, and it is rare in two different parts. The lesions are slightly uplifted, light brown to brown, flushed, smashed, covered with scales and suede, with clear boundaries. Itching, painful feeling, a small amount of bleeding, but in the perianal and perineal area may be like a papillary or papillary tumor, the female genital lesions sometimes resemble proliferative erythema, the damage diameter from 0.4 to 12cm, an average of about 3cm.
Examine
Examination of extraembryal eczema-like cancer
Histopathological examination: Paget cells in the epidermis are distributed in a single or cluster. The cells are large and round, with no intercellular bridges, large nuclei, abundant cytoplasm and lightly stained or vacuolated.
Diagnosis
Diagnosis and diagnosis of extraembryonic eczema-like cancer
diagnosis
The diagnosis of this disease is generally not difficult, the key is to increase vigilance.
1. Clinical features Older people over the age of 50 occur in the external genital area or the perianal long-term unhealed, and the border has obvious eczema-like skin damage.
2. Pathological diagnosis.
Differential diagnosis
1. Eczema skin lesions are itchy, often bilaterally symmetrical, only occurs in the areola and surrounding skin and generally does not invade the nipple.
2. The boundary between the vacuole cells of Bowen disease and the surrounding epidermal cells is clear. There are multinuclear epidermal cells and individual keratinocytes. The tumor cells are positive for PAS, but not amylase.
3. In situ malignant melanoma (Paget disease-like) Tumor cells can be directly connected to the dermis, and often invade the dermis, PAS reaction is positive, dopa reaction is positive.
