Iranian Journal of Pathology (2015) 10 (1), 65 - 65

68

Case Report

Eccrine Porocarcinoma of Scalp:

a Rare Case Report
Subrata pal, Jyoti Prakash Phukan,
Sanjay Sengupta, Anuradha Sinha

Department of Pathology, Bankura Sammilani Medical College, Bankura, India

ABSTRACT
Eccrine porocarcinoma is a rare malignant adnexal tumor of ductal portion of eccrine sweat
gland. It occurs commonly in the lower extremities and rarely in scalp, face, ear, trunk and upper
extremities. This survey presents a classic case of eccrine porocarcinoma of scalp in a 58 yr old
male patient, presenting as cauliflower like growth over parietal aspect of scalp.

Keywords: Eccrine porocarcinomas, Scalp, India

Introduction result of malignant transformation of long stand-

E
ing benign counterpart(2). Commonest location
ccrine porocarcinoma is a rare malignant
of eccrine porocarcinoma is lower extremities.
adnexal tumor arising from intra-epider-
Other uncommon sites are scalp, face & ear, up-
mal ductal portion of sweat gland(1).The
per extremities, trunk etc(1,2,4). Though uncom-
first case was reported by Pinkus and Mwhregan
mon, local recurrence and lymph node metastasis
in 1963 and after that few cases have been docu-
both may occur in eccrine porocarcinoma. Wide
mented(2). These rare tumors accountfor 0.005%
excision with negative marginal status is the key
of all epithelial cutaneous tumors and have been
management and chemotherapy may be neces-
termed as malignant hidroacanthoma simplex,
sary(2,3).
malignant intra epithelial eccrineporoma, eccrine
In this case report we are presenting a rare case
poroepithelioma, malignant syringoacanthoma,
of eccrine porocarcinomaof scalp in a 58 year old
dysplastic poroma and sweat gland carcinoma
male.
(1-3). It is the malignant counterpart of eccrine-
poroma, a common benign adnexal tumor. Ec-
crine porocarcinoma may arise denovo or as a
Case Report
A 58 yrold male patient presented with gradually

Received: 12 September 2013

Accepted: 26 March 2014
Address Communications to: Dr.Subrata pal, Department Of Pathology, Bankura Sammilani Medical College, Bankura,
India.
Email:subratapal1985@gmail.com

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66 Eccrine Porocarcinomaof Scalp ...

increasing painless lobulated exophyticmass at

scalp over left parietal region (Fig. 1). It was
(544) cm in dimension and not fixed with
underlying structures. No lymphadenopathy
was noted at cervical, pre-auricular and post
auricular regions. CT scan of brain did not show
any intracranial extension and no calcification
was noted in the tumor. All other routine
investigations were within normal limit. Wide
surgical excision and primary closure of the
scalp wound were done. Excised specimen was
Fig.2: Photomicrograph of histopathology of the
sent for histopathological evaluation. Multiple
resected tumor mass shows lobular proliferation
sections were examined from the tumor tissue.
of neoplastic cells which invade downwards into
The sections showed well defined tumor lobules dermis and subcutaneous tissue ( H& E stain 40)
ornests of polygonal to cuboidal cells invading
laterally and deep into dermis & subcutaneous
tissue (Fig. 2, 3). Individual tumor cell had
clear cytoplasm, large pleomorphic and hyper
chromatic nuclei with prominent nucleoli.
Necrosis and frequent mitosis were also found in
the examined sections (Fig. 4). Histopathological
examination confirmed the diagnosis of eccrine
porocarcinoma. Margins were free from tumor
involvement and the lesion involved >7mm
deep in dermis. The patient received 6 cycles
Fig.3: Microscopy shows lobules of infiltrating
of chemotherapy and had no recurrence during
tumor cells in at dermis with marked epidermot-
follow up period of one year.
ropism( H& E stain 40)

Fig.4: Microscopy shows polygonal tumor cells

with clear cytoplasm,large hyperchromatic nuclei
and prominent nucleoli and frequent mitotic
Fig.1: Large reddish lobulated exophytic mass
figure (H & E stain 40)
over scalp of left parietal region

IRANIAN JOURNAL OF PATHOLOGY Vol.10 No.1, Winter 2015

 Subrata pal, et al. 67

Discussion li. Frequent mitosis and necrosis are also seen.

