Primary Mucinous Carcinoma of the Skin: Coming Back for More for 27 Years.
KDA Rajan, Christopher Burris, Nicholas T Iliff. Wilmer Eye Institute at the Johns Hopkins Hospital, Baltimore, MD; Maryland General Hospital, Baltimore; Wilmer Eye Institute, Baltimore, MD
Background: Primary mucinous carcinoma of the skin is a rare adnexal neoplasm, often with periocular involvement. It is slow growing and locally destructive, at times forming tumor satellites. It frequently recurs locally, however lymph node as well as distant metastases are rare. We discuss the pathologic and clinical features of a patient with mucinous carcinoma of the skin with an unusually long history of recurrences and successful local management.
Design: A 53 year old African American presented to us initially in 1993 with a 3-month history of a right lateral canthal mass. He noted that he had had two previous operations at the site in 1983 and 1989 for a “rare cancer without spread”, which he was told 'may, or may not come back'. We reviewed all prior recurrences and later recurrences, in all a total of seven times, including the latest occuring this year, occurring over a period of over 27 years.
Results: In all instances, histologic examination revealed non-encapsulated, poorly circumscribed tumor with thin delicate fibrous trabeculae enclosing large pools of mucin. Over 90% of the mass was comprised of mucin, which was PAS positive. Nestled within these pools were benign-appearing epithelial islands forming branching- and duct-like structures. The epithelial cells were strongly positive for CK7 and ER, but negative for all other markers tested. No 'dirty' necrosis, foci of acute inflammation or mitotic figures were identified. To date the patient is clinically well, and no lymph node or distant metastases have been detected.
Conclusions: The long follow-up in the present case, not hitherto reported in the literature, highlights the biologic behavior of these uniquely indolent malignancies. We believe the clinical management of this case may offer insight into the optimal treatment of these lesions. Clinicopathologic and immunohistochemical differentiation from metastatic mucinous carcinoma from the breast, colon are pancreas is discussed
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 287, Wednesday Afternoon