PMC2850546_01
Clinical morphology prior to the Mohs surgery for a biopsy-proven ACC: A 58-year-old woman with a poorly defined erythematous patch on the mid-chest, measuring about 15 mm approximately. Note focal crust and a hypopigmented scar within the patch. An adenoid BCC of the right chest was treated by excision 14 years earlier. ACC: adenoid cystic carcinoma, BCC: basal cell carcinoma.
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fig1
A thorough preoperation physical examination revealed a healthy-appearing Caucasian female with an approximately 15 x 15 mm, poorly defined, tender, erythematous patch with focal crust and a hypopigmented scar notable on the right mid-sternum region (Figure 1).
Microscopic finding of typical ACC characterized by multiple glandular and ductal structures in the deep dermis. There are multiple cysts with some being clear and others with eosinophilic materials (Fresh frozen tissue, H & E, original magnification x40). ACC: adenoid cystic carcinoma.
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Prominent glandular and ductal differentiation and cystic spaces containing mucinous materials, and eosinophilic globules of amorphous material were noted (Figure 2).
High magnification demonstrating characteristic cribriform pattern in which multiple cysts are embedded in an island of basaloid cells. Three representative cysts are shown by arrows (Fresh frozen tissue, H & E, original magnification x100).
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The characteristic cribriform pattern was better appreciated at a higher magnification (Figure 3).
The cyst lining showing cytoplasmic blebbing reminiscent of apocrine-like decapitation secretion within the cyst (Fresh frozen tissue, H & E, original magnification x400).
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Interestingly, the cells lining the cyst showed cytoplasmic blebbing reminiscent of apocrine-like decapitation secretion (Figure 4).
Several foci of ACC are situated adjacent to nerves (n) as indicated by arrows (Paraffin-embedded tissue, H & E, original magnification x200). ACC: adenoid cystic carcinoma.
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The specimens were also submitted for permanent sections, which clearly demonstrated several foci of basaloid tumor cells situated adjacent to nerves (Figure 5).