Metastatic cancer neck lump


Ele constituie un capitol tumors. They represent a special chapter in oncological special al dermato-oncologiei. Aceste tumori sunt rare, bine dermatology. These tumors are rare, well individualized, individualizate, cu diagnostic susþinut numai pe baza with a diagnosis sustained only on histopathological exam examenelor histopatologice ºi imunohistochimice. Nu au and immunohistochemistry.

Introduction

They have no distinctive caractere clinice distinctive, ceea ce face ca ºi un clinician clinical feature, which can make even an experimented experimentat sã metastatic cancer neck lump diagnosticul în urma doar a phisician miss the diagnosis, after performing only a examenului obiectiv.

Tumorile maligne ale anexelor pielii clinical exam. Adnexal malignant tumors are represented cuprind: tumorile maligne ale glandelor sebacee; tumorile by: malignant tumors of the sebaceous glands; malignant maligne cu diferenþiere apocrinã ºi ecrinã; tumorile maligne tumors with appocrine and eccrine differentiation; cu diferenþiere folicularã.

Aceste grupe includ mai multe malignant tumors with follicular differentiation.

These entitãþi, pentru fiecare fiind prezentate particularitãþile groups include multiple entities, for each being presented clinico-evolutive, aspectele histopatologice, imunohisto- the clinico-evolutive particularities, histopathological chimice ºi conduita terapeuticã.

Cuvinte cheie: carcinoame anexiale; examen histo- Key words: adnexal carcinomas; histopathological patologic; investigaþii imunohistochimice; tratament.

Intrat în redacþie: 7. Tumorile maligne ale glandelor I. Localizarea de elecþie o constituie faþa They are mainly localized on the face especially în special metastatic cancer neck lump sau scalpul. Tumora atinge pink or yellow-brown colored.

The tumor usually dimensiuni medii în jur de 1 cm diametru, poate had 1 cm diameter, can be polylobate and can deveni polilobatã ºi uneori poate ulcera. Pe present ulcerations on the surface.

On the section suprafaþa de secþiune are culoare gãlbuie, uneori surface, the color is yellow, sometimes sprinkled presãratã cu mici chisturi din care la presiune se with small cysts that eliminate a coarse, yellow- scurge un material grunjos, de culoare galben grey material. This type of tumor, if present in cenuºie. Poate fi asociatã, în cadrul sindromului Muir-Torre syndrome, can be associated with Muir-Torre, cu neoplazii maligne viscerale.

Se apreciazã cã metastasized form. Histopathologically, the tumors are made of Histopatologic, tumorile sunt formate din cells with a morphology that resembles the one of celule cu morfologie ce aminteºte de cea metastatic cancer neck lump, dispuse grupat în centru lobulilor tumorali ºi din the sebaceous glands, situated in the center of the celule carcinomatoase nediferenþiate dispuse mai tumoral metastatic cancer neck lump.

The tumors also contain non- ales cãtre periferia lobulilor tumorali. Tumorile maligne cu diferenþiere apocrinã ºi ecrinã II. Malignant tumors with apocrine and metastatic cancer neck lump differentiation Sunt mai frecvente decât cele dezvoltate din celelalte structuri anexiale ale pielii.

Aceastã This type of tumor is more frequent than hpv oropharyngeal cancer epidemiology categorie de tumori cuprinde urmãtoarele one developed from the adnexal structures of the entitãþi: skin.

This type contains the next entities: 1. Carcinomul microchistic anexial carci- 1. Adnexal microcystic carcinoma scleros- nomul ductal sclerozant ecrin, epiteliomul ecrin, ing sweat duct carcinoma, eccrine epithelioma, carcinomul siringomatos este un adenocarcinom syringomatous carcinoma is a well differentiated bine diferenþiat cu capacitate scãzutã de meta- adenocarcinoma, with low metastasis capacity.

În zona centralã lar ducts or cysts. In the central area, the tumor is tumora este alcãtuitã numai din structuri ductale made of small ductal structures, with frequent mici, frecvent cu implicarea neuralã ºi peri- neural and perineural involvement. In the neuralã. This appearance gives the tumor Aceastã aparenþã îi conferã tumorii un aspect a specific aspect of layered lesion: in the caracteristic de leziune stratificatã: în zona superficial area, it has a cystic and tubular aspect, superficialã prezintã aspect chistic ºi tubular, iar while the depths of the tumor are mainly made of spre profunzime cordoane de celule ºi sclerozã.

