title: Apocrine carcinoma of the vulva in a band-like arrangement with inflammatory and telangiectatic metastasis via local lymphatic channels.
abstract: BACKGROUND
  Primary adenocarcinomas of the vulva have been classified as sweat gland carcinomas, extramammary Paget's disease, and primary breast carcinomas of the vulva. They share some common histopathologic features.
  
  
  METHODS
  We describe a 72-year-old Japanese woman with apocrine carcinoma of the vulva and local lymphatic metastasis.
  
  
  RESULTS
  The patient presented with a bruise on her inguinal area. Physical examination revealed a 4 cm x 7 cm, dark-red, irregularly elevated tumor on the left labium majora. Dome-shaped, flesh-colored, small papulovesicles were scattered on the abdomen, accompanied by erythema and induration. The lesion showed a band-like arrangement. General examination revealed multiple bone metastases, particularly in the spine. Microscopic examination revealed a moderately differentiated adenocarcinoma with signet ring cells. A few pagetoid clear cells were present in the hypertrophic epidermis. The peripheral papulovesicles demonstrated the same histopathologic view as in inflammatory and telangiectatic, metastatic breast carcinoma. Tumor cells were positive for various ductal and glandular markers. Estrogen and progesterone receptors were not expressed. Ultrastructural findings suggested differentiation towards apocrine or mammary glands because of the presence of an apocrine process and electron-dense mucous granules. The patient died in spite of combination chemotherapy and irradiation therapy.
  
  
  CONCLUSIONS
  We report a rare case of apocrine carcinoma of the vulva in a band-like arrangement with local lymphatic metastasis which showed the clinical and histopathologic characteristics of inflammatory and telangiectatic carcinoma.
authors.affiliation: Department of Dermatology, Fukui Medical University, Fukui, Japan. kiyo@fmsrsa.fukui-med.ac.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kiyohara
authors.forename: Masanobu
authors.initials: M
authors.lastname: Kumakiri
authors.forename: Kenya
authors.initials: K
authors.lastname: Kawami
authors.forename: Sachio
authors.initials: S
authors.lastname: Kouraba
authors.forename: Akiteru
authors.initials: A
authors.lastname: Takeuchi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sawai
authors.forename: Lin-Min
authors.initials: LM
authors.lastname: Lao
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ansai
authors.forename: Ken
authors.initials: K
authors.lastname: Hashimoto
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary* / Q000628:therapy; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001707:Biopsy, Needle; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D010166:Palliative Care / Q000379:methods; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D013545:Sweat Glands / Q000473:pathology*; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000628:therapy