Are clinicians successful in diagnosing cutaneous adnexal tumors? a retrospective, clinicopathological study

Background/aim: Cutaneous adnexal tumors CAT are rare tumors originating from the adnexal epithelial parts of the skin. Due to its clinical and histopathological characteristics comparable with other diseases, clinicians and pathologists experience difficulties in its diagnosis. We aimed to reveal the clinical and histopathological characteristics of the retrospectively screened cases and to compare the prediagnoses and histopathological diagnoses of clinicians. Materials and methods: The data of the last 5 years were scanned and patients with histopathological diagnosis of CAT were included in the study. Results: A total of 65 patients, including 39 female and 26 male patients aged between 8 and 88, were included in the study. The female to male ratio was 1.5, and the mean age of the patients was 46.15 ± 21.8 years. The benign tumor rate was 95.4%, whereas the malignant tumor rate was 4.6%. 38.5% of the tumors were presenting sebaceous, 35.4% of them were presenting follicular, and 18.5% of them were presenting eccrine differentiation. It was most commonly seen in the head-neck region with a rate of 66.1%. When clinical and histopathological prediagnoses were compared, prediagnoses and histopathological diagnoses were compatible in 45% of the cases. Most frequently, it was the basal cell carcinoma, epidermal cyst, and sebaceous hyperplasia identified in preliminary diagnoses. Conclusion: Cutaneous adnexal tumors are very important, as they can accompany different syndromes and may be malignant. Due to difficulties in its clinical diagnosis, histopathological examination must be performed from suspicious lesions for definitive diagnosis.

___

  • 1. Ahmed TSS, Priore JD, Seykora JT. Tumors of epidermal appendages. In: Elder DE, Elenitsas R, Johnson BL, Murphy GF (editors). Lever’s Histopathology of the Skin. 9th ed. Philadelphia, PA, USA: Lippincott Williams and Wilkins; 2005. pp. 867-868.
  • 2. Zaballos P, Gómez-Martín I, Martin JM, Bañuls J. Dermoscopy of adnexal tumors. Dermatologic Clinics 2018; 36 (4): 397-412 doi: 10.1016/j.det.2018.05.007
  • 3. Massi D, Cree IA, Elder DE, Kazakov DV, Scolyer RA. Appendageal Tumours. In: Elder DE, Massi D, Scolyer RA, Willemze R. (editors). World Health Organization Classification of Skin Tumors. 4th ed. Argonay, France: IARC; 2018. pp.154-222.
  • 4. Güler Şimşek G, Yalçın GŞ. The World Health Organization Classification of Skin Appendageal Tumors: A Summary of the Changes of the 2018 (4th) Edition in Turkish: Deri Eki TümörlerinDünya Sağlık Örgütü Sınıflandırması:2018 (4.) Basım Değişikliklerinin Özeti. Journal of Current Pathology 2019; 1 (3): 15-20 doi: 10.5146/jcpath.2019.38
  • 5. Shrivastava V, Tangde A, Joshi A, Bindu R. Clinicopathological study of skin tumours. International Journal of Research in Medical Sciences 2019; 7 (5): 1712-1719 doi: 10.18203/2320- 6012.ijrms20191664
  • 6. Suri J, Mahajan D, Koul KK, Kumari R. A Clinicopathological analysis of skin adnexal tumours: four year retrospective study. Journal of Medical Education & Research 2016; 18 (4): 248- 251.
  • 7. Sharma A, Paricharak DG, Nigam JS, Rewri S, Soni PH et al. Histopathological study of skin adnexal tumours—institutional study in South India. Journal of Skin Cancer 2014; 2014: 543756. doi: 10.1155/2014/543756
  • 8. Radhika K, Phaneendra BV, Rukmangadha N, Reddy MK. A study of biopsy confirmed skin adnexal tumors: experience at a tertiary care teaching hospital. Journal of Clinical and Scientific Research 2013; 2 (3): 132-138.
