Patient Report

Yonago Acta Medica 2017;60:64–66

Apocrine Adenocarcinoma Occurring on the Chin
Hiromi Higaki-Mori,* Kazunari Sugita,* Reiko Tsutsumi,* Koji Adachi,† Yuichi Yoshida* and Osamu
Yamamoto**Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Tottori University Faculty ofMedicine, Yonago 683-8503, Japan and †Tottori Prefectural Central Hospital, Tottori 680-0901, JapanABSTRACT
We report a case of adenocarcinoma affecting the chinof a 48-year-old man. The tumor showed signs of apocrine differentiation and had infiltrated the muscle. The
patient had no history or clinical evidence of breast
cancer. We made a diagnosis of cutaneous apocrine adenocarcinoma. Apocrine adenocarcinoma rarely arises
in areas with scarce apocrine glands. We reviewed theliterature on apocrine adenocarcinoma of the face inareas other than the eyelids and auditory canal, wherespecialized apocrine glands are present.

Immunohistochemical analysis was performed by thestandard avidin-biotin complex method.3 The primary
antibodies used in this study are listed in Table 1. Tumorcells were positive for a pancytokeratin marker (AE1/3)
and cytokeratin 7 but negative for cytokeratin 20. Alpha-smooth muscle actin and p63 were partially detected in the peripheral part of the tumor nests (Figs. 1e andf). S-100 protein was expressed focally in tumor nests.
Approximately 10% of the tumor cells were positivefor Ki-67 (data not shown). F-18-fluoro-2-deoxyglucose
positron emission tomography/computed tomography
showed no evidence of malignancy of other sites. On thebasis of these findings, we diagnosed the lesion as apocrine adenocarcinoma occuring on the chin. There has
been no evidence of local recurrence, metastasis or any
other malignancies including breast cancer for about 3
years after excision.

Key words adnexal tumors; apocrine adenocarcinoma;chin; sweat gland tumors

Apocrine adenocarcinoma is a rare neoplasm and usually occurs in areas of apocrine glands such as axillae.1, 2
Therefore, predilection sites are a hallmark for diagnosis, and dermatologists may miss a differential diagnosis
of apocrine adenocarcinoma for lesions occurring onother sites. Here, we report a case of apocrine adenocarcinoma affecting the chin, which usually contains noapocrine glands.

DISCUSSION
Apocrine adenocarcinoma on the face usually occurs on
the eyelids or ears, where apocrine glands are abundant,
and apocrine adenocarcinoma arising in the other structures is extremely rare. Except for ceruminal carcinoma
and adenocarcinoma of Moll’s glands, our review of theliterature revealed only 4 cases of apocrine adenocarcinoma arising on the face, including the forehead, 4,5upper lip6 and chin7 (Table 2). The mean age of thosepatients at diagnosis was 58 years, ranging from 40 to 94
years, which is almost the same as that for patients withapocrine adenocarcinoma on axillae. Eighteen previously reported cases of apocrine adenocarcinoma on theaxillae had an average history duration of 6.5 years.1 On
the other hand, history durations of cutaneous apocrine
adenocarcinoma on the face were several weeks to a few
years as in our case. To our knowledge, the present caseis the second reported case of apocrine adenocarcinoma
occurring on the chin. Thus, an etiologic relationships
between apocrine adenocarcinoma and the chin isstrongly suggested by these 2 cases. Although the chinis an unexpected site for apocrine adenocarcinoma, thisdisease should be included in the differential diagnosis
of a nodule on the chin.

PATIENT REPORTA 48-year-old man was referred to us with a 6-month
history of a tumor on the chin. He had no past historyof breast cancer or other malignancies. In addition,
there had been no congenital lesion suggesting nevus
sebaceous on the chin. Clinical examination revealed anodule, bright red in color, of 6 × 4 mm in diameter (Fig.
1a). Histopathologically, the lesion was non-encapsulated and was composed of many nodular or lobular nests,
varying in size and shape, infiltrating into the deep dermis and muscle with an asymmetrical distribution (Figs.
1b and c). The solid nests showed a proliferation of
atypical cells with abundant eosinophilic granular cytoplasm and prominent nuclei. There were many ducts andglandular structures showing apical snouts in the luminal border, indicating apocrine differentiation (Fig. 1d).
Corresponding author: Hiromi Higaki-Mori, MDhigaki.h@med.tottori-u.ac.jp
Received 2016 November 30
Accepted 2017 February 2The authors declare no conflict of interest.

