Immunohistochemical demonstration of myoepithelial cells in sweat gland carcinomas

Although myoepithelial cells are detectable in many benign sweat gland tumours, little is known about their role in sweat gland carcinomas. To specifically demonstrate myoepithelial cells, paraffin sections from 46 sweat gland carcinomas were stained, using a standard avidin-biotin-peroxidase complex method, with the monoclonal alpha-smooth muscle actin antibody 1A4. Myoepithelial cells were not found in adenoid cystic eccrine carcinoma (n = 2), malignant nodular hidradenoma (n = 2), porocarcinoma (n = 4), extramammary Paget's disease (n = 12), sclerosing sweat duct carcinoma (n = 4) or in adenosquamous-mucoepidermoid carcinoma (n = 1). In contrast, myoepithelial cells were demonstrated in two of eight apocrine adenocarcinomas, one of six mucinous eccrine carcinomas and two of seven eccrine adenocarcinomas. In all these tumours myoepithelial differentiation was found in peripheral cells of solid tumour islands, or in basal cells of tubular structures. However, in most areas of the tumours, myoepithelial layers were discontinuous. Cells in the centre of solid tumour nodules, and luminal cells of tubular structures, were negative for alpha-smooth muscle actin. In analogy to breast tumours, in which malignancy and invasiveness correlate with scattered or absent myoepithelial cells, we suggest that disrupted myoepithelial layers in sweat gland carcinomas may be interpreted as a loss of the invasion barrier.     

Demonstration of anionic sites in human eccrine and apocrine sweat glands in post-embedded ultra-thin sections with cationic colloidal gold: effect of enzyme digestion on these anionic sites

We localized anionic sites ultrastructurally in human eccrine and apocrine sweat glands with a poly-L-lysine-gold complex (cationic colloidal gold). Anionic sites were labeled by incubating Lowicryl K4M-embedded sections on droplets of cationic colloidal gold. In eccrine sweat glands, colloidal gold particles were restricted to the basolateral membrane of the secretory cells at low pH, whereas the luminal membrane did not react with the gold particles. Chondroitinase ABC digested these anionic sites. This indicates that chondroitin sulfate and/or dermatan sulfate constitutes anionic sites in the basal labyrinth of eccrine sweat glands. In apocrine sweat glands, the luminal membrane of the secretory cells showed strong reaction at low pH, whereas the contraluminal membrane did not show any reaction. Neuraminidase completely digested these anionic sites, which indicated that the anionic charge of the apocrine lumen was due to sialic acid. Differences in distribution and susceptibility to enzymes of anionic sites in cell membranes between eccrine and apocrine sweat glands may reflect functional differences between these glands. Dark cell granules in eccrine secretory cells were negative for the anionic sites when sections were labeled without any pre-treatment. However, pre-incubation of the grids on EGTA or deionized water unmasked the anionic sites on the dark cell granules. The positive staining after EGTA treatment was greatly decreased by reincubation with CaCl2. These results suggested that Ca blocked anionic sites in dark cell granules. Exposed anionic sites were digested with chondroitinase ABC. This indicated that chondroitinase ABC and/or dermatan sulfate composed the anionic sites in dark cell granules.     

The determinants of user satisfaction with community psychiatric nursing care

A 70-year-old diabetic woman with sensory polyneuropathy presented with osteonecrosis of the toes and a plaque-like lesion on the dorsum of the ipsilateral foot. Histological diagnosis of eccrine syringofibroadenoma (ES) was made. A review of the literature reveals several cases of solitary ES of the foot in diabetic patients with peripheral neuropathy. This variant of ES seems to be an eccrine sweat duct hyperplasia during the restoration of skin structures damaged by traumas in a situation of peripheral neuropathy. Diabetes and polyneuropathy should be searched for in patients with ES, particularly in acral locations.     

