Papillary eccrine adenoma of the heel: a case report

Papillary eccrine adenoma is a rare, slow-growing cutaneous tumor of sweat gland origin. It is a benign lesion that occurs most often in the distal extremities. Only 33 cases have been reported in the literature with few located in the distal lower extremity. There have been no cases reported in the podiatric literature. The clinical and surgical history of a case report of a papillary eccrine adenoma in a 35-year-old white male is presented.

DNA image cytometry in malignant and benign sweat gland tumours

The histopathological differentiation between well-differentiated carcinomas and atypical adenomas of sweat gland origin may be difficult, even if immunohistochemical methods are used. Therefore, additional techniques may be helpful. We previously demonstrated that DNA image cytometry (ICM-DNA) can be useful in distinguishing between malignant and benign clear cell hidradenoma. In the present study, a larger series of sweat gland tumours, with a clear-cut diagnosis as malignant or benign on histopathological criteria, was examined by ICM-DNA. Enzymatic cell separation specimens were prepared from paraffin-embedded tissues of 18 sweat gland carcinomas (14 porocarcinomas, one classic eccrine adenocarcinoma, two microcystic adnexal carcinomas and one mostly ductal apocrine carcinoma) and 47 benign sweat gland tumours (three syringocystadenomas, five spiradenomas, 14 cylindromas, three syringomas, seven nodular hidradenomas, 10 cutaneous mixed tumours, four poromas and one apocrine hidrocystoma). Specimens were examined by ICM-DNA according to the current recommendations of the European Society for Analytical Cellular Pathology with the AutoCyte QUIC-DNA workstation using mesenchymal cells as an internal reference. DNA aneuploidy was detected by the stemline interpretation according to Böcking and/or at least three 5[c]-exceeding events. DNA aneuploidy was detected in 16 of 18 (89%) of the sweat gland carcinomas, but in none of the 47 adenomas. These results suggest that the detection of DNA aneuploidy in sweat gland tumours using ICM-DNA is a clear and specific indicator of prospective malignancy.

Papillary hidradenoma: immunohistochemical analysis of steroid receptor profile with a focus on apocrine differentiation

AIM

To make a quantitative evaluation by image analysis of oestrogen receptors, progesterone receptors, and androgen receptors in papillary hidradenomas and anogenital sweat glands.

METHODS

20 papillary hidradenomas and the anogenital sweat glands detected in surgical specimens selected from 10 vulvectomies for squamous carcinoma, eight haemorrhoidectomies, and one anal polypectomy, all from female patients, were investigated by the avidinstreptavidin peroxidase testing system.

RESULTS

90% of papillary hidradenomas and almost all the anogenital sweat glands showed immunoreactivity for oestrogen receptor and, more weakly, for progesterone receptor, with immunolabelled nuclear area ranging from 10% to 90%. Conversely conventional sweat glands did not show any nuclear staining. Overexpression of androgen receptors occurred in 20% of papillary hidradenomas, with nuclear staining strictly bordering papillary epithelium with apocrine differentiation. There was no immunoreactivity for androgen receptors in anogenital sweat glands.

CONCLUSIONS

Oestrogen and progesterone receptors seem to represent reliable markers for differentiating between anogenital sweat glands and conventional sweat glands, and a further link to explain why papillary hidradenomas occur almost exclusively in the female anogenital region. Positivity for oestrogen/progesterone receptors suggests that epithelia either of anogenital sweat glands or of papillary hidradenomas are controlled by ovarian steroid hormones. Androgen receptor nuclear staining of the epithelium with apocrine differentiation in vulvar papillary hidradenoma strengthens its homology with breast duct papilloma.

Malignant eccrine spiradenoma: a previously unreported presentation and review of the literature

Malignant eccrine spiradenomas (MESs) are rare tumors arising from previously benign eccrine spiradenomas. A review of the literature reveals only 25 published reports of malignancy arising from eccrine spiradenoma and no prior reports of an MES of the scalp. The tumors have a metastasis rate of >50 per cent in reported cases with high resultant mortality rates. We present the first case report of a single MES of the scalp. Multiple resections were required for local control. Both magnetic resonance imaging and lymphoscintigraphy were used to assess regional spread. A review of the literature follows to include histopathology, diagnosis, and both surgical and adjuvant therapeutic options.