Sometimes it can present Uneori poate prezenta zone sebocitice, alteori arii sebocytic areas, while other times it can present asemãnãtoare tecii foliculare, acest lucru with areas resembling the follicular sheath. This sugerând faptul cã poate avea diferenþiere cãtre suggests that it can have differentiation towards unitatea foliculo-sebaceo-apocrinã. În unele the follicular-sebaceous-apocrine unity. In some cazuri leziunea este exclusiv ductalã, ceea ce i-a cases, the lesion is exclusively ductal, which has determinat pe unii autori sã o denumeascã determined some authors to call it syringo- metastatic cancer neck lump siringomatos sau carcinom ductal matous carcinoma or sclerosing sweat duct sclerozant ecrin.

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Citologic matous or clear-cell aspects. Cytologically, the leziunile sunt bine diferenþiate, fãrã pleomorfism lesions are well differentiated, without nuclear nuclear sau figuri mitotice. De fapt pleomor- pleiomorphism or mitotic figures.

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Actually, the fismul nuclear trebuie sã se ia în calcul, atunci nuclear pleiomorphism must be taken in când diagnosticul de carcinom microchistic este consideration when the microcystic carcinoma corect. P53 este positive in the tubular periphery. There is a neoplazice. Radioterapia a condus oncological safety margins. Radiotherapy has rareori la succes. În unele cazuri s-a observat rarely lead to success.

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In some cases, metastatic cancer neck lump has chiar o agresivitate crescutã a tumorii dupã acest been observed a slightly increased aggression of tratament. Tumora mixtã malignã MMT este o 2.

Tumori Maligne Anexiale Ale Tegumentului Ro | Metastasis | Carcinoma

Mixt malignant tumor MMT is an tumorã anexialã cutanatã extrem de rarã cu un extremely rare skin adnexal tumor with an comportament agresiv local ºi potenþial crescut aggressive local behavior and a high metastasis de metastazare.

Cunoscutã ºi sub alte denumiri potential. Also known as mixt malignant apo- tumorã mixtã malignã apocrinã, siringom crine tumor or malignant chondroid syringoma, condroid malign tumora mixtã malignã este mixt malignant tumor is considered the privitã ca omologul malign al tumorilor mixte malignant correspondent for mixt benign tumors, benigne, deºi diagnosticul histologic se bazeazã although the histological diagnosis is based in the în primul rând pe caracterul bifazic al neo- first place in the biphasic character of the plasmului, decât pe o combinaþie de resturi neoplasia, rather than on a combination of benign metastatic cancer neck lump benigne cu þesutul carcinomatos.

În comparaþie than men. Compared to the metastatic cancer neck lump cu forma omoloagã benignã, aceasta prezintã benign form, the malignant one presents predilecþie pentru trunchi, extremitãþi, în predilection for the trunk and extremities, principal mâini ºi picioare.

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Clinic, majoritatea MMT sunt tumori slab Clinically, most MMT are circumscripted and circumscrise ºi pot apãrea chistice, iar la may appear cystic, and in the moment of the momentul prezentãrii pot avea cm în medical examination, most of them are cm diametru.

Ele nu sunt dureroase, nu ulcereazã ºi diameter. They are not painful or ulcerated and nu prezintã nici un aspect clinic metastatic cancer neck lump. Foarte have no distinctive clinical aspect.

metastatic cancer neck lump

They rarely rar au metastatic cancer neck lump rapidã, prezintã ulceraþii sau have a rapid growth, with ulcerations or pain. Suprafaþa de secþiune a tumorii poate The section surface of the tumor can reveal a dezvãlui un material gelatinos în cantitate gelatinous material in variable quantity.

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Because variabilã. Din cauza creºterii infiltrative nu este of the infiltrative growth, the tumor enucleation posibilã enucleaþia tumorii. Histopatologic MMT se dezvoltã în derm ºi Histopathologically, MMT develops in the subdermic ºi se prezintã ca o tumorã mare, dermis and sub dermis and is presented as a asimetricã, slab circumscrisã, bifazicã, lobulatã, large, asymmetrical tumor, poorly circum- cu margini infiltrative ºi noduli tumorali sateliþi scripted, biphasic, lobulated, with infiltrative adiacenþi.

