Eccrine mucinous nevus: clinical and histopathological description in an adult Nevus mucinoso ecrino en el adulto: descripción clínicohistológica

Eccrine mucinous nevus is an uncommon hamartoma whose histological diagnosis is simple because of its peculiar morphological features, which include an increase in the number and/or size of the glands and eccrine ducts accompanied by abundant mucin deposits. When it presents with the typical symptom, focal hyperhidrosis, clinical suspicion is possible. El nevus mucinoso ecrino (NME) es un hamartoma escasamente reportado en la literatura cuyo diagnóstico histológico es sencillo debido a sus peculiares rasgos morfológicos, que incluye un aumento del número y/o tamaño de las glándulas ductos ecrinos acompañado de abundante depósito de mucina. Cuando presenta los hallazgos típicos, como la hiperhidrosis focal, es posible su sospecha clínica.

Apocrine adenocarcinoma in the setting of apocrine hidrocystoma of the leg

Apocrine hidrocystoma is a benign, cystic lesion often presenting in the periorbital region. Apocrine adenocarcinoma is the rare, malignant counterpart occurring mainly in the axilla and anogenital region. There is a paucity of literature on both entities and co-occurrence has been reported in only 5 cases. We present the case of a 48-year-old man with a history of total body irradiation for chronic myelocytic leukemia, diabetes mellitus, and obesity who presented with a calf mass of two years' duration. Epidermal inclusion cyst was presumed and excisional biopsy was carried out. Pathologic analysis revealed apocrine adenocarcinoma in the setting of a precursor apocrine hidrocystoma. Our patient's unique altered immunity and the direct effects of irradiation on the local microenvironment may have resulted in his rare presentation of co-occurrence of apocrine adenocarcinoma within an existing apocrine hidrocystoma. To our knowledge, our patient is the first reported patient with this presentation in the lower extremity.

Scalp porocarcinoma and lichen planopilaris

Porocarcinoma (PC) is a malignant neoplasm arising from the intraepidermal ductal portion of the sweat gland duct. Lichen planopilaris (LPP) is a not so rare variant of cutaneous lichen planus (LP) with a preferential involvement of hair follicles, consisting of a chronic lymphocytic inflammation, leading to cicatricial alopecia. A 42-year-old woman, recently diagnosed with HIV infection, was referred to our clinic because of an alopecic patch of 6 years' duration. In the upper region of the alopecia a 1.5cm nodule was noticed, which the patient stated had started growing soon after the appearance of the hair loss. Biopsy of the alopecia margin confirmed the diagnosis of LPP, whereas biopsy of the nodule revealed an infiltrating tumor consistent with the diagnosis of PC. We present a scalp PC emerging in a background of LPP in an HIV patient. We do not know the role, if any, HIV infection and LPP played in this particular case. Immunosuppression and HIV have been implicated in the etiology of PC. However, her HIV diagnosis was made after the appearance of the scalp nodule. We did not find any association between LPP and PC in the literature. Even though an association by chance cannot be excluded, this deserves further investigation.

Linear syringocystadenoma papilliferum on the retroauricular area associated with nevus sebaceus

Syringocystadenoma papilliferum is a rare cutaneous adnexal tumor that usually arises in the head and neck region. It may develop de novo or within a nevus sebaceus. Linear syringocystadenoma papilliferum is an uncommon variant of this benign tumor. We report a child with linear retroauricular distribution of syringocystadenoma papilliferum. A background nevus sebaceus was shown histologically. Total excision was curative with no recurrence. An association between the linear variant of syringocystadenoma papilliferum and nevus sebaceus has not been reported previously.

A chronic, bleeding, and painful nodule on the chest

An 81-year-old man presented to the dermatology clinic with a painful lesion on his chest. The nodule would occasionally bleed and leak serous fluid for 10 years. Physical examination revealed an unspecified nodule with two superimposed nodules. A deep shave biopsy of the lesion was obtained and expressed a solid-cystic dermal neoplasm that was comprised of an admixture of cell types. Through the presenting clinical and histological features seen, a final diagnosis of nodular hidradenoma was made.

