Dermal Duktus Tümörü
Özet
Dermal duktus tümörü (DDT), ter bezlerinin intradermal segmentlerinden köken alan, oldukça nadir görülen benign bir poroid neoplazi türüdür. Genellikle baş-boyun bölgesi ve ekstremitelerde yavaş büyüyen, asemptomatik, 1-2 cm’den küçük, deri renginde papül veya nodüllerle klinik olarak prezente olur. Epidermis ile bağlantısı bulunmayan bu tümör, dermis içine yerleşmiş, küçük ve monomorfik bazaloid poroidal hücreler ile geniş eozinofilik sitoplazmalı kutiküler hücrelerden oluşan lobüller ve belirgin duktus benzeri yapılar içerir. İmmünhistokimyasal olarak CK 5/14 ve lümen çevresinde EMA, CEA pozitifliği izlenirken; histokimyasal olarak PAS pozitifliği ve son çalışmalarda YAP1 gen füzyonları saptanmıştır. Klinik özelliklerinin nonspesifik olması nedeniyle ayırıcı tanısında bazal hücreli karsinom ve diğer benign-malign dermal lezyonlar yer alır. Histopatolojik açıdan ekrin poroma ve poroid hidradenom ile yakın benzerlik gösterdiğinden, epidermisle olan ilişkisini netleştirmek adına seri kesitlerin incelenmesi kritik önem taşır. Prognozu mükemmel olup, nadir görülen malign transformasyon (porokarsinom) riskine karşı tedavisinde tam cerrahi eksizyon önerilir ve nüks riski oldukça düşüktür.
Dermal duct tumor (DDT) is a very rare benign poroid neoplasia originating from the intradermal segments of the sweat gland ducts. It typically presents clinically on the head-neck region and extremities as a slow-growing, asymptomatic papule or nodule, generally smaller than 1-2 cm. Lacking epidermal attachment, the tumor is characterized by dermal lobules composed of small, monomorphic basaloid poroid cells, wider eosinophilic cuticular cells, and distinct duct-like structures. Immunohistochemically, it exhibits CK 5/14 expression, along with EMA and CEA positivity around luminal areas, while histochemically demonstrating PAS positivity and recently identified YAP1 gene fusions. Due to its nonspecific clinical findings, the differential diagnosis includes a wide range of entities such as basal cell carcinoma and other dermal lesions. Histopathologically, it closely resembles eccrine poroma and poroid hidradenoma; thus, evaluating serial sections is crucial to rule out epidermal involvement. The prognosis is excellent, and simple surgical excision is recommended to prevent rare malignant transformation (porocarcinoma), with recurrence being extremely uncommon.
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