Rar tumora poate prezenta juxtapuneri margins and adjacent satellite tumoral nodules. MMT este Rarely, the tumor can present juxtapositions of alcãtuitã din douã componente: epitelialã ºi benign and malignant areas. MMT is metastatic cancer neck metastatic cancer neck lump of two mezenchimalã, componenta epitelialã metastatic cancer neck lump components: epithelial and mesenchymal, the dominantã la periferie, iar componenta mezen- epithelial component is situated in the periphery, chimalã condromixoidã spre centru.

Stroma while the mesenchymal one is situated in the tumoralã condromixoidã este PAS negativã, fiind center. The tumoral chondromyxoid stroma is alcãtuitã din acid hialuronic ºi mucopolizaharide PAS negative, being mainly made of hyaluronic acide.

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Rareori stroma se poate osifica. Agregatele acid and acid mucopolysaccharides. Rarely, the de celule epiteliale se prezintã sub formã de stroma can turn to bone.

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The epithelial cellular cordoane confluente ºi cuiburi celulare de forme aggregates can present like confluent cords and ºi mãrimi variabile, intercalate cu zone cu aspect cellular nests cancer col uterin barbati simptome variable shapes and sizes, tubular. Structurile tubulare pot fi tapetate de cel mixed with tubular aspect areas.

The tubular puþin douã rânduri de celule epiteliale, cele structures can be paved with at least two layers of dinspre lumen având aspect metastatic cancer neck lump celule cu secreþie epithelial cells, the ones close to the lumenum are apocrinã, iar celulele perilumenale prezintã similar to the cells with apocrine secretion, and diferenþiere plasmocitoidã sau mioepitelialã.

CK, including actine in some cells. Spindle cells DermatoVenerol. Decesul nodes, metastatic cancer neck lump and bones. În atypical mix skin tumor. Excizia parazi?ii intestinali simptome evolution. Eccrine porocarcinoma eccrine carcinoma, 3. Porocarcinomul ecrin carcinomul ecrin, malignant eccrine poroma, malignant hidro- porom ecrin malign, hidroacantom simplex acanthoma simplex, malignant intraepidermal malign, porom ecrin intraepidermal malign, eccrine poroma, poroepithelioma is a malignant poroepiteliom este o tumorã malignã cu origine tumor originating in the eccrine glands ducts.

It la nivelul ductului glandelor ecrine prezentând has both intraepidermal metastatic cancer neck lump dermal component.

The tumor was first described by Pinkus and Tumora a fost descrisã pentru prima datã de Mehregan in The age of observatã predominant la persoanele vârstnice. Men and women are equally Media de vârstã la care apare aceastã tumorã este affected. Bãrbaþii ºi femeile sunt în mod egal or through malignant transformation of a afectaþi. Sunt mai nodular or ulcerated verrucous lesion. It can puþin frecvente la nivelul extremitãþilor supe- resemble an eccrine poroma, verruca metastatic cancer neck lump, rioare.

The diagnosis is histopathological. Leziunea poate semãna cu un porom ecrin, [12,13] verucã vulgarã, keratozã seboreicã, nev Histopathologically, porocarcinoma forms melanocitar, fibrom, CBC, CSC metastatic cancer neck lump granulom piogenic.

Diagnosticul se precizeazã prin examen nests and cords made of epithelial cells with pale histopatologic. Tumoral masses are well delimited, Histopatologic, porocarcinomul formeazã frequently round, with polygonal cells that cuiburi ºi cordoane de celule epiteliale cu contain pleomorphic nuclei and irregular, citoplasmã palidã. Masele tumorale sunt bine prominent nucleoli and numerous mitotic delimitate ºi frecvent rotunde, cu celule figures.

These is a clear delimitation between the poligonale cu nuclei pleomorfi, neregulaþi, cellular nests and the adjacent epidermal nucleoli proeminenþi ºi numeroase figuri keratinocytes. The epidermis can be acanthotic. Existã o delimitare netã între cuiburile Both isolated cells and cellular nests can invade celulare ºi keratinocitele epidermice aliat dezintoxicare. Keratinization Epidermul supraiacent poate fi acantotic.