[Apocrine hidrocystoma associated with gouty tophi of the pinna]

BACKGROUND

Apocrine hidrocystomas, also known as apocrine cystadenomas, are bening cystic tumours derived from the secretory portion of apocrine sweat glands.

CLINICAL CASE

A 78-year old female was referred to our division for assesment an asymptomatic translucent, well-defined cystic lesion located on the upper helix. The histological features were consistent with apocrine hidrocystoma coexisting with gouty tophi.

CONCLUSIONS

We report the second case of apocrine hydrocystoma located in the pinna, outside of ear canal and the first case of its association with gouty tophi described. It is difficult to know which lesion was first established and if the tophi may lead to ductal obstruction and subsequent cystic retention.

Lymphangiectatic Variant of Eccrine Spiradenoma - A Diagnostic Challenge

Conventional eccrine spiradenoma is a benign, slow growing and painful tumor of the skin. While the tumor does not usually present a diagnostic dilemma, a rare variant with marked stromal lymphedema can be a challenge to interpret. We present a case of lymphangiectatic variant of eccrine spiradenoma in an 82-year-old white male who presented with a persistent left flank lesion for several months. The patient was initially asymptomatic and subsequently developed a suspected abscess that was excised to reveal a 6.5 cm subcutaneous mass. Microscopic examination reveals strands and cords of dark, epithelial, round to oval cells with inconspicuous nucleoli streaming between prominently dilated and congested vascular spaces. Within the cystic component there are small ductular structures. Additionally, prominent stromal lymphedema is present. To the best of our knowledge, there is only one reported case of this entity in the English literature. This case represents a diagnostic challenge and the purpose of reporting it is to alert surgical pathologists, dermatopathologists and dermatologists of the existence of this unusual variant of eccrine spiradenoma.

The story of a deformed leprous foot

Eccrine syringofibroadenoma (ESFA) is a rare adnexal tumour of eccrine ductal proliferation. A 50 year old treated case of leprosy presented with a chronic non healing ulcer of 5 years duration on the deformity laden right foot. Multiple verrucous papules and plaques were seen surrounding the ulcer which showed histopathological findings consistent with ESFA. Although ESFA constitutes a rare association with leprosy, considering the load of treated cases in our country and elsewhere, it may represent an under-reported entity which requires more attention in the post elimination era.

Psoriasis with extramammary paget disease in a male: a case report

Psoriasis is a chronic inflammatory skin disease that is characterized by erythematous, sharply demarcated papules and plaques covered by scales. Extramammary Paget disease (EMPD) is a uncommon neoplastic condition of apocrine gland-bearing skin and its occurrence in combination with psoriasis is very rare. We report an interesting case of a 61-year-old male with extensive psoriasis presented with penoscrotal EMPD, which was confirmed by histopathological stain.

Eccrine poromatosis in a patient with acute myeloid leukemia following chemotherapy

Eccrine poromas are rare, benign adnexal tumors that often occur as solitary papules. Rarely, eccrine poromas can present as multiple lesions, which is referred to as eccrine poromatosis. We report a case of eccrine poromatosis occuring on the palms and soles occuring after chemotherapy in a patient with a history of acute myeloid leukemia.

Syringocystadenoma

We present a case of a 35-year-old woman with a yellow, verrucous, and itchy plaque on her scalp. Within this plaque, there was an erythematous, bleeding papule. Histopathologic findings were compatible with a diagnosis of syringocystadenoma papilliferum within a nevus sebaceous. We present a brief review of the natural history of nevus sebaceus, its pathogenesis, and management.

Eruptive syringoma in a patient with trisomy 21

Syringomas are benign adnexal neoplasia that are classified into four main types, according to their clinical features and associations. Syringoma associated with trisomy 21 typically presents with a periorbital cutaneous involvement. We report an 18-year-old Chinese girl with trisomy 21, who presented with eruptive syringoma, an unusual generalised form involving her trunk and limbs. A histological examination was performed to confirm the diagnosis.

