Adenocarcinoma with Signet Ring Cells of the Axilla: Two Case Reports and Review of the Literature

Abstract

Adenocarcinoma with signet ring cells (ASRC) is a rare skin neoplasm whose histology shows a solid tumor intermingled with signet ring cells in variable numbers. There have been only ten reported cases. All were elderly males affected on the eyelids except for a single case in the axilla. Two new patients with ASRC of the axilla are described. In both of them, immunohistochemical studies revealed neoplastic cells that had differentiated toward apocrine glands. These are the second and third reported cases of ASRC in the axilla, one of them is the first ASRC case in a female. It seemed that the apocrine sweat gland or aberrant breast tissue in the axilla were possible origins of these tumors.

Primary cutaneous signet ring cell carcinoma expressing cytokeratin 20 immunoreactivity

“…[17][18][19] Recently, a few cases involving the axilla have been reported. 20,21 None of the reported cases had any detectable primary internal malignancies. Previous investigators have agreed that PCSRCC is of eccrine origin, 14,16,18 while recent investigators have insisted on an apocrine origin.…”

Spindle Cell Thymomas (WHO Type A) With Prominent Papillary and Pseudopapillary Features

“…3,8,11,19,31,[35][36][37]46,63,70 In contrast, CK 20 has been reported as positive in some cases 31,70 and negative in other cases. 19,36,37,63 Furthermore, CK5/6, Ca 19.9, S-100 protein, ASMA, SMA, calponin, bcl-2, and c-erbB-2 are usually negative.…”

“…3,7,8,11,[19][20][21]27,[30][31][32][35][36][37]44,46,55,63,65,69,70 In brief, the clinical features of the 33 studied cases are the following: 27 neoplasms arose in male patients and 6 in female patients, which clearly shows a male predominance for the neoplasm. The age ranged from 42 to 87 years (median, 65.87 y).…”

“…5 Primary cutaneous signetring cell carcinoma is a rare and aggressive neoplasm. 3,7,8,11,19,20,21,27,30,31,32,[35][36][37]44,46,55,63,65,69,70 Usually, this carcinoma involves the dermis and subcutis of the eyelid diffusely, without epidermal involvement and, more rarely, the axillary skin. Although the eccrine or apocrine differentiation of this neoplasm remains controversial, neoplastic cells show signet-ring cell or histiocytoid morphology; thus, the neoplasm has received several names, including eccrine sweat gland tumor of clear cell origin, 55 adenocarcinoma of eccrine sweat glands, 21 primary mucinous sweat gland carcinoma, 65 primary infiltrating signet-ring cell carcinoma, 27 and primary histiocytoid carcinoma of the eyelid.…”

A brief review of different types of sweat-gland carcinomas in the eyelid and orbit

“…Thus, early detection and radical excision or exenteration is considered the preferred treatment of choice, but local radiotherapy may have a beneficial effect in retarding the spread of the disease 45. Adjuvant therapies such as radiotherapy or 5-fluorouracil chemotherapy have been proven to increase life expectancy 42,46. In axillary cases with a probable breast origin, estrogen and progesterone receptors chemotherapy are proposed, such as tamoxifen therapy, as is done in lobular infiltrating breast carcinoma.…”