64Figure1	

Apocrine adenocarcinoma on the chinabcdefFig. 1. Clinical presentation and histopathology. (a) Clinical appearance of the nodule on the chin. (b) Histopathologic examination of thelesion of the chin. An asymmetric tumor composed of nests varying in size and shape is located in all of the dermis and subcutis (hematoxylin-eosin, scale bar = 0.5 mm). (c) Tumor nests in the muscle layer (hematoxylin-eosin, scale bar = 50 μm). (d) Some nests containglandular structures that show apical snouts suggesting apocrine differentiation (hematoxylin-eosin, scale bar = 25 μm). (e) Immunostaining for alpha-smooth muscle actin (hematoxylin-eosin, scale bar = 50 μm). (f) Immunostaining for p63 (hematoxylin-eosin, scale bar= 50 μm).

Table 1. List of antibodies used for immunohistochemistry
Antibodies

CloneType

AE1/AE3
AE1, AE3
MonoclonalCK 7
OV-TL12/30
Monoclonal
CK 20
Ks20.8
Monoclonal
1A4
Monoclonal
α-SMA
p63
4A4
Monoclonal
S-100 protein
Polyclonal
Ki-67
MIB-1
Monoclonal
α-SMA, alpha-smooth muscle actin; CK, cytokeratin.

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SourceDilution

Nichirei
Dako
Dako
Dako
Nichirei
NichireiDako

Pre-diluted
1:100
1:50
1:100
Pre-diluted
Pre-diluted
1:100

H. Higaki-Mori et al.
Table 2. Review of apocrine adenocarcinoma arising on the face
Authors

AgeSex

Site

History
duration

Size (cm)Depth ofcancerinvasion

Local
recurrence

Metastasis

Outcome(month)

Smith [4]40
MForehead 2.5 years
ND
ND
Yes
LN
AWD (22)
Hayes [6]54
MUpper lip Several weeks 5Muscle
NoNoNED (24)Misago [5]94FForehead A few years
1.6
Subcutis
NoNo
NED (48)
Ruiz-Villaverde [7] 56
MChin
1 year
1.3
DermisND
ND
ND
Our case48
M
Chin
6 months
0.6
MuscleNoNo
NED (33)
We exclude ceruminal carcinoma and adenocarcinoma of Moll’s grands glands. AWD, alive with disease; F, female; LN, lymph node; M,male; NED, no evidence of disease; ND, not described.

REFERENCES

4 Smith CC. Metastasizing carcinoma of the sweat-glands. Br JSurg. 1955;43:80-4. PMID: 13260595.
5 Misago N, Ohkawa T, Narisawa Y. An unusual apocrine carcinoma on the forehead. Am J Dermatopathol. 2007;29:404-7.
PMID: 17667178.
6 Hayes MM, Matisic JP, Weir L. Apocrine carcinoma of thelip: a case report including immunohistochemical and ultrastructural study, discussion of differential diagnosis, andreview of the literature. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod. 1996;82:193-9. PMID: 8863310.
7 Ruiz-Villaverde R, Martinez FE, Barona RJL, Trelles AS. Primary cutaneous cribriform apocrine carcinoma on an atypicallocation. Eur J Dermatol. 2010;20:832-3. PMID: 20923754.

1 Katagiri Y, Ansai S. Two cases of cutaneous apocrine ductal
carcinoma of the axilla. Case report and review of the literature. Dermatology. 1999;199:332-7. PMID: 0640844.
2 Sugita K, Yamamoto O, Hamada T, Hisaoka M, Tokura Y.
Primary apocrine adenocarcinoma with neuroendocrine
differentiation occurring on the pubic skin. Br J Dermatol.
2004;150:371-3. PMID: 14996118.
3 Watanabe S, Kato M, Kotani I, Ryoke K, Hayashi K. Lymphatic Vessel Density and Vascular Endothelial Growth
Factor Expression in Squamous Cell Carcinomas of Lip andOral Cavity: A Clinicopathological Analysis with Immunohistochemistry Using Antibodies to D2-40, VEGF-C andVEGF-D. Yonago Acta Med. 2013;56:29-37. PMID: 24031149.

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