Mucinous Carcinoma of the Skin: Evaluation of Lymphatic Invasion With D2-40

Abstract

Primary cutaneous mucinous carcinoma is a rare adnexal sweat gland neoplasm that mainly affects elderly people. Differential diagnosis includes mammary and gastrointestinal metastatic mucinous carcinoma (MC) and secondary cutaneous involvement by underlying neoplasms. An 83-year-old woman presented with an 8-year history of slow-growing infiltrate plaque in her right hemithorax, with ulceration on supraclavicular area, right upper limb edema and palpable axillary lymphadenopathies. She underwent partial excision of the tumor and local radiotherapy. Imaging studies showed widespread cutaneous dissemination with enlargement of ipsilateral axillary lymph nodes but without evidence of underlying breast cancer. Histopathological examination showed large amounts of mucin in the dermis including small islands of epithelial cells. They stained positive for cytokeratin 7, carcinoembryonic antigen, epithelial membrane antigen, gross cystic disease fluid protein-15, and c-erbB-2. Lymphatic invasion was demonstrated by D2-40-immunostained sections. A diagnosis of primary cutaneous mucinous carcinoma was made. Our aim was to reevaluate the differential clinical, histopathological, and immunohistochemical criteria for distinguishing primary cutaneous mucinous carcinoma from skin metastases of visceral mucinous carcinoma, especially those arising in breast. We also propose D2-40 as a reliable marker to detect lymphatic invasion that indicates a strong aggressive trend with shorter recurrence-free and predicts nodal metastases.

Malignant sweat gland tumours: an update

“…The characteristic histological features of mucinous carcinoma are the presence of nests and strands of epithelial cells imbedded in abundant pools of mucin that are separated from each other by thin fibrous septae (Figure A,B). However, histological features seem to be more variable than described in most reports, and lesions can have a significant proportion of solid areas …”

“…PCMC is a rare tumour that presents most often on the scalp and face (with a significant proportion of cases arising on the eyelid), and shows predilection for elderly female patients . It is usually slow‐growing, with an indolent behaviour.…”

Primary mucinous carcinoma of the skin in the hypogastric region: A case of regional lymph node metastases 2 years after surgery

“…Paradela et al. 5 proposed D2‐40 as a reliable marker to detect lymphatic invasion that indicates a strong aggressive trend with a shorter recurrence‐free period and predicts nodal metastases. Although PMCS is usually an indolent tumor with slow growth and rare metastasis, additional imaging studies and oncologic evaluation after surgery should be performed for early diagnosis of metastasis.…”

Primary Cutaneous Mucinous Carcinoma of the Vulva Displaying a Papillary Pattern

“…Primary cutaneous mucinous carcinoma (PCMC) typically presents as a slowly growing nodule in the head and neck region in the elderly individuals [1,2]. A vulvar location of this tumor is extremely rare and has been documented only in rare case reports [3].…”

“…Primary mucinous carcinoma of the skin is an uncommon but histologically distinct adnexal neoplasm that mainly affects the head and neck in the elderly population [1,2]. Primary cutaneous mucinous carcinoma of the vulva is extremely rare and very rarely shows a papillary pattern on histology.…”