Letter - Research
Squamoid eccrine ductal carcinoma: series of five cases of a rare tumor
Cecília Mirelle Almeida Honorato
, Giovanna Gelli Carrascoza, Nubia Marrer Abed, Fernanda Gonçalves Moya
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Department of Dermatology, Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
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(A) Corte histológico evidenciando tumor com crescimento infiltrativo invadindo a derme profunda (Hematoxilina & eosina, 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>). (B) Diferenciação escamosa nas porções mais superficiais (Hematoxilina & eosina, 20<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>). (C) Diferenciação ductal écrina na profundidade do tumor (Hematoxilina & eosina, 10<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cecília Mirelle Almeida Honorato, Giovanna Gelli Carrascoza, Nubia Marrer Abed, Fernanda Gonçalves Moya" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Cecília Mirelle Almeida" "apellidos" => "Honorato" ] 1 => array:2 [ "nombre" => "Giovanna Gelli" "apellidos" => "Carrascoza" ] 2 => array:2 [ "nombre" => "Nubia Marrer" "apellidos" => "Abed" ] 3 => array:2 [ "nombre" => "Fernanda Gonçalves" "apellidos" => "Moya" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059624001752" "doi" => "10.1016/j.abd.2023.10.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624001752?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275224001875?idApp=UINPBA00008Z" "url" => "/26662752/0000009900000006/v1_202410301154/S2666275224001875/v1_202410301154/pt/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "S0365059624001715" "issn" => "03650596" "doi" => "10.1016/j.abd.2024.02.005" "estado" => "S300" "fechaPublicacion" => "2024-11-01" "aid" => "1012" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - 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(A) Nodular swelling covered with intact mucosa in the left region of the palate corresponding to an intramucosal nevus (B) Nests of pigmented nevus cells separated from the epithelial lining by an evident basement membrane. Note polygonal and epithelioid cells in the subepithelial region and the depth cells similar to lymphocytes (Hematoxylin & eosin, scale bar: 50 μ) (C) Intramucosal nevus showing deep-seated angled, spindle-shaped cells with neurotization; Type C (Hematoxylin & eosin, scale bar: 50 μ) (D) Blue nevus composed of spindle-shaped cells with long cytoplasm and dendritic cells containing brownish melanic pigment (Hematoxylin & eosin, scale bar: 50 μ).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Izadora Fernanda Veiga de Jesus Costa, Deyla Duarte Carneiro Vilela, Bruno Cunha Pires, Jener Gonçalves de Farias, Valéria Souza Freitas, Jean Nunes dos Santos" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Izadora Fernanda Veiga de Jesus" "apellidos" => "Costa" ] 1 => array:2 [ "nombre" => "Deyla Duarte Carneiro" "apellidos" => "Vilela" ] 2 => array:2 [ "nombre" => "Bruno Cunha" "apellidos" => "Pires" ] 3 => array:2 [ "nombre" => "Jener Gonçalves" "apellidos" => "de Farias" ] 4 => array:2 [ "nombre" => "Valéria Souza" "apellidos" => "Freitas" ] 5 => array:2 [ "nombre" => "Jean Nunes dos" "apellidos" => "Santos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275224001814" "doi" => "10.1016/j.abdp.2024.07.026" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275224001814?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624001648?idApp=UINPBA00008Z" "url" => "/03650596/0000009900000006/v1_202410230911/S0365059624001648/v1_202410230911/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Research</span>" "titulo" => "Squamoid eccrine ductal carcinoma: series of five cases of a rare tumor" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "936" "paginaFinal" => "939" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Cecília Mirelle Almeida Honorato, Giovanna Gelli Carrascoza, Nubia Marrer Abed, Fernanda Gonçalves Moya" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Cecília Mirelle Almeida" "apellidos" => "Honorato" "email" => array:1 [ 0 => "draceciliahonorato@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Giovanna Gelli" "apellidos" => "Carrascoza" ] 2 => array:2 [ "nombre" => "Nubia Marrer" "apellidos" => "Abed" ] 3 => array:2 [ "nombre" => "Fernanda Gonçalves" "apellidos" => "Moya" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1979 "Ancho" => 1675 "Tamanyo" => 615497 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical aspect. (A) Normochromic plaque, measuring approximately 2 cm, with irregular vessels at the border and an ulcerated center. (B) Erythematous nodule, measuring approximately 2 cm, presenting a friable surface covered by an hematic crust.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Squamoid eccrine ductal carcinoma (SEDC) is a rare malignant cutaneous neoplasm that is biphasic on histopathology, with both squamous (tumor surface) and ductal eccrine (tumor depth) differentiation, often being confused with squamous cell carcinoma (SCC), especially in superficial biopsies. SDEC has significant clinical relevance due to its potential for metastasis and local aggressiveness.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Therefore, the objective of this case series is to demonstrate the clinical and histopathological presentation of five cases of SEDC aiming to improve knowledge and management of this rare neoplasm.</p><p id="par0010" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the main information of the five SEDC cases. The disease affected exclusively elderly male adults, averaged 68 years old. All cases occurred in the head and neck region, with a predilection for the face (three of five cases). There was a history of immunosuppression due to organ transplantation in three patients and previous local radiotherapy in one case. On histopathology (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), the tumors showed an infiltrative growth pattern in the dermis, occasionally invading the subcutaneous and muscular tissue. In the most superficial regions of the tumors, squamous differentiation was observed, similar to well-differentiated SCC, while in the deeper regions, there were different degrees of ductal differentiation and nests and cords of epithelial cells with moderate to severe atypia, surrounded by desmoplastic stroma. The presence of perineural invasion was observed in three cases, and angiolymphatic invasion in one case. Ductal differentiation was confirmed by immunohistochemistry positivity for epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA) in all tumors (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Information on treatment and evolution is available for four of the five patients, as one of them was lost to follow-up after incisional biopsy of the tumor. All four cases underwent surgical treatment with free surgical margins after the procedure. The surgical margins were evaluated intraoperatively by frozen sections in two of the four cases, while in the other two cases, margin analysis occurred after surgery. The mean follow-up time after surgery was 28.5 months. Evidence of local recurrence was observed in two patients: one had undergone conventional surgery with margin analysis, while the other had intraoperative margin analysis performed using frozen sections. Moreover, in addition to developing local recurrence, one of the patients also showed lymph node and lung metastases, resulting in death.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">SEDC is traditionally classified as a subtype of eccrine carcinoma. However, its etiopathogenesis remains uncertain, as it is not clear whether it arises from the eccrine ducts with subsequent squamoid differentiation, whether it is an SCC subtype, or whether it is a truly hybrid tumor. SEDC mainly affects the elderly, generally in the seventh or eighth decade of life, and it is suggested that immunosuppression may be a risk factor. Most cases are observed on sun-damaged skin, especially on the head and neck, with the face being the most common location. Clinically, it appears as small, often ulcerated, nodules and plaques, as shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The diagnosis is made through anatomopathological examination, in which the SEDC presents as a biphasic tumor. In the superficial areas of the tumor, squamous differentiation occurs with connection to the epidermis, while in deeper areas there is clear ductal eccrine differentiation. Squamous differentiation is typically absent in deeper regions. Furthermore, infiltrative growth is observed, with the presence of cords of cytologically atypical epithelial cells, as well as a surrounding desmoplastic stromal response.