Syringocystoadenoma papilliferum associated with apocrine hidrocystoma and verruca

Syringocystoadenoma papilliferum is a benign adnexal tumor usually located in head and neck that occurs during childhood or adolescence. A case of a syringocystoadema papilliferum associated with apocrine hydrocystoma and verruca is presented. It is unusual to see the occurrence of three histopathologic types of tumors coexisting in one cutaneous lesion.

Vulvar syringoma causing pruritus and carcinophobia: treatment by argon laser

Syringomas are benign lesions most commonly appearing around the eyelids and in malar areas, but they have also been described on other body sites. Depending on the site they may cause either aesthetic disturbance (e.g. face, neck, arms) or pruritus (e.g. vulva). This is the first report of argon laser treatment of syringoma in a patient with multiple vulvar syringomas in association with pruritus vulvae and carcinophobia.

Eccrine hidrocystoma: a neoformation to be considered in differential diagnoses of facial swellings

Hidrocystomas are relatively rare cystic skin tumors. The precise histogenetic derivation and the cellular differentiation of these tumors has been largely debated. Usually, the mean age at diagnosis of the patients with eccrine hidrocystomas (EH) is 51.6 years, 54.0 years for females and 32.5 years for males. EH develop predominantly in females (sex ratio 1:6.5). Most patients are asymptomatic; predilection sites are the lower eyelids, nose and lateral canthus. The authors report a rare case of EH of the lower face in a 57-year-old Caucasian male patient presented with mandibular asymmetry due to an asymptomatic neoformation on the left mandibular region. The present report is relevant for the clinical differential diagnoses that a submandibular lesion requires, to exclude neoplasms of osteogenic, mesenchymal, epithelial, vascular or glandular origin. In the case described the histopathological findings, characterized by the presence of partially collapsed, unilocular cyst lined by small, monomoprhous cuboidal epithelial cells with eosinophilic cytoplasm and a highly vascular, slightly edematous stroma, suggested the diagnosis of EH. The standard treatments for EH is surgical excision, which is associated with a high cure rate and a low recurrence rate. In conclusion, in case of EH in the submandibular region, a specific clinical and instrumental diagnosis is very difficult to make, and histopathological diagnosis represents the standard diagnostic procedure.

The squamous variant of eccrine porocarcinoma: a clinicopathological study of 21 cases

AIM

Squamous differentiation in eccrine porocarcinoma (EPC) is an unusual phenomenon that has rarely been reported in the literature. This study describes the clinical and pathological findings in a series of 21 cases of EPC showing extensive squamous differentiation.

METHODS

The H&E-stained sections, epithelial membrane antigen and carcinoembryonic antigen immunohistochemical stains were reviewed for each case. The following variables were examined: age, gender, race, site and size of the EPC. The prevalence of other cutaneous lesions and/or underlying systemic disease was also documented.

RESULTS

There was an almost equal gender distribution. Mean age was 61.5 years and the average tumour size was 46.5 mm. An inordinately large number (10/21, 48%) of EPCs occurred in black patients. The tumours were located at various sites with the extremities predominating (10/19, 53%). Seven patients developed other sun-induced skin tumours, three patients were renal transplant recipients, and two patients were HIV-positive, one of whom also suffered from albinism. Six of the 11 patients in whom follow-up was available had an adverse outcome: local recurrence developed in one patient, one patient developed nodal metastases, and one patient experienced both local recurrence and nodal metastases, and of the three patients who died of disease, two developed distant metastases.

CONCLUSION

The findings suggest a possible role for ultraviolet radiation and chronic immunosuppression in the induction of malignant squamous differentiation in a subset of EPCs. Further reports on this histological variant of EPC are required to determine whether a pathogenetic link does indeed exist or whether these tumours simply represent a unique variant of squamous cell carcinoma with divergent acrosyringial differentiation.

