Dome-shaped solitary nodule

Wei Zhang, Yun He, Xiaofang Li, Yiqun Jiang, Xuesi Zeng, Weida Liu, Jianfang Sun

 Department of Dermatopathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu Province, China

Correspondence Address:
Yiqun Jiang
Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, 12, Jiangwangmiao Street, Nanjing 210 042, Jiangsu Province
China
Xiaofang Li
Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, 12, Jiangwangmiao Street, Nanjing 210 042, Jiangsu Province
China

A 64-year-old, otherwise healthy woman was referred to our hospital with a 3-year history of an asymptomatic lesion on the medial aspect of her right leg.

Physical examination disclosed a dome-shaped, firm, reddish-brown, solitary nodule, approximately 3 cm in diameter [Figure - 1]a. She had no previous significant medical or surgical history or a family history of such a tumor. Histopathology showed an unencapsulated, well-circumscribed tumor in the upper to mid dermis. The tumor was composed of multiple, oval to irregularly-shaped, tubular structures lined by two or more layers of epithelial cells and surrounded by fibrous stroma [Figure - 1]b. The luminal layers were composed mainly of cuboidal cells forming papillary projections in some tubules [Figure - 1]c. The peripheral layer was lined with flattened to cuboidal cells. Neither decapitation secretions nor connection of the neoplastic tubules to the overlying epidermis were seen. The overlying epidermis was slightly atrophied. Within some tubules, eosinophilic amorphous material was noted. Cell necrosis, mitosis and nuclear pleomorphism were absent. Immunostaining revealed positivity for cytokeratin-7 [Figure - 1]d. Positive staining with epithelial membrane antigen highlighted the tumor cell membranes [Figure - 1]e. The inner epithelial cells were partly positive for carcinoembryonic antigen. Gross cystic disease fluid protein-15 was negative in tumor cells.

Question

What is the diagnosis?

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This work was supported by the Fundamental Research Funds for the Central Universities (2016RC320006) and the CAMS Innovation Fund for Medical Sciences (CIFMS-2017-I2M-1-017).

Conflicts of interest

There are no conflicts of interest.

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