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Mucinous Carcinoma of the Skin, Primary, and Secondary: A Clinicopathologic Study of 63 Cases With Emphasis on the Morphologic Spectrum of Primary Cutaneous Forms: Homologies With Mucinous Lesions in the Breast

Kazakov, Dmitry V MD, PhD*; Suster, Saul MD; LeBoit, Philip E MD; Calonje, Eduardo MD, Dip RCPath§; Bisceglia, Michele MD; Kutzner, Heinz MD; Rütten, Arno MD; Mentzel, Thomas MD; Schaller, Jörg MD#; Zelger, Bernhard MD, MSc**; Baltaci, Mehmet MD**; Leivo, Ilmo MD††; Rose, Christian MD‡‡; Fukunaga, Masaharu MD§§; Simpson, Roderick H. W BSc, MB, ChB MMed (Anat Path), FRCPath∥∥; Yang, Yu MD¶¶; Carlson, J Andrew MD, FRCPC##; Cavazza, Alberto MD***; Hes, Ondrej MD, PhD*; Mukensnabl, Petr MD*; Vanecek, Tomas MSc*; Fidalgo, Ana MD†††; Pizinger, Karel MD‡‡‡; Michal, Michal MD*

The American Journal of Surgical Pathology: June 2005 - Volume 29 - Issue 6 - p 764-782
doi: 10.1097/01.pas.0000159104.02985.6b
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We present the largest series of mucinous carcinoma involving the skin, describing the histopathologic, immunohistochemical, electron microscopic, and cytogenetic findings. Our aim was fully to characterize the clinicopathologic spectrum and compare it with that seen in the breast. In addition, we wished to reevaluate the differential diagnostic criteria for distinguishing primary mucinous carcinomas from histologically similar neoplasms involving the skin secondarily, and study some aspects of their pathogenesis. We demonstrate that primary cutaneous mucinous carcinomas span a morphologic spectrum compatible to their mammary counterparts. Both pure and mixed types can be delineated morphologically, and some lesions have mucocele-like configurations. Most lesions seem to originate from in situ lesions that may represent, using mammary pathology terminology, ductal hyperplasia, atypical ductal hyperplasia, or ductal carcinoma in situ or a combination of the three. Inverse cell polarity appears to facilitate the progression of the changes similar to lesions in the breast. The presence of an in situ component defines the neoplasm as primary cutaneous, but its absence does not exclude the diagnosis; although for such neoplasms, full clinical assessment is essential. Mammary mucinous carcinoma involving the skin: all patients presented with lesions on chest wall, breast, axilla, and these locations can serve as clue to the breast origin. Microscopically, cutaneous lesions were of both pure and mixed type, and this correlated with the primary in the breast. Dirty necrosis was a constant histologic finding in intestine mucinous carcinomas involving the skin, and this feature may serve as a clue to an intestinal origin.

From *Sikl's Department of Pathology, Charles University, Medical Faculty Hospital, Pilsen, Czech Republic; †Department of Pathology, Ohio State University Medical Center, Columbus, OH; ‡Dermatopathology Section, University of California, San Francisco, CA; §Department of Dermatopathology, St. John's Institute of Dermatology, St. Thomas's Hospital, London, UK; ∥Department of Pathology, IRCCS-Ospedale “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Italy; ¶Dermatohistopathologische Gemeinschaftspraxis, Friedrichshafen, Germany; #Unit of Dermatopathology, Department of Dermatology, St. Barbara Hospital, Duisburg, Germany; **Clinical Department of Dermatology and Venereology, Medical University Innsbruck, Innsbruck, Austria; ††Department of Pathology, Haartman Institute, University of Helsinki, Finland; ‡‡Department of Dermatology, University of Lübeck, Lübeck, Germany; §§Department of Pathology, Jikei 3rd Hospital, Tokyo, Japan; ∥∥Department of Histopathology, Royal Devon and Exeter Hospital, Exeter, UK; ¶¶Department of Pathology, Health Science Center, Peking University, Beijing, China; ##Division of Dermatopathology, Albany Medical College, Albany, NY; ***Department of Pathology, Arcispedale “S. Maria Nuova,” Reggio Emilia, Italy; †††Department of Dermatology, Hospital do Desterro, Lisbon, Portugal; and ‡‡‡Department of Dermatology, Charles University, Medical Faculty Hospital, Pilsen, Czech Republic.

Presented in part at the 2005 USCAP Annual Meeting, February 26-March 4, San Antonio, TX.

Reprints: Michal Michal, MD, Sikl's Department of Pathology, Charles University, Medical Faculty Hospital, Alej Svobody 80, 304 60 Pilsen, Czech Republic (e-mail: michal@medima.cz).

© 2005 Lippincott Williams & Wilkins, Inc.