Apocrine acrosyringeal keratosis in association with syringocystoadenoma papilliferum

Mucosal Alpha-Papillomavirus (HPV89) in a rare skin lesion

Background

Apocrine acrosyringeal keratosis is a rare skin lesion showing a unique benign keratotic lesion associated with syringocystoadenoma papilliferum. It is characterized by an exophytic proliferation of the epidermis with two distinct keratinocytic structures: a) columns of hyperkeratotic mass surrounded by acanthotic epidermis and b) papillated and/or cystic invaginations typical of syringocystoadenoma papilliferum. No causative agents were reported.

Findings

The present report describes a typical case of apocrine acrosyringeal keratosis localized in the right retro-auricular area of 57-year-old man in which the presence of HPV was evaluated. PCR analysis and direct sequencing revealed the presence of HPV 89. The presence of this low risk mucosal HPV in a skin localization was never reported as well as in association with this rare tumor. Furthermore rolling circle amplification, RT-PCR and in situ hybridization confirmed the presence of a transcriptionally active HPV 89.

Conclusions

Taken together our results suggest that HPV89 plays a role in apocrine acrosyringeal keratosis with syringocystoadenoma papilliferum, in consideration of the documented biological activity of the virus. The association of low risk mucosal HPV infection with this skin lesion opens new perspectives in its clinical management. Further studies on samples from other patients are needed to confirm this association.

Syringocystadenoma papilliferum in the right lower abdomen: a case report and review of literature

Syringocystadenoma papilliferum (SCAP) is an uncommon benign adnexal tumor of the skin. It is frequently seen in association with other benign adnexal lesions, such as nevus sebaceous, apocrine nevus, tubular apocrine adenoma, apocrine hidrocystoma, apocrine cystadenoma, and clear cell syringoma. The unusual reported locations of SCAP include the head and neck, the buttock, the vulva, the scrotum, the pinna, the eyelid, the outer ear canal, the forehead, the back, the scalp, the thigh, the nipple, the axilla, and the postoperative scar. The occurrence of SCAP in the right lower abdomen is distinctly uncommon. Herein, we report an unusual case of a 41-year-old man with SCAP occurring in the right lower abdomen that did not develop malignancy, despite a long disease course and an absence of medical treatment. The clinical and histopathologic features and the differential diagnosis of SCAP are also discussed.

Syringocystadenoma papilliferum of the eyelid

PURPOSE

To describe 6 patients with syringocystadenoma papilliferum of the eyelid and to review the literature regarding this rare eyelid tumor.

METHODS

Clinicopathologic series of 6 cases, diagnosed at the New York Eye and Ear Infirmary from 1990 to 2006. The PubMed database was searched for reported cases of syringocystadenoma papilliferum of the eyelid (keywords: syringocystadenoma, eyelid, apocrine, eccrine).

RESULTS

Fourteen patients (6 from the current case series and 8 previously reported) with syringocystadenoma papilliferum of the eyelid were identified. Patient age ranged from 8 to 82 years (mean, 44.6 years). Most cases had a preoperative diagnosis of basal cell carcinoma or cyst. Histopathologic evaluation of excised lesions revealed proliferation of duct-like channels in the dermis. These channels were lined by nonkeratinizing epithelium and communicated with the epidermis. Papillary structures with plasma cell-rich stromal infiltrate protruded in the cystic invaginations. Nine lesions (64%) were associated with apocrine, eccrine, or sebaceous tumors or malformations. None of the lesions was associated with a malignant neoplasm. One lesion recurred after incomplete excision. None of the completely excised lesions recurred.

CONCLUSIONS

Syringocystadenoma papilliferum can rarely affect eyelid skin. This lesion is frequently clinically misdiagnosed as basal cell carcinoma or cyst. Although syringocystadenoma papilliferum of the eyelid can be associated with other benign lesions, no malignant transformation or association with malignant neoplasms has been reported. The evidence suggests that this tumor should be managed with conservative complete excision.

Syringocystadenoma papilliferum: a rare breast tumor in a young boy

Syringocystadenoma papilliferum of the breast is extremely rare in children. However, some occasional cases have been diagnosed in females. This report documents a case of syringocystadenoma papilliferum occurring in a healthy 4-year-old male. Histopathologically, this tumor, located deep in the dermis, was characterized by the presence of papillary projections extending into the lumen of epithelial cystic invaginations in a background of dense fibrous tissue. The papillary projections and the duct-like structures were lined by an inner columnar epithelium, which demonstrated luminal apical decapitation secretion, and had an outer layer of smaller cuboidal cells. These findings support apocrine differentiation in this case. A fairly dense mononuclear infiltrate in the stroma of the tumor, especially in the papillary projections, was also present. Although syringocystadenoma papilliferum is rare in children, it should not be summarily ruled out during examinations of masses found in the pediatric male breast. It is important to recognize this unusual location of the tumor so that a prompt diagnosis, based on histopathology and surgical excision, can be proposed.

Syringocystadenoma papilliferum contiguous to a verrucous cyst

BACKGROUND

Syringocystadenoma papilliferum (SCAP) and verrucous cyst are two uncommon benign tumors. The simultaneous occurrence of the two lesions has not been reported before.

METHODS

We report four cases of the simultaneous occurrence of the two rare lesions as so-called collision lesions with a review of the literature.

CONCLUSION

The relationship of SCAP with viral infection needs further investigation.

An immunohistochemical and ultrastructural study of syringocystadenoma papilliferum

BACKGROUND

Syringocystadenoma papilliferum is a benign hamartomatous tumour of the skin. The histogenesis of this tumour is still controversial. There have been few reports regarding immunohistochemical investigations using only a limited range of antibodies and ultrastructural studies on this rare tumour.

OBJECTIVES

To elucidate the immunohistochemical and ultrastructural properties of this tumour.

METHODS

We investigated the immunohistological patterns of 12 different anticytokeratin (CK) antibodies and several other markers in five cases of this tumour, comparing them with the patterns in adult sweat glands. One of these cases was also evaluated ultrastructurally.

RESULTS

The luminal columnar cells of the tumour were mostly positive for CK7 and more than 70% were positive for CK19. These cells showed the heterogeneous expression of CK1/5/10/14, CK14 and CK5/8. These patterns were also observed in the luminal cells in the secretory or the ductal portion of the adult sweat glands. The basal cuboidal cells of the tumour almost constantly expressed CK1/5/10/14, CK5/8, CK14 and CK7 (except for one case), similar to the patterns of basal cells in the transitional portion and myoepithelial cells in the sweat glands. However, the basal tumour cells expressed CK19 and vimentin heterogeneously, and alpha-smooth muscle actin focally (three cases). Ultrastructurally, the constituent epithelial cells were mainly divided into three types: luminal cells, basal cells and clear cells. The luminal tumour cells bore features of the secretory or ductal luminal cells of sweat glands, although they were somewhat immature in appearance. The basal tumour cells were fundamentally basaloid in nature. The clear cells were undifferentiated or primitive in appearance, suggesting stem or progenitor cell properties. Transitional forms between the clear cells and the other two cell types were also identified.

CONCLUSIONS

The tumour epithelium was composed of several cell types demonstrating various developmental stages from the primitive clear cells to the basal cells demonstrating a tendency to differentiate toward basal cells in the apocrine transitional portion or myoepithelial lineage, or luminal cells toward the ductal or secretory epithelium. These results support the classical concept that syringocystadenoma papilliferum is a hamartomatous tumour that arises from pluripotent cells.