Capillary electrophoresis chips with integrated electrochemical detection

Porokeratotic eccrine ostial and dermal duct naevus (PEODDN) is a rare, benign hamartomatous malformation involving the eccrine sweat duct. The existence of filiform keratinous plugs that represent cornoid lamellae overlying dilated infundibula of eccrine ducts is a distinctive feature and the presence of associated abnormal dermal ducts is frequent. We report a patient with PEODDN who exhibited lesions on the left side of her chest. Cases of PEODDN reported in the literature are reviewed. Our experience in treating this patient with ultrapulsed carbon dioxide laser is also presented.     

Carcinosarcoma arising in eccrine spiradenoma of the breast. Report of a case and review of the literature

Although the vast majority of eccrine spiradenomas behave in a benign fashion, 23 cases of malignant transformation have been reported to date. We describe a unique example of malignant eccrine spiradenoma that arose in the right breast of a 68-year-old woman. The quiescent mass, which was present for approximately 50 years, experienced sudden enlargement with erythematous changes of the overlying skin and nipple discharge. Microscopically, the tumor showed the typical features of an eccrine spiradenoma with areas of adenocarcinoma, squamous cell carcinoma, and sarcoma. The sarcomatous component consisted of rhabdomyosarcoma and osteosarcoma. The immunoperoxidase staining revealed p53 protein expression only in the carcinomatous and sarcomatous components. This suggests that accumulation of p53 protein may be an important event in the malignant transformation of spiradenomas. Because of its location and biphasic nature, this malignant eccrine spiradenoma should be distinguished from metaplastic breast carcinoma. To our knowledge, this represents the first carcinosarcomatous transformation of eccrine spiradenoma in the breast. This case led us to conclude that breast tissue, which often undergoes apocrine metaplasia and gives rise to apocrine neoplasms, is also capable of originating benign and malignant tumors with eccrine sweat duct phenotype.     

"Basal" palmar skin potentials and body fluid potassium

When palmar eccrine sweat glands are inactive the potential difference between palmar skin and a prepared forearm site is a function of the ratio of external (electrode electrolyte) and internal (tissue fluid) potassium concentrations. Evidence indicates that this "basal" palmar skin potential changes systematically with changes in ECF K+, and may be used to monitor such shifts, as, for example, in stress.     

Cutaneous adenolipoma

INTRODUCTION: Adenolipoma of the skin is an unusual microscopic variant of the solitary lipoma, superposable to the adenolipoma of the breast, characterized by the presence of normal eccrine sweat glands inside the fat proliferation. OBSERVATIONS: Two new cases are reported. DISCUSSION: Adenolipoma of the skin is a benign lesion whose clinical features are similar to those of solitary lipoma. Probably, it is only a histological curiosity in which the eccrine glands are entrapped and carried by the adipose proliferation.     

Adenocarcinoma of eccrine sweat glands

A man developed left-sided proptosis and orbital edema that progressed during a three-week period. Ten years ago he had a skin lesion of the left lower lid excised and the histopathologic diagnosis then was granular cell myoblastoma. In 1972, the tumor recurred; a biopsy was again performed, but no definite diagnosis was made despite multiple consultations from general and ophthalmic pathologists. Biopsy specimens of the orbit, lids, and preauricular lymph node taken in 1974 showed a poorly differentiated mucus-secreting adenocarcinoma. A comparison of the three biopsy specimens showed cells with similar characteristics. Medical evaluation failed to reveal a primary tumor elsewhere in the body. The tumor most likely arose locally from an eccrine sweat gland. This is the second reported case of an adenocarcinoma of an eccrine sweat gland invading the orbit. The tumor, usually considered radioresistant, was successfully treated with radiotherapy, and the patient has remained free of tumor for 18 months.     

Eccrine porocarcinoma

Eccrine porocarcinoma is a malignant tumor of eccrine sweat glands. It is a very rare, slow growing tumor and clinically resembles other skin cancers. We report a case and review its clinical and pathological features. These tumors have a propensity for local recurrence, and wide excision with negative margins is recommended.     

Pediatric management problems. What is your assessment? Scarlet fever

Apocrine hidrocystoma is a cyst from the secretory portion of the apocrine sweat gland and tends to occur as a solitary facial lesion. We report a 66-year-old woman with multiple, cystic lesions on her face. Histopathology revealed cystic spaces lined by a row of secretory cells showing decapitation secretion. We emphasize the multiple character of the case and discuss its distinction from so-called eccrine hidrocystomas.     