  • 9. Samaila MOA. Adnexal skin tumors in Zaria, Nigeria. Annals of African Medicine 2008; 7 (1): 6-10. doi: 10.4103/1596- 3519.55691
  • 10. Rajalakshmi V, Selvakumar S, Rajeswari K, Meenakshisundaram K, Veena G et al.Case series of skin adnexal tumours. Journal of Clinical and Diagnostic Research 2014; 8 (9): FC07- 10. doi: 10.7860/JCDR/2014/8710.4844
  • 11. Nair PS. A clinico-histopathologicalstudy of skin appendageal tumors. Indian Journal of Dermatology, Venereology and Leprology 2008; 74 (5): 550. doi: 10.4103/03786323.44339
  • 12. Kaur K, Gupta K, Hemrajani D, Yadav A, Mangal K. Histopathological analysis of skin adnexal tumors: a three year study of 110 cases at a tertiary care center. Indian Journal of Dermatology 2017; 62 (4): 400-406. doi: 10.4103/ijd.IJD38016
  • 13. Singh S, Debnath A, Datta D, Chakravarty S, Chaubey RN. Histopathological evaluation of skin lesions with special reference to skin adnexal tumors in a tertiary centre of NorthEastern India– a three year study. Journal of Dental and Medical Sciences 2016; 15 (2): 34-39. doi: 10.9790/0853-15223439
  • 14. Gandi R, Srinivasan S. A morphologic study of cutaneous adnexal tumours. National Journal of Laboratory Medicine 2016; 5 (4): PO08-PO11. doi: 10.7860/NJLM/2016/21800:2161
  • 15. Gayathri SS, Ezhilvizhi A, Kumar SA. An analysis of skin appendageal tumours in South India. Journal of Evolution of Medical and Dental Sciences 2012; 1 (6): 907-912. doi: 10.14260/jemds/145
  • 16. Oyasiji T, Tan W, Kane J, Skitzki J, Francescutti V et al. Malignant adnexal tumors of the skin: a single institution experience. World Journal of Surgical Oncology 2018; 16 (1): 99. doi: 10.1186/s12957-018-1401-y
  • 17. Vani D, Ashwini NS, Sandhya M, Dayananda TR, Bharathi M. A 5 year histopathological study of skin adnexal tumours at a tertiary care hospital. IOSR Journal of Dental and Medical Sciences 2015; 14 (4): pp. 1-5. doi: 10.9790/0853-14470105
  • 18. Kamyab-Hesari K, Balighi K, Afshar N, Aghazadeh N, Rahbar Z et al. Clinicopathological study of 1016 consecutive adnexal skin tumours. Acta Medica Iranica 2013; 51 (12): 879-885.
  • 19. Harada H, Hashimoto K, Ko MS. The gene for multiple familial trichoepithelioma maps to chromosome 9p21. Journal of Investigative Dermatology 1996; 107 (1): 41-43. doi: 10.1111/1523-1747.ep12297860
  • 20. Brooke JD, Fitzpatrick JE, Golitz LE. Papillary mesenchymal bodies: a histologic finding useful in differentiating trichoepitheliomas from basal cell carcinomas. Journal of the American Academy of Dermatology 1989; 21 (3): 523-528. doi: 10.1016/s0190-9622(89)70220-6
  • 21. Hornstein OP, Knickenberg M. Perifollicular fibromatosis cutis with polyps of thecolon--a cutaneo-intestinal syndrome sui generis. Archives of Dermatological Research 1975; 253 (2): 161-175. doi: 10.1007/bf00582068
  • 22. Diluvio L, Caporali L, Lozzi F, Campione E, Mazzilli S et al. Birt-Hogg-Dubé syndrome, from non-invasive dermatologic assessment to gene testing, molecular and ultrastructural histologicanalysis. Journal of European Academy of Dermatology 2020; 34 (4): e206-e209. doi: 10.1111/jdv.16168
  • 23. Happle R. Hornstein-Birt-Hogg-Dube syndrome: a renaming and reconsideration. American Journal of Medical Genetics Part A 2012; 158A (6): 1247-1251. doi: 10.1002/ajmg.a.35330
  • 24. Kidd A, Carson L, Gregory DW, de Silva D, Holmes J et al. A Scottish family with Bazex-Dupré-Christol syndrome: follicular atrophoderma, congenital hypotrichosis, and basal cell carcinoma. Journal of Medical Genetics 1996; 33 (6): 493- 497. doi: 10.11.1136/jmg.33.6.493
