BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant tumor of the skin that is commonly found on the face.It grows slowly and has a low mortality rate.However,for various reasons,including strong histologi...BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant tumor of the skin that is commonly found on the face.It grows slowly and has a low mortality rate.However,for various reasons,including strong histological invasiveness,clinical inexperience and inadequate procedure design,immediate or permanent facial deformity may occur after surgical operations.CASE SUMMARY This article describes a middle-aged female artist who was diagnosed with MAC on the left upper lip.She declined the recommended treatment plan,which included two-stage reconstruction,skin grafting,or surgery that could have resulted in obvious facial dysfunction or esthetic deformity.We accurately designed a personalized procedure involving a“jigsaw puzzle advancement flap”for the patient based on the lesion location and the estimated area of skin loss.The procedure was successful;both pathological R0 resection and immediate and long-term esthetic reconstruction effects were achieved.CONCLUSION This study suggests that when treating facial MAC or other skin malignancies,a surgical team should have sufficient plastic surgery-related knowledge and skills.An optimal surgical plan for an individual is needed to achieve good facial esthetics and functional recovery and shorten the treatment course.展开更多
BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant cutaneous adnexal neoplasm,often presenting as a flesh-colored and slow-growing indurated plaque or cystic nodule in the mid-facial region.Its character...BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant cutaneous adnexal neoplasm,often presenting as a flesh-colored and slow-growing indurated plaque or cystic nodule in the mid-facial region.Its characteristic indolent presentation usually leads to initial misdiagnosis,resulting in tumor mismanagement and added morbidity due to increased propensity for local invasion.CASE SUMMARY A 63-year-old Chinese male patient with a long-term history of excessive ultraviolet irradiation had received two surgeries for an“epidermal cyst”on his glabella and was presented to our hospital’s Dermatology Department for further diagnosis and therapy of the lesion on his glabella.One month ago,his two 7 mm×7 mm subcutaneous nodules were diagnosed as"recurrent epidermal cysts",and he underwent local excision surgery.Additionally,he has post medical history of surgery for right clear cell renal carcinoma.According to his biopsy,the patient was diagnosed as MAC in our hospital,and a tumor remnant was found on his wound.He then underwent wide local excision to achieve negative margins and reconstruction of full-thickness flap transplantation for tissue coverage.He remained tumor-free after six months of follow-up.CONCLUSION This case highlights the importance of MAC’s possible pathogenic factor of excessive ultraviolet exposure,its differential diagnosis to avoid misdiagnosis and mismanagement to adverse prognosis,the patient’s particular medical history of clear cell renal carcinoma,the alert for any tumor recurrence in older patients,and his uncommon multiple nodules mess consisting of two 7 mm×7 mm subcutaneous nodules,that will enrich the existing knowledge of MAC’s clinical features.展开更多
AIM： To identify multi-detector computed tomography （MDCT） features most predictive of serous cystadenomas （SCAs）, correlating with histopathology, and to study the impact of cyst size and MDCT technique on reade...AIM： To identify multi-detector computed tomography （MDCT） features most predictive of serous cystadenomas （SCAs）, correlating with histopathology, and to study the impact of cyst size and MDCT technique on reader performance. METHODS： The MDCT scans of 164 patients with surgically verified pancreatic cystic lesions were reviewed by two readers to study the predictive value of various morphological features for establishing a diagnosis of SCAs. Accuracy in lesion characterization and reader confidence were correlated with lesion size （≤3 cm or 〉≥3 cm） and scanning protocols （dedicated vs routine）. RESULTS： 28/164 cysts （mean size, 39 mm; range, 8-92 mm） were diagnosed as SCA on pathology. The MDCT features predictive of diagnosis of SCA were microcystic appearance （22/28, 78.6%）, surface Iobulations （25/28, 89.3%） and central scar （9/28, 32.4%）. Stepwise logistic regression analysis showed that only microcystic appearance was significant for CT diagnosis of SCA （P = 0.0001）. The sensitivity, specificity and PPV of central scar and of combined microcystic appearance and Iobulations were 32.4%/100%/100% and 68%/100%/100%, respectively. The reader confidence was higher for lesions 〉 3 cm （P = 0.02） and for MDCT scans performed using thin collimation （1.25-2.5 mm） compared to routine 5 mm collimation exams （P 〉 0.05）. CONCLUSION： Central scar on MDCT is diagnostic of SCA but is seen in only one third of SCAs. Microcystic morphology is the most significant CT feature in diagnosis of SCA. A combination of microcystic appearance and surface Iobulations offers accuracy comparable to central scar with higher sensitivity.展开更多
文摘BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant tumor of the skin that is commonly found on the face.It grows slowly and has a low mortality rate.However,for various reasons,including strong histological invasiveness,clinical inexperience and inadequate procedure design,immediate or permanent facial deformity may occur after surgical operations.CASE SUMMARY This article describes a middle-aged female artist who was diagnosed with MAC on the left upper lip.She declined the recommended treatment plan,which included two-stage reconstruction,skin grafting,or surgery that could have resulted in obvious facial dysfunction or esthetic deformity.We accurately designed a personalized procedure involving a“jigsaw puzzle advancement flap”for the patient based on the lesion location and the estimated area of skin loss.The procedure was successful;both pathological R0 resection and immediate and long-term esthetic reconstruction effects were achieved.CONCLUSION This study suggests that when treating facial MAC or other skin malignancies,a surgical team should have sufficient plastic surgery-related knowledge and skills.An optimal surgical plan for an individual is needed to achieve good facial esthetics and functional recovery and shorten the treatment course.