Anhidrosis: an unusual presentation of diabetes insipidus

A 61-year-old man who had a 10-year history of anhidrosis was found to have idiopathic diabetes insipidus. He showed no spontaneous sweating or pilocarpine-induced sweat response. Skin pathology showed a normal eccrine gland. Microneurography detected no skin sympathetic nerve activity. Within a month of desmopressin treatment for diabetes insipidus, sweating and skin sympathetic nerve activity returned.     

Hyperhidrosis treated by botulinum A exotoxin

BACKGROUND: Hyperhidrosis, or excessive sweating, can be emotionally challenging and socially and professionally disruptive, and there have been few effective treatments. Recently, botulinum toxin has been demonstrated to be an effective treatment for hyperhidrosis of the axillae and palms and for gustatory sweating. OBJECTIVE: This article reviews the current treatments and outcomes achieved with chemodenervation of the eccrine sweat glands. RESULTS: The antihydrotic response lasted 6-17 months for gustatory sweating, 2-8 months for axillary sweating, and 13 weeks to 12 months for palmar sweating. CONCLUSIONS: Intracutaneous injections of botulinum toxin offer a simple, safe, and effective alternative to other conservative and surgical options.     

False basalnomas and false cutaneous metastasis of visceral cancer. Apropos of 7 observations of eccrine carcinoma

After a review of the bibliography on the subject of eccrine sweat gland carcinomas, the authors emphasize the confusing terminology used for the designation of these cases and the difficulties for a correct clinical and histological diagnosis of these tumors. According to the data obtained from the study of 7 personal cases, the most characteristic features of the eccrine carcinomas could be the following: 1) From the clinical standpoint--Appearance of a single tumour, lasting unmodified for a long period of time.--Tendency to reccurrence of the neighbouring areas after tumour excision, and to a slow progression through the superficial lymphatic channels.--Appearance of distant metastasis a long time after the original lesion. These metastases are observed, a) on the regional lymph nodes, b) on the superficial lymphatic channels and c) in some cases in the skin by intraepidermal growth. 2) From the histological point of view--Localisation in the deep dermis of the tumoral masses in the original lesion.--Acinar or tubular structures. Abundant nitoses and considerable indifferntiation of the cellular elements.--Tendency to the formation of empty peritumoral spaces separating the tumoral masses from the connective tissue by the retraction caused by the fixative.--Styloid or trabecular growth surrounding the main mass of the tumor.--Two types of cells can be observed in some tumours; large cells with a clear cytoplasm and small deeply-stained cells resembling the mioepithelial cells.--Tendency to the formation of clear cell tumoral masses.--Squamous metaplasia of isolated cells or groups of cells.--Presence of PAS-positive cytoplasmatic granulations in some cellular elements.--Degenerative changes with secondary cystic formations.--Frequent features of tumoral lymphangitis. 3y From theions.--Frequent features of tumoral lymphangitis. 3) From the cytological standpoint Staining in yellow of the cytoplasms of the tumour cells with the Panpanicolau method. 4) From the ultrastructural standpoint--Impossibility of classifiying the cells into serous or mucous due to the considerable anaplasia.--Absence of eccrine-apocrine differentiation, of ductal formation and of embrionary sweat cell features.     

Acquired generalized anhidrosis

A patient developed generalized anhidrosis, probably following sunstroke. Light microscopy showed an atrophic, deeply lobulated or elongated configuration of the eccrine sweat glands, most of them containing many vacuoles that possessed strong acid phosphatase activity. Electron microscopy revealed that the vacuoles were bound by a unit membrane and that the contents varied. Fusion of the vacuoles and accumulation of cellular debris in the lumen were also seen. It was concluded that the vacuoles showed areas of autolysis and were classified in the group of lysosomes. In addition, it is postulated that the anhidrosis resulted from a critical rise in body temperature with subsequent changes in the secretory cells.     