MRI appearance of clear cell hidradenoma

We present the first reported MR imaging findings of a histologically proven clear cell hidradenoma. A fluid level was noted on all pulse sequences in this lesion, which demonstrated a prominent hemorrhagic component on sectioning. The presence of an enhancing nodule was also noted, differentiating this lesion from a post-traumatic hematoma. Fluid levels in a well-defined subcutaneous soft tissue mass should suggest the possibility of a hidradenoma.

[Eccrine spiradenoma of the eyelid]

PATIENT

A 60-year-old woman was evaluated for a nodular tumor in her right upper eyelid, which has developed over the last four years. The tumor measured 10 x 8 mm and was ulcerated. The patient's ophthalmologic und medical history was normal. Clinically, a basal cell carcinoma was suspected, and an excision was carried out under local anaesthesia. The histopathology was suggestive for an eccrine spiradenoma.

CONCLUSION

Eccrine spiradenomas rarely involve the eyelids. This tumor represents a benign, usually painful, sweat gland tumor. The possibility of sweat gland tumor should be kept in mind in the diagnosis of eyelid tumors. The complete excision is the only therapeutic option.

Benign vulvar tumors

Benign tumors of the vulva, although relatively uncommon, are often referred to dermatologists for evaluation and treatment. The clinical features of benign tumors may overlap with malignant neoplasms, and therefore, a biopsy is often necessary to make a definitive diagnosis. This article discusses benign tumors of the vulva that are not associated with infectious agents and presents their classification according to cell of origin.

Papillary eccrine adenoma with a pomegranate-like appearance

Papillary eccrine adenoma (PEA) is a rare cutaneous tumor which histopathologically presents numerous intradermal tubular structures with inward papillary projections. Only a few cases of PEA have been reported recently. We report a case of PEA of a 58-year-old Japanese man. The marked hyperkeratosis and pits gave the tumor the clinical appearance of a burst-open pomegranate. Compact hyperkeratosis within proliferated epidermis contained spiral ducts mimicking intraepidermal eccrine sweat ducts histopathologically. These keratinous structures were thought to correspond to the pores. Several tubular structures running up to the overlying thickened epidermis were observed in the upper dermis. With these findings and with immunohistochemical studies, we proposed that this tumor originated from eccrine sweat ducts.

Basal cell carcinoma with thickened basement membrane: a variant that resembles some benign adnexal neoplasms

Because cutaneous basal cell carcinoma (BCC) is such a common malignancy, its unusual histologic manifestations are important. We identified a variant of BCC in which thickened basement membranes surround aggregations of neoplastic epithelial cells. Thickened basement membranes of similar appearance have previously been observed in benign cutaneous adnexal neoplasms, in basaloid monomorphic adenomas of the salivary gland and in other benign conditions, such as folliculocentric basaloid proliferation. We identified nine BCCs that otherwise met standard criteria, but which also had thick basement membranes surrounding some of the aggregations, and examined them by routine and histochemical staining. The cases included BCC with nodular, micronodular, and infiltrating patterns. Two neoplasms were composed largely of clear cells, suggesting, together with the thickened membranes, outer root sheath differentiation. CD34, which labels keratinocytes of the outer root sheath, marked only the epithelial cells of one of these cases. The thickened membranes were stained by periodic-acid Schiff with and without diastase (PAS-D) and by antibodies to type IV collagen and laminin, with slightly different staining patterns. Intraepithelial droplets within aggregations stained with PAS-D and type IV collagen antibodies. Thickened basement membranes therefore can occur in most of the common growth patterns of BCC. The absence of CD34 staining of epithelial cells in most cases makes it problematic at this time to prove that the thickened membranes indicate trichilemmal differentiation. BCC with thick basement membranes can closely mimic benign neoplasms, such as cylindroma and trichilemmoma, from which they can be distinguished in routinely stained sections. The presence of a continuous thick basement membrane around aggregates of epithelial cells does not in and of itself distinguish between benign and malignant cutaneous epithelial neoplasms.

Eccrine spiradenoma mimicking adenoid cystic carcinoma on fine needle aspiration. A case report

BACKGROUND

Although the cytologic features of salivary gland tumors are well recognized, an adnexal skin tumor occurring in the same region, on occasion, may resemble and be confused with a salivary gland neoplasm.

CASE

A case of eccrine spiradenoma presented as a painful mass in the region of the parotid that mimicked an adenoid cystic carcinoma on fