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Journal of the American Academy of Dermatology
Volume 57, n° 3
pages 467-483 (septembre 2007)
Doi : 10.1016/j.jaad.2007.02.029

Apocrine mixed tumor of the skin (“mixed tumor of the folliculosebaceous-apocrine complex”) : Spectrum of differentiations and metaplastic changes in the epithelial, myoepithelial, and stromal components based on a histopathologic study of 244 cases

Dmitry V. Kazakov, MD, PhD a, , Irena E. Belousova, MD, PhD b, Michele Bisceglia, MD c, Eduardo Calonje, MD, DipRCPath d, Michael Emberger, MD e, Wayne Grayson, MBChB, PhD, FCPath f, Markus Hantschke, MD g, Werner Kempf, MD h, Heinz Kutzner, MD g, Michal Michal, MD a, Dominic V. Spagnolo, MMBS i, Susanna Virolainen, MD j, Bernhard Zelger, MD, MSc k
a From Sikl’s Department of Pathology, Charles University Medical Faculty Hospital, Pilsen 
b Department of Dermatology, Medical Military Academy, Saint Petersburg 
c Department of Pathology, IRCCS-Ospedale “Casa Sollievo della Sofferenza,” San Giovanni Rotondo 
d Department of Dermatopathology, St John’s Institute of Dermatology, St Thomas’ Hospital, London 
e Department of Dermatology, Paracelsus Private Medical University Salzburg 
f Division of Anatomical Pathology, School of Pathology, National Health Laboratory Service, University of the Witwatersrand, Johannesburg 
g Dermatohistopathologische Gemeinschaftspraxis, Friedrichshafen 
h Kempf und Pfaltz, Histologische Diagnostik, Zürich 
i Division of Tissue Pathology, PathWest Laboratory Medicine WA, Nedlands 
j Department of Pathology, Haartman Institute, University of Helsinki 
k Clinical Department of Dermatology and Venereology, Innsbruck Medical University 

Reprint requests: Dmitry V. Kazakov, MD, PhD, Sikl’s Department of Pathology, Charles University Medical Faculty Hospital, Alej Svobody 80, 304 60 Pilsen, Czech Republic.

Pilsen, Czech Republic; Saint Petersburg, Russia; San Giovanni Rotondo, Italy; London, United Kingdom; Salzburg and Innsbruck, Austria; Johannesburg, South Africa; Friedrichshafen, Germany; Zürich, Switzerland; Nedlands, Western Australia, Australia; Helsinki, Finland


A systematic analysis of the entire spectrum of various forms of differentiation and metaplastic epiphenomena in cutaneous apocrine mixed tumor (AMT) has never been performed.


The purpose of our study was to study a large number of cutaneous mixed tumors so as to fully characterize the entire spectrum of differentiations and metaplastic changes that may occur in the epithelial, myoepithelial, and stromal components of AMT.


This article reports a light-microscopic study of 244 cases of cutaneous AMT, complemented by a literature review.


All types of differentiation along the lines of the folliculosebaceous-apocrine unit can be seen in AMT. The spectrum of metaplastic changes in the epithelial components includes squamous metaplasia, mucinous metaplasia, oxyphilic metaplasia, clear cell change, columnar metaplasia, hobnail metaplasia, and cytoplasmic vacuolization. The following changes in the myoepithelial component were documented: clear cell change, hyaline cells, plasmacytoid cells, spindling, and collagenous spherulosis. Stromal alterations included chondroid metaplasia, osseous metaplasia, and adipose metaplasia.


This study utilizes tissue specimens that mainly came as consultations; therefore some inherent selection bias exists.


AMT displays a wide range of differentiation and metaplastic changes in its epithelial, myoepithelial, and stromal components. These phenomena are not mutually exclusive. When unduly prominent, they may present diagnostic pitfalls. Our findings corroborate those of previous publications, stressing the remarkable diversity of differentiation and metaplasias that may be found in cutaneous AMT. We propose that the most appropriate name for these lesions is “mixed tumor of the folliculosebaceous-apocrine complex.”

The full text of this article is available in PDF format.

 Funding sources: None.
Conflict of interest: None declared.

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