文摘BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant cutaneous adnexal neoplasm,often presenting as a flesh-colored and slow-growing indurated plaque or cystic nodule in the mid-facial region.Its characteristic indolent presentation usually leads to initial misdiagnosis,resulting in tumor mismanagement and added morbidity due to increased propensity for local invasion.CASE SUMMARY A 63-year-old Chinese male patient with a long-term history of excessive ultraviolet irradiation had received two surgeries for an“epidermal cyst”on his glabella and was presented to our hospital’s Dermatology Department for further diagnosis and therapy of the lesion on his glabella.One month ago,his two 7 mm×7 mm subcutaneous nodules were diagnosed as"recurrent epidermal cysts",and he underwent local excision surgery.Additionally,he has post medical history of surgery for right clear cell renal carcinoma.According to his biopsy,the patient was diagnosed as MAC in our hospital,and a tumor remnant was found on his wound.He then underwent wide local excision to achieve negative margins and reconstruction of full-thickness flap transplantation for tissue coverage.He remained tumor-free after six months of follow-up.CONCLUSION This case highlights the importance of MAC’s possible pathogenic factor of excessive ultraviolet exposure,its differential diagnosis to avoid misdiagnosis and mismanagement to adverse prognosis,the patient’s particular medical history of clear cell renal carcinoma,the alert for any tumor recurrence in older patients,and his uncommon multiple nodules mess consisting of two 7 mm×7 mm subcutaneous nodules,that will enrich the existing knowledge of MAC’s clinical features.
文摘AIM： To identify multi-detector computed tomography （MDCT） features most predictive of serous cystadenomas （SCAs）, correlating with histopathology, and to study the impact of cyst size and MDCT technique on reader performance. METHODS： The MDCT scans of 164 patients with surgically verified pancreatic cystic lesions were reviewed by two readers to study the predictive value of various morphological features for establishing a diagnosis of SCAs. Accuracy in lesion characterization and reader confidence were correlated with lesion size （≤3 cm or 〉≥3 cm） and scanning protocols （dedicated vs routine）. RESULTS： 28/164 cysts （mean size, 39 mm; range, 8-92 mm） were diagnosed as SCA on pathology. The MDCT features predictive of diagnosis of SCA were microcystic appearance （22/28, 78.6%）, surface Iobulations （25/28, 89.3%） and central scar （9/28, 32.4%）. Stepwise logistic regression analysis showed that only microcystic appearance was significant for CT diagnosis of SCA （P = 0.0001）. The sensitivity, specificity and PPV of central scar and of combined microcystic appearance and Iobulations were 32.4%/100%/100% and 68%/100%/100%, respectively. The reader confidence was higher for lesions 〉 3 cm （P = 0.02） and for MDCT scans performed using thin collimation （1.25-2.5 mm） compared to routine 5 mm collimation exams （P 〉 0.05）. CONCLUSION： Central scar on MDCT is diagnostic of SCA but is seen in only one third of SCAs. Microcystic morphology is the most significant CT feature in diagnosis of SCA. A combination of microcystic appearance and surface Iobulations offers accuracy comparable to central scar with higher sensitivity.
