Apocrine Adenocarcinoma of the Vulva
A 67 year old female presented with an enlarging left vulvar lesion thought to be cystic clinically. Her past medical history was remarkable for a remote history of treated lymphoma, the details of which were not available. There was no history of apocrine or adenexal tumor elsewhere in the body. Clinically there was no regional lymph node enlargement.\nExcisional biopsy of the tumor showed a pink, tan hair bearing fragment of skin measuring 2.7×2.0×1.8 cm. The resection margin was inked. Serial sectioning of the specimen revealed a nodular dermal tumour with focal areas of cystic degeneration filled with a tan coloured paste like material.\nMicroscopic examination revealed fairly well circumscribed but unencapsulated dermal nodule composed of solid sheets and trabeculae of cells with features of adenocarcinoma (). The cells were large, polygonal with well-defined cell membrane and abundant granular eosinophilic cytoplasm. The nuclei showed moderate pleomorphism with vesicular chromatin and prominent central nucleoli. Abundant mitotic activity and focal necrosis were evident (). Focal involvement of the deep inked resection margin was identified. The overlying epidermis was unremarkable (). Normal mammary-like glands were not identified in the surrounding tissue. There was no lymphovascular invasion.\nThe carcinoma cells expressed carcinoembryonic antigen (CEA), Cytokeratin (CK) 7, epithelial membrane antigen (EMA) and Gross cystic disease fluid protein (GCDFP)-15, confirming the apocrine nature of the tumor (). The cells were negative for estrogen/progesterone (ER/PR), CK20, leukocyte common antigen (LCA), CK5/6, wilms tumor (WT)-1 and hepatocyte paraffin (HepPar)-1.