This 69 year old man presented with multiple ill-defined tumors on his back. There was a clinical concern for metastases. Adenoid cystic carcinoma is a rare primary skin tumor, with probable eccrine origin. The characteristic histologic feature is the cribriforming architecture, that is, the rigid punched-out-appearing holes within the individual islands. There are also abnormal pink and bluish mucinous secretions. Basal cell carcinoma has an adenoid basal pattern, which mimics adenoid cystic carcinoma, but should have areas of more recognizable basal cell carcinoma. This lesion metastasized, which would also argue against basal cell carcinoma. Treatment of adenoid cystic carcinoma is local control, but as this case illustrates, metastases may occur.
Description
This higher power view highlights the cribriforming architecture. Note both the bluish and pink mucinous secretions. The cytology is not terribly atypical, with a fairly monomorphous small tumor population. There is peritumoral clefting, mimicking a basal cell carcinoma. Mitoses are present, but not prominent.
