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Case Reports

Abstract

We report a first case, to the best of our knowledge, in documented literature, of an apocrine type mixed tumor with psammoma bodies. A 55-year-old male presented with a growing pink papule on the nasolabial fold. The biopsy showed a well-circumscribed tumor composed of lobules of uniform epithelial cells containing a few elongated ducts embedded in a myxoid stroma. Numerous psammoma bodies were present. The patient’s comorbidities included dyslipidemia, right ventricular hypertrophy, and hypothyroidism. Psammoma bodies are concentric laminated calcifications that are most known to be associated with papillary thyroid carcinoma, meningioma, and ovarian papillary serous cystadenocarcinoma. It has also been associated with benign lesions such as Hashimoto thyroiditis, Graves’ disease, thyroid follicular nodular disease, ovarian cystadenofibromas, endosalpingosis and endometriosis. Presence of psammoma bodies in these benign entities warrant careful evaluation to eliminate underlying malignancy but is not specific for malignancy. The pathogenesis of psammoma bodies remains a debate. Dystrophic calcification of neoplastic papillae vessel, thrombosis, necrosed tumoral cell, and/or tumoral collagenous stroma have all been proposed as possible inciting events. There are also speculations that psammoma bodies represent a physiologic mechanism against the spread of neoplasm, leading to tumoral cell death and subsequent calcification. Psammoma bodies are rare in cutaneous neoplasms but have been documented in squamous cell carcinoma, mucinous carcinoma, melanoma and melanotic schwannoma.  Our case expands the reported literature.