Recurrent malignant acrospiroma. Treatment by chest wall excision

Malignant acrospiroma is an uncommon tumor of the eccrine sweat gland. In contrast to its relatively more common benign counterpart, malignant acrospiroma is highly invasive, often with significant lymphatic and distant metastasis. The establishment of this diagnosis is difficult on both clinical and histopathologic grounds. After diagnosis, wide surgical excision is warranted to completely extirpate these lesions. We report the case of a 66-year-old female with a recurrent malignant acrospiroma. This patient's tumor was removed by wide radical resection, including chest wall excision, followed by reconstructive surgery and radiotherapy. After 16 months there is no evidence of local recurrence or distant metastasis.     

Identification of a new splice form of the EDA1 gene permits detection of nearly all X-linked hypohidrotic ectodermal dysplasia mutations

X-linked hypohidrotic ectodermal dysplasia (XLHED), the most common of the ectodermal dysplasias, results in the abnormal development of teeth, hair, and eccrine sweat glands. The gene responsible for this disorder, EDA1, was identified by isolation of a single cDNA that was predicted to encode a 135-amino-acid protein. Mutations in this splice form were detected in <10% of families with XLHED. The subsequent cloning of the murine homologue of the EDA1 gene (Tabby [Ta]) allowed us to identify a second putative isoform of the EDA1 protein (isoform II) in humans. This EDA1 cDNA is predicted to encode a 391-residue protein, of which 256 amino acids are encoded by the new exons. The putative protein is 94% identical to the Ta protein and includes a collagen-like domain with 19 repeats of a Gly-X-Y motif in the presumptive extracellular domain. The genomic structure of the EDA1 gene was established, and the complete sequence of the seven new exons was determined in 18 XLHED-affected males. Putative mutations, including 12 missense, one nonsense, and four deletion mutations, were identified in approximately 95% of the families. The results suggest that EDA1 isoform II plays a critical role in tooth, hair, and sweat gland morphogenesis, whereas the biological significance of isoform I remains unclear. Identification of mutations in nearly all of the XLHED families studied suggests that direct molecular diagnosis of the disorder is feasible. Direct diagnosis will allow carrier detection in families with a single affected male and will assist in distinguishing XLHED from the rarer, clinically indistinguishable, autosomal recessive form of the disorder.     

Skin capillary changes in early systemic scleroderma. Electron microscopy and "in vitro" autoradiography with tritiated thymidine

Skin biopsy specimens obtained from involved and noninvolved areas in a patient with early diffuse systemic scleroderma were processed for histology, electron microscopy, and "in vitro" autoradiography with tritiated thymidine. The affected area revealed cellular infiltrates around the eccrine sweat glands, consisting of plasma cells and lymphocytes. The capillaries showed thickening of the basement lamina, damage of endothelial cells, and obstruction of their lumens. However, in some vessels, endothelial cells were preserved and appeared in prophase. Autoradiography with tritiated thymidine showed a marked increase in endothelial and periendothelial cell labeling. Blood immunological studies revealed an increase in B-lymphocytes, IgG, and IgA and the presence of antinuclear and antismooth muscle antibodies.     

Chondroid syringoma: an immunohistochemical study using antibodies to Ca 15-3, KA-93, Ca 19-9, CD44 and BM-1

The expression of Ca 15-3, KA-93, Ca 19-9, CD44 and BM-1 in normal skin and chondroid syringoma was investigated immunohistochemically using antibodies to these antigens. In the normal skin, the eccrine ducts and/or secretory elements were positive for all these antigens. On the other hand, the apocrine ducts and/or secretory elements were positive for the antibodies to Ca 15-3, KA-93 and CD44. In chondroid syringoma, the luminal cells of tubuloglandular structures were positive for the antibodies to Ca 15-3 and BM-1, and partly positive for those to KA-93 and Ca 19-9. The basal cells of the tubular structures and solid nests were positive only for the antibody to CD44. Stromal cells in the myxoid area were positive for the antibodies to KA-93 and CD44, and the chondroid matrix was positive for the antibody to BM-1. It is suggested that chondroid syringoma might originate from, or differentiate into the ducts and/or secretory elements of the eccrine sweat glands. In addition, the significance of the expression of BM-1 in the chondroid matrix is discussed.