  • 25. Yung A, Newton-Bishop JA. A case of Bazex-DupréChristol syndrome associated with multiple genital trichoepitheliomas. British Journal of Dermatology 2005; 153 (3): 682-684. doi: 10.1111/j.1365-2133.2005.06819.x
  • 26. Alsaad KO, Obaidat NA, Ghazarian D. Skin adnexal neoplasms-part 1: an approach to tumours of the pilosebaceous unit. Journal of Clinical Pathology 2007; 60 (2): 129-144. doi: 10.1136/jcp.2006.040337
  • 27. Obaidat NA, Alsaad KO, Ghazarian D. Skin adnexal neoplasm-part 2: an approach to tumours of cutaneous sweat glands. Journal of Clinical Pathology 2007; 60 (2): 145-159. doi: 10.1136/jcp.2006.041608
  • 28. Kazakov DV. Brooke-Spiegler syndrome and phenotypic variants: an update. Head and Neck Pathology 2016; 10 (2): 125-130. doi: 10.1007/s12105-016-0705-x
  • 29. Brownstein MH. The genodermatopathology of adnexal tumors. Journal of Cutaneous Pathology 1984; 11 (5): 457-465. doi: 10.1111/j.1600-0560.1984.tb00402.x
  • 30. Flux K. Sebaceous neoplasms. Surgical Pathology Clinics 2017; 10 (2): 367-382. doi: 10.1016/j.path.2017.01.009
  • 31. McCarthy RL, Thomas CL, Isaacs F. Multiple benign adnexal tumours: anything but benign. Australasian Journal of Dermatology 2019; 60 (3): 234-236. doi: 10.1111/ajd.12989
  • 32. Ho J, Bhawan J. Folliculosebaceous neoplasms: a review of clinical and histological features. The Journal of Dermatology 2017; 44 (3): 259-278. doi: 10.1111/1346- 8138.13773
  • 33. Kanitakis J. Adnexal tumours of the skin as markers of cancer-prone syndromes. Journal of The European Academy of Dermatology and Venereology 2010; 24 (4): 379-387. doi: 10.1111/j.1468-3083.2009.03420.x
  • 34. Rambhia KD, Kharkar V, Mahajan S, Khopkar US. SchopfSchulz-Passarge syndrome. Indian Dermatology Online Journal 2018; 9 (6): 448-451. doi: 10.4103/idoj.IDOJ_26_18
  • 35. Chauhan P, Meena D, Dhanta A, Kansal NK, Durgapal P. BazexDupré-Christol syndrome: first report in an Indian family. Indian Journal of Dermatology, Venereology and Leprology 2018; 84 (4): 451-456. doi: 10.4103/ijdvl.IJDVL_599_17
  • 36. Petrof G, Fong K, Lai-Cheong JE, Cockayne SE, McGrath JA. Schöpf-Schulz-Passarge syndrome resulting from a homozygous nonsense mutation, p.Cys107X, in WNT10A. Australasian Journal of Dermatology 2011; 52 (3): 224-226. doi: 10.1111/j.1440-0960.2011.00788.x
  • 37. Tellechea O, Cardoso JC, Reis JP, Ramos L, GameiroAR et al. Benign follicular tumors. Anais Brasileiros de Dermatologica 2015; 90 (6): 780-798. doi: 10.1590/abd1806-4841.20154114
  • 38. Storm CA, Seykora JT. Cutaneous adnexal neoplasms. American Journal of Clinical Pathology 2002; 118 (1): 33-49. doi: 10.1309/LR16-VURN-JNWC-B0KD
  • 39. Herwig MC, Vogel A, Holz FG, Löffler KU. Pilomatrixom der okulären adnexe: klinische und histologische aufarbeitung von 13 Fällen. Klinische Monatsblatter fur Augenheilkunde 2009; 226 (5): 404-408 (in German). doi: 10.1055/s-0028-1109145
  • 40. Cotton D. Troublesome tumors 1: adnexal tumors of the skin. Journal of Clinical Pathology 1991; 44 (7): 543-548. doi: 10.1136/jcp.44.7.543
  • 41. Tirumalae R, Roopa MO. Benign vs. malignant skin adnexal neoplasms: how useful are silhouettes? Indian Journal of Dermatology 2013; 58 (1): 30-33. doi: 10.4103/0019- 5154.105282
  • 42. Ackerman AB. Differentiation of benign from malignant neoplasms by silhouette. The American Journal of Dermatopathology 1989; 11 (4): 297-300.