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a> SEDC frequently extends to the subcutaneous tissue and may be associated with perineural and angiolymphatic invasion, factors that may explain its high local recurrence rate (25%), even after complete excision, and its potential for metastasis (13%), according to literature data.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> SEDC demands involves wide local excision and regular clinical follow-up, with Mohs micrographic surgery as a beneficial option.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore, given the rarity and lack of knowledge associated with this neoplasm, together with its potential for unfavorable outcomes, it is essential to conduct additional studies to expand the understanding and management of SEDC. The present findings suggest the need for intensified surveillance of kidney transplant recipients, as three of the five cases occurred in this group of patients. Raising awareness about this neoplasm is essential, as it is probably underdiagnosed, aiming to ensure its early diagnosis and adequate treatment and, consequently, improve clinical outcome.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Cecília Mirelle Almeida Honorato: Design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Giovanna Gelli Carrascoza: Drafting and editing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Nubia Marrer Abed: Approval of the final version of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Fernanda Gonçalves Moya: Approval of the final version of the manuscript; design and planning of the study; effective participation in research orientation; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-08-07" "fechaAceptado" => "2023-10-19" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, São Paulo, Brazil.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1716 "Ancho" => 2508 "Tamanyo" => 761208 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histopathology. Histological section showing tumor with infiltrative growth invading the deep dermis (A: Hematoxylin & eosin, ×4), with squamous differentiation in the tumor surface (B: Hematoxylin & eosin, ×20) and eccrine ductal differentiation in the tumor depth (C: Hematoxylin & eosin, ×10).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1760 "Ancho" => 1675 "Tamanyo" => 371432 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry positivity for EMA (A) and CEA (B), confirming the presence of ductal differentiation.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1979 "Ancho" => 1675 "Tamanyo" => 615497 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical aspect. (A) Normochromic plaque, measuring approximately 2 cm, with irregular vessels at the border and an ulcerated center. (B) Erythematous nodule, measuring approximately 2 cm, presenting a friable surface covered by an hematic crust.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">M: Male.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Gender</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Age (years)</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Site of the tumor</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Immunosuppression</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Presence of perineural and angiolymphatic invasion</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Treatment</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Time of follow-up (months)</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Outcome</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Eyebrow \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kidney transplant recipient using tacrolimus, azathioprine and prednisone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perineural invasion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not applicable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Does not apply \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lost to follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Temporal region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kidney transplant recipient using tacrolimus and everolimus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perineural and angiolymphatic invasion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgical excision with intraoperative margin control by frozen sections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No signs of local recurrence or metastasis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">3</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Forehead \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Conventional surgical excision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No signs of local recurrence or metastasis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">4</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cervical region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Conventional surgical excision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Local recurrence \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">5</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scalp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kidney transplant recipient using prednisone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perineural invasion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgical excision with intraoperative margin control by frozen sections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Local recurrence and lung and lymph node metastasis, resulting in death \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3698862.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Summary of cases of squamoid eccrine ductal carcinoma.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Squamoid eccrine ductal carcinoma a clinicopathologic study of 30 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.P.J. Van Der Horst" 1 => "A. Garcia-Herrera" 2 => "D. Markiewicz" 3 => "B. Martin" 4 => "E. Calonje" 5 => "T. Brenn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PAS.0000000000000599" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "2016" "volumen" => "40" "paginaInicial" => "755" "paginaFinal" => "760" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26796504" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Squamoid eccrine ductal carcinoma: treatment and outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "MM Lim" 1 => "JA Macdonald" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2022" "volumen" => "44" "paginaInicial" => "249" "paginaFinal" => "253" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Squamoid eccrine ductal carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.I.R. 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Miletta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0000000000001214" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2019" "volumen" => "41" "paginaInicial" => "140" "paginaFinal" => "143" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29979196" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009900000006/v1_202410230911/S0365059624001752/v1_202410230911/en/main.assets" "Apartado" => array:4 [ "identificador" => "95149" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter - Research" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009900000006/v1_202410230911/S0365059624001752/v1_202410230911/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624001752?idApp=UINPBA00008Z" ]
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