Eccrine porocarcinoma: a case with an obscure primary tumor diagnosed from lymph node metastasis

Eccrine porocarcinoma (EPC), a rare malignant epidermal appendage tumor, is mainly seen in elderly patients. A long history is one of its main characteristics. Two types of EPC are known: juxtaepidermal and dermal. The juxtaepidermal type usually has a more aggressive behavior. Lymph node metastasis and high mitotic activity are associated with poor prognosis. A case of EPC with a long-standing but indolent primary site diagnosed from lymph node metastasis is presented here. There was also accompanying chronic dermatitis as a paraneoplastic syndrome. Diagnosing EPC prior to the regional lymph node involvement is the most valuable factor for a successful treatment. Persistent examinations and attempts to find the primary site(s) have to be made in such cases.

Mucocutaneous findings in 100 children with Down syndrome

Down syndrome is the most common chromosomal abnormality affecting numerous organs, including the skin. Our aim was to study mucocutaneous findings in this syndrome. To do so, 100 children with Down syndrome attending Schools for Children with Special Educational Needs and centers affiliated to the Welfare and Rehabilitation Organization in two provinces of Iran were thoroughly examined for skin and mucosal lesions. Their mean age was 11.2 years (3-20 years). Mucocutaneous findings were noted in 61. These were as follows (in decreasing order)--fissured tongue 28%, hypertrophy of tongue papilla 22%, premature graying 14%, cheilitis 13%, xerosis 12%, alopecia areata 11%, palmoplantar hyperkeratosis 10%, syringoma 6%, keratosis pilaris 4%, geographic tongue 4%, trichotillomania 4%, vitiligo 3%, seborrheic dermatitis 3%, livedo reticularis 2%. No instances of atopic dermatitis or skin infections and infestations were noted. The lack of atopic dermatitis in our series was in concordance with its low prevalence reported in recent articles. Improved hygiene due to patient care at home may underlie the absence of infections. With the increasing survival rate of those with Down syndrome, physicians should be more aware of the skin findings seen so frequently in this genetic disorder.

Cutaneous manifestations of Costello syndrome

Cutaneous findings are common in Costello syndrome, but have not been extensively reviewed in the dermatology literature. We present the cutaneous and histopathologic findings from two cases of Costello syndrome and review previously described cutaneous features of this syndrome. Both patients had manifestations of Costello syndrome with thick, lax skin on the dorsal aspects of hands and feet, deep palmar and plantar creases, curly hair, hyperkeratoses, acanthosis nigricans, papillomas, and multiple pigmented lesions. One patient had multiple syringomas on the forearms, a finding not previously reported. Pigmented lesions have previously been reported as nevi in the literature though no biopsies have been reported. We conclude that thick, loose skin on the dorsal aspects of hands and feet and deep palmar and plantar creases are cardinal manifestations of Costello syndrome and benign tumors of ectodermal origin such as papillomas, calcified epitheliomas, dermoid cysts, mammary fibroadenosis, and syringomas are important features of this syndrome.

[Malignant nodular hidradenoma and multiple nodular hidradenomas in a hypogonadic patient]

BACKGROUND

We report a case of multiple benign nodular hidradenomas associated with malignant nodular hidradenoma in a hypogonadic patient.

CASE-REPORT

A 49 year-old man presented 11 benign nodular hidradenomas in the pectoral region. A malignant nodular hidradenoma had recently appeared in this region some distance from the pre-existing benign modular hidradenomas. This patient had peripheral hypogonadism associated with congenital bilateral cryptorchidia responsible for gynecomastia due to "relative hyperestrogenism". Large numbers of estrogen receptors were demonstrated in each of the benign nodular hidradenomas. The malignant nodular hidradenoma mass was unavailable and screening for these receptors was not possible.