Atât is usually absent. Intercellular bridges within the celulele isolate cât ºi cuiburile celulare pot invada tumoral cells are invisible.

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Their connection with epidermul sub un aspect pagetoid. Keratinizarea the intraepidermal eccrine ducts can be observed, este de obicei absentã. Punþile intercelulare în but the intralimphatic invasion of the profound cadrul celulelor tumorale sunt greu vizibile.

Conectarea cu ductele ecrine intradermice poate The differential diagnosis includes: eccrine fi observatã, dar ºi invazia intralimfaticã în poroma, hidroacanthoma simplex, Paget disease. Diagnosticul diferenþial be atypical, but the lesions are symmetrical and include: poromul ecrin, hidroacantomul simplex, well circumscripted. Porocarcinoma is differen- boala Paget. Poromul ecrin ºi hidroacantomul simplex pot prezenta atipii, însã leziunile sunt tiated from Paget disease through the fact that the simetrice ºi bine circumscrise.

Porocarcinomul se intraepidermal implication is rare, and the diferenþiazã de boala Metastatic cancer neck lump prin faptul cã metastatic cancer neck lump dermis is more frequently affected. Another carea intraepidermicã este rarã, iar interesarea difference between those two is the number of dermicã este mai mare, precum ºi prin conþinutul glycogen rich cells, compared to the mucine in celulelor bogate în glicogen, faþã de mucina din Paget cells.

In the absence of an eccrine poroma, celulele Paget. În absenþa unui porom ecrin residual porocarcinoma is hard to distinguish rezidual porocarcinomul este greu de diferenþiat form squamous cell carcinoma. Tumoral cells are positive for a panel of Celulele tumorale sunt pozitive pentru un antibodies anti pan CK, but they are paler, panel de anticorpi împotriva pan CK, însã sunt compared to the adjacent epidermal ker- mai palide comparative cu keratinocitele atinocytes.

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The ductal structures from the interior epidermice adiacente. Structurile ductale din of the tumor are strongly positive for CEA and interiorul tumorii sunt puternic pozitive pentru EMA. Ganglionii regionali sunt recidivate after excision. Pacienþii of the cases develop distance metastasis.

Tumori Maligne Anexiale Ale Tegumentului Ro 322

The cu boalã metastatic cancer neck lump au o ratã crescutã de patients with metastatic disease have a high mortalitate. Numãrul crescut de mitoze, invazia mortality rate. The high number of mitoses, the limfoganglionilor ºi profunzimea tumorii mai lymph node invasion and a tumoral depth bigger mare de 7 mm sunt asociate cu un prognostic than 7 mm are associated with a bad prognosis. Spiradenocarcinomul este o tumorã ma- 4. Spiradenocarcinoma is an adnexal malig- lignã anexialã ce rezultã din transformarea nant tumor that results from the malignant malignã a unui spiradenom benign.

The vârstã medie, iar incidenþa este egalã pentru incidence is equal for both sexes. Spiradeno- ambele sexe. Spiradenocarcinomul poate afecta carcinoma can affect any body region, but mostly orice regiune a corpului, însã cea paraziti brad frecventã localizare este la nivelul extremitãþilor frequently it is located on the upper extremities, superioare, urmatã de extremitãþile inferioare, followed by low extremities, trunk, head and trunchi, cap ºi gât.

The tumor dimensions modificã culoarea.

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Dimensiunile tumorii pot fi can variate between 0, cm. The time period in DermatoVenerol. Durata de timp în care which the malignant tumor develops on a pe o leziune preexistentã apare tumora malignã preexistent lesion is almost 20 years.

The patient este de aproximativ 20 de ani. Pacientul poate can have multiple spiradenomas that can coexist avea multiple spiradenoame care pot coexista cu with cilindromas. Spiradeno- alcãtuiþi din douã tipuri de celule. Spiradeno- carcinoma develops on a spiradernoma and is carcinomul se dezvoltã pe un spiradenom ºi este made of two major histopathological types.

In alcãtuit din douã tipuri histopatologice majore. În from the benign metastatic cancer neck lump the malignant form. In these aceste leziuni populaþia celularã dualã a formei lesions, the dual cell population of the benign benigne trece imperceptibil cãtre populaþia form goes imperceptible to the monomorphic celularã monomorfã malignã.