Our case showed classical histological features
Eccrine porocarcinomas, are very rare malignant
of eccrine porocarcinoma including invasion
adnexal tumors arising from intra-epidermal duc-
into dermis, necrosis &increased rate of mitosis.
tal portion ofeccrine sweat gland. More than 50%
Histopathological differential diagnosis includes
cases involve lower extremities(3). On rare oc-
metastatic adenocarcinoma, trabecular carcino-
casion, it may involve head and neck region, up-
ma and Merkel cell carcinoma(4). Metastatic ad-
per limbs, trunk and abdomen(1,3). The tumors
enocarcinomas often exhibit nests of tumor cells
commonly affect elderly patients of more than 60
in glandular or acinar pattern in epidermis and
years, though cases have been reported in young-
dermis with hyperplasia of overlying squamous
er age group as well(4). Eccrine porocarcinoma
epithelium. Lack of such pattern and absence of
may arise as de-novo or secondary to any pre-
any features of primary carcinoma helps to dif-
existing lesions like eccrine poroma, nevus seba-
ferentiate our case from metastatic adenocarci-
ceous, chronic lymphocytic leukemia and actinic
noma(8). Trabecular carcinoma and Merkel cell
keratoses(3,5,6). The commonest presentation is
carcinoma exhibit trabecular pattern with classi-
reddish nodular cauliflower like growth or infil-
cal nuclear features of fine granular chromatin,
trative verrucous plaque lesion which frequently
nuclear moulding, fragmentation and abundant
shows superficial ulceration & bleeding due to
mitosis which were lacking in the present case.
trivial trauma(5). In the present case, it was il-
Occasionally the neoplastic cells of eccrineporo-
lustrated with a reddish- yellow, lobulated cau-
ma may exhibit low grade cytological atypia but
liflower like mass without superficial ulceration.
the lesions lack infiltrative growth pattern, necro-
Clinically lesions of the extremities should be
sis and frequent mitosis (7). Cytoplasmof tumor
differentiated from seborrheickeratoses, pyogen-
cells in porocarcinoma show PAS reactive, dia-
ic granuloma, amelanotic melanoma, squamous
stase labile glycogen(1). Immunohistochemical
cell carcinoma and basal cell carcinoma and ver-
features like positivity for CEA, EMA, CK-7 and
ruca vulgaris(5,7).In their large series, Robson
negative staining for S-100, CK-20 help in diag-
et al. found that specific clinical diagnosis were
nosis of difficult cases where histopathological
never correct (7). Clinical features of eccrine po-
findings are not conclusive(1,3,4).
rocarcinoma from scalp also mimic cylindroma,
Treatment of eccrine porocarcinoma is wide local
eccrine poroma, sebaceous adenoma, sebaceous
excisionwith histopathological confirmation
carcinoma, pilar tumor and metastatic carcino-
of clear margin(1,3,6,7). In case of regional
ma(3). In our case it was clinically diagnosed as
lymph node involvement, lymph node dissection
benign adnexal tumor of scalp.
should be considered. In contrast to radiotherapy,
Searching the English literature revealed tha-
chemotherapy is suitable and effective for
tonly few cases of porocarcinoma are involving
management of metastatic lesions(1,3).
scalp (3) which was similar to this survey. But
Regional lymph node metastasis has been
involvement of occipital region was document-
reported in 20% cases and local recurrence
ed by Ritter et al.(6). Microscopically eccrine
in 25% cases(2,3,5,9). Distant metastasis is
porocarcinoma shows intra-epidermal nests or
uncommon but reported in previous literatures(9).
cords of polygonal anaplastic cells which invade
Prognosis of eccrine porocarcinoma varies on
downwards into dermis and subcutaneous tissue.
lymph vascular invasion, tumor margin status
Epidermotropism and ulceration of epidermis
after resection, mitotic count (>14/HPF), depth
are often seen in eccrine porocarcinomas. The
of invasion in deeper tissue (>7mm)(7).All of the
tumor cells contain clear cytoplasm, large hy-
above features are poor prognostic factors. In our
perchromatic nuclei and prominence of nucleo-

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68 Eccrine Porocarcinomaof Scalp ...
case no nodal metastasis was found and tumor
margins were free but depth of the tumor was
>7mm and average mitosis was 12/HPF.
Eccrine porocarcinoma of scalp is a rare malig-
nant adnexal neoplasm. Local excision with neg-
ative margin is the cornerstone of management.
Our case is a classical example of this rare malig-
nancy and emphasizes inclusion of the lesion in
the list of differential diagnosis during evaluation
of any exophytictumor of scalp.
Acknowledgement
The author declares that there is no conflict of
interest.
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