DISCUSSION

Cases of multiple nodular hidradenoma are extremely rare: we have seen only two. To the best of our knowledge, there have been no reports to date of combined malignant nodular hidradenoma and multiple benign nodular hidradenoma. However, there is histological evidence of transition forms. The coexistence of endocrine anomalies associated with this type of tumour has never been reported. However, the presence of estrogen receptors has occasionally been demonstrated in benign nodular hidradenomas. Our patient's endocrine disease may have played a role in the presentation of multiple hidradenomas, but this cannot be demonstrated.

Papillary eccrine adenoma in association with cutaneous horn

Papillary eccrine adenoma (PEA) is an uncommon sweat gland neoplasm that occurs more frequently on the distal extremities of Black women. Clinically, it appears as a small, isolated, firm, dome-shaped cutaneous nodule. We report two unusual cases of PEA that presented clinically as cutaneous horn. Histologically, both cases showed the typical dermal morphology of PEA with overlying epidermal changes suggestive of human papillomavirus (HPV). However, HPV immunoperoxidase staining and polymerase chain reaction for HPV were negative in both cases. Concurrent occurrence of PEA and HPV-like epidermal changes may be coincidental; however, their co-occurrence may also be related to the environment induced by this adnexal tumor. Whether PEA with verrucous epidermal changes has a different clinical behavior or increased risk for a malignant transformation is unknown, as both patients were lost to follow-up.

Hidrocystomas--a brief review

Hidrocystomas, eccrine and apocrine, are rare cystic lesions that form benign tumors of the sweat glands. In this clinical review, we present a "classic" case of hidrocystoma and review the main epidemiologic, histologic, and clinical features. We also review the effectiveness of experimental treatment methods and present information about associated syndromes and differential diagnosis, focusing especially on hidrocystomas' resemblance to basal cell carcinoma.

A case of Grover's disease with syringoma-like features and leukemia cutis

Leukemia cutis used to be a late manifestation of leukemia. On the other hand, Grover's disease has been described in the setting of cancer.

CASE REPORT

A patient diagnosed as having a chronic myelomonocytic leukemia presented with lichenoid, slightly infiltrated plaques on the anterior aspect of his thorax and abdomen and papulovesicles on his back. A skin biopsy showed the co-existence of leukemia cutis, Grover's disease, and syringoma-like features.

DISCUSSION

We discuss and comment upon this unusual association.

[Pigmented apocrine hidradenoma]

Apocrine hidradenoma is a benign adnexal neoplasm. It has no specific site predilection, and usually affects middle-aged people. The same as other tumors of the sweat glands, there is a pigmented variety. We present the case of a 92-year-old male who consulted his physician for a slow-growing asymptomatic lesion in the right groin which had been developing for 2 years. After the histopathological study, the diagnosis was established as pigmented apocrine hidradenoma.

Trichostasis spinulosa arising within syringoma

A forty-eight-year-old man presented with multiple pinhead to rice-sized papules on the face. Histopathologic examination showed a typical syringoma and dilated hair follicles containing several vellus hairs in the middle of a fibrotic stroma. We discuss the possible pathomechanism between these two conditions in the same lesion.

Congenital orbital sudoriferous cyst: radiological findings

We report an extremely unusual case of a 4-month-old boy who presented with a sudoriferous gland cyst of the orbit. Congenital sudoriferous cyst is extremely rare in both the adult and pediatric populations. The CT and MRI findings are presented and the pertinent literature reviewed.

Unilateral syringoma of the face associated with hyperthyroidism

Syringomas are benign tumors derived from the intraepidermal portion of eccrine sweat ducts. They usually occur on the periobital area, but have also been found on the scalp, forehead, cheeks, axillae, abdomen, extremities, genitalia, and buttocks. We describe a patient with an unusual presentation of unilateral syringoma of the face associated with hyperthyroidism.

Sebaceous carcinoma, basal cell carcinoma, trichoadenoma, trichoblastoma, and syringocystadenoma papilliferum arising within a nevus sebaceus

BACKGROUND

Nevus sebaceus has a well-documented potential to develop a wide variety of neoplasms of both epidermal and adnexal origins. It is highly unusual for more than three tumors to arise simultaneously within a single nevus sebaceus. Sebaceous carcinoma arising within a nevus sebaceus is a rare occurrence.

OBJECTIVE

The objective was to report the case of a patient with a nevus sebaceus that simultaneously developed five distinct neoplasms of epidermal and various adnexal origins and to report the fourth case of sebaceous carcinoma arising within a nevus sebaceus.

METHODS

A 45-year-old woman presented with a nevus sebaceus that contained five separate neoplasms, including sebaceous carcinoma, basal cell carcinoma, trichoadenoma, trichoblastoma, and syringocystadenoma papilliferum.

RESULTS

Complete excision of the nevus sebaceus and the five tumors was performed. Systemic work-up showed no evidence of metastatic disease or association with Muir-Torre syndrome.

CONCLUSION

This case report highlights the diverse neoplastic potential of nevus sebaceus and demonstrates the capacity of this hamartoma to develop aggressive tumors, such as sebaceous carcinoma. Prophylactic excision or at least close clinical surveillance for sudden development of new growths is warranted in all cases of nevus sebaceus.

Eccrine nevus

Localized hyperhidrosis on the left forearm of a 7-year-old girl is described. Biopsy revealed an eccrine nevus. The differential diagnosis of localized hyperhidrosis is discussed.

Apocrine carcinoma, adenopathies, and raised TAG-72 serum tumor marker

BACKGROUND

The detection of tumor-associated glycoprotein-72 in the serum of patients with carcinomas, basically of the colon, has proved to be of great use in the follow-up of these gastrointestinal adenocarcinomas.

RESULTS

We report the case of a male patient presenting adenopathies in the right axilla. The histologic study of an adjacent skin tumor enabled the diagnosis of a cutaneous apocrine carcinoma. Among the studies made, the increase in the serum antibody CA72.4 can be highlighted. The tumor marker was negative after the extirpation of the skin tumor and the axillary adenopathies.

CONCLUSION

To our best knowledge, this is the first case in which a tumor serum marker is associated with a cutaneous apocrine carcinoma, a fact that should be confirmed with further patients. Its use in the monitoring of this infrequent skin neoplasia is also noteworthy.

Eccrine syringofibroadenoma arising in peristomal skin: a report of two cases

Eccrine syringofibroadenoma (ESFA) is a benign neoplasm arising from the intraepidermal portion of eccrine ducts. It is characterized by a distinctive histologic pattern of epithelial cells arranged in anastomosing cords surrounded by a fibrovascular stroma. Approximately 50 cases of ESFA have been reported, and in recent years the lesion has been described occurring in association with other skin conditions. We report 2 cases of ESFA arising in abdominal skin adjacent to enterostomy sites.

Extramammary Paget Disease of the Axilla Associated With Comedo-like Apocrine Carcinoma In Situ

Extramammary Paget disease of the axilla with underlying apocrine carcinoma has been reported only in six cases until now. This report deals with a seventh case characterized by the unique finding of comedo-like features evocative of large cell ductal breast carcinoma within an otherwise typical in situ apocrine carcinoma. This is characterized by spiral-shaped foci of epithelial proliferation with decapitation secretion and central masses of necrotic debris. A possible connection between the solid neoplasm and the overlying Paget disease is illustrated by a few apocrine-follicular units colonized by both the Paget cells and the structured adenocarcinoma. Here, although they display the same immunohistologic pattern of glandular differentiation, the two populations seem to be cytologically different and do not show signs of gradual transition to one another. Thus, they give the impression of parallel but distinct processes, which is consistent with the hypothesis of proliferative induction of a preexisting intraepidermal scattered population from the underlying adnexal carcinoma. The observed resemblance between apocrine carcinoma and comedo carcinoma of the breast, with its ontogenetic and phylogenetic implications, links not only the two neoplasms and the corresponding glands of origin but also mammary and extramammary Paget disease. This reinforces the unifying conception of Paget disease.