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PCMC is more frequently found in males and it usually appears between the ages of 50 and Mendoza and Hedwig does hpv cause blood cancer the first contemporary description of this eyelid-located tumour. Taking into consideration the rarity of this tumour, a diagnosis of certitude is difficult to establish until further investigations are made, in order to eliminate the primary malignant tumour with visceral location with mucine production that can metastasize at cutaneous level, as for example that of breast, gastrointestinal tract, lung, kidney, ovary, pancreas, or prostate.
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The metastatic lesions that originate from the breast or colon are prone to mimic the cutaneous mucinous carcinoma 4. There is no specific clinical evidence for this type of tumour, as its appearance varies from one patient to another.
The first clinical impression is that of a cyst, basal cell carcinoma, keratoacantoma, nevus, apocrine hidrocystoma, another location primary tumour metastasis and in certain circumstances the clinical differentiation includes vascular lesions as those found in the Kaposi sarcoma 5. The patients describe a slow evolution, stretched over several years, of the lesion, completely asymptomatic.
Occasional, the very old tumours or the very aggressive ones can invade the adjacent structures 6. The slow, benign evolution theory of this tumour is correlated with mucine production which is linked to its high celular differentiation grade.
Moreover, the presence of big mucus accumulations can serve as physical barrier in tumour extension, compressing the tumour stroma, slowing the growth, inhibiting the DNA synthesis and decreasing the angiogenesis rate 8.
Although the clinical presentation of PCMC is non-specific, the histopathological exam is pathognomonic. Usually, the tumour is well delimitated, with small accumulations or tubules of epithelial cells which float in mucine. Mucine is separated by fine collagen fibres septa and is positive to PAS stain, mucicarmina, alcian blue at a pH of 2.
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Mucine, same as sialomucine, was characterized as sialidase-labile. The cells are small, basaloid, vacuolated with eosinophilic cytoplasm.
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The cellular pleomorfism and the 1. Primary mucinous carcinoma, J Dermatolog Surg Oncol Primary mucinous carcinoma of the skin with metastases to the lymph nodes. Am J Dermatopathol ; Carcinomas of sweat glands, report of 60 cases.
Arch Pathol Lab Med ; Smith CC Metastazing carcinoma of the sweat-glands. Br J Surg43 Primary mucinous carcinoma of cancer la colon skin: A population based study.
Int J Dermatol. Further investigations are necessary in order to eliminate the skin metastasis 7,8.
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The immunohistochemistry exam can facilitate the differential diagnoisis. PCMC cells remain positive for CK 7 and negative for CK 20, the same occurs for the mucinous adenocarcinoma of the breast, but in the case of the mucinous colorectal adenocarcinoma CK 7 is negative and CK 20 is positive.
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This way, the absence of CK does hpv cause blood cancer excludes skin metastases originated from the mucinous colorectal adenocarcinoma. Another CK 7 positive and CK 20 negative tumours, as the adenocarcinoma of the lung or of the gallbladder, can also produce skin metastases.
These can be excluded using systemic suplimentary investigations and another types of immunohistochemistry specific colorations 9.
Because the skin metastases originating from breast and lung can express the p63 protein, the use of this expression remains controversial and so, further investigations are mandatory. Quereshi et al. In a complex analysis of the skin metastasis, Brownstein et al.
The treatment of PCMC imposes local surgical excision. Because of the high local relapse rate, the proper excision with oncological safety margins at least 1 cm is recommended.
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The patients are informed that the periodical check-ups are of great importance regarding the local recurrence or the appearance of locoregional lymphadenopathy. Conclusions PCMC is a rare malignant tumour that must be evaluated and treated correctly. The certainty of diagnosis is achieved by histopathological exam, specific investigations for excluding a metastasis, followed by surgical treatment with oncologic safety margins.
For the case report presented, we must underline that the local clinical exam was unspecific; the location of the tumour was extremely rare, with local invasion in sternal distal region, the anterior abdominal wall, peritoneum and mediastinum, since the diagnosis needed suplimentary investigations in order to establish the primary cutaneous mucinous adenocarcinoma.
Mucinous carcinoma of the skin, J Am Acad Dermatol ; Bone marrow relapse in primary mucinous carcinoma of the skin. Am J Clin Oncol ; Report of a case: primary mucinous carcinoma of the skin, Dermatol On J, 14 6 Primary mucinous carcinoma of the eyelid, a clinicopathologic does hpv cause blood cancer immunohistochemical study of 4 cases and an update on recurrence rates; Arch Ophthalmol ; 9 Although belived to be uncommon and despite campaigns that advocate safe sun exposure habbits and early consult for suspicious lesions, the annual incidence is in continuous rise.
Surgery is the best treatment for early stage disease, medical therapy being reserved for adjuvant situations and for unresectable and metastatic melanoma. Chemotherapy offers poor response rates.
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The introduction of immunotherapy brought a great improvement to melanoma treatment median PFS: This article is a review of the latest clinical trials and therapeutic guidelines regarding immunotherapy in unresectable or metastatic MM. Keywords: malignant melanoma, therapeutic guidelines, immunotherapy Melanomul malign MM este o tumoră a celulelor care se dezvoltă din melanocite. Deşi considerat ca având frecvenţă redusă şi în pofida campaniilor care militează pentru o expunere judicioasă la soare şi consult medical al leziunilor suspecte, incidenţa anuală este în continuă creştere.
Chirurgia este tratamentul cel mai eficient pentru stadiile incipiente, tratamentul medical fiind rezervat în situaţia de adjuvanţă şi în MM inoperabil şi metastatic. Chimioterapia oferă rate scăzute de răspuns.