Anogenital Mammary Type Sclerosing Adenosis – Two Case
Reports and the Review of Literature
Kinkor Z.1,2, Michal M.2
1Bioptická laboratoř s.r.o., Plzeň, vedoucí lékařka MUDr.. A. Skálová, CSc. 2Šiklův patologicko-anatomický ústav LF UK, Plzeň, přednosta prof. MUDr. M. Michal |
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Summary:
Objective: To describe a rare case of mammary type sclerosing adenosis arising in anogenital,
mammary-like adnexal glands. Differential diagnosis is discussed and detailed review of literature
is presented.
Design: Two case reports.
Setting: Private Biopsy Lab s.r.o. and Šikl‘s Department of Pathology, Charles University and
Faculty Hospital, Pilsen.
Methods: Included are two cases from Breast Registry, Biopsy Lab s.r.o. and from personal consulting
registry of Prof. Michal, Šikl‘s Department of Pathology, Pilsen. Detailed morphology of the
lesion is described and documented by pictures. The presence of myoepithelial cell is demonstrated
by immunohistochemistry using streptavidin-bioptin detection system (LSAB+, Dako) and
three conventional myoepithelial markers (actin S, calponin and CD10). Expression of estrogen
and progesteron receptors and apocrine antigen GCDFP-15 were studied too.
Results: There were two women at the age of 54 and 60-years with lesion located on vulva and
anus; the maximum tumor diameter was 7 and 10 mm, respectively. The histological picture was
virtually the same in both cases displaying under hyperplastic epidermis small glands proliferation
set in sclerotic fi brous stroma. In spite of relatively sharp circumscription, the chaotic and
irregular distribution of the glands imparted the invasive image of the lesion. The luminal cells
showed no cytological and nuclear atypia and visible was only minimal regular mitotic activity.
The signs of luminal, decapitation-type, apocrine secretion were dispersal seen throughout the
lesion. By immunohistochemistry the myoepithelial cells regularly and systematically decorated
periphery of the glands and all the composition was similar to sclerosing adenosis in the breast including massive hormonal receptors expression. In the periphery of one lesion an insolated,
single, typical anogenital gland was found. Features of conventional papillary hidradenoma were
not seen.
Conclusion: Mammary – type anogenital adnexal glands are regularly present in vulvar and perianal
skin; these are considered there as a substrate for analogous lesion occurring in the breast
(lactation change, papilloma and fi broadenoma, but also some types of carcinomas including primary
extrammary Paget‘s disease). In these physiological structures there are combined features
of both eccrine and apocrine adnexal glands creating a primitive caricature of basic tubulolobular
unit in the breast. Their existence dispel historical dogma about running of the embryonal
milk lines or mammary ridges and explains the fi ndings of varied scale of neoplasms differing
from well known lesion derived from conventional adnexal glands.
Key words:
anogenital adnexal glands, mammary-like (mammary-type) sweat glands, vulva, anus,
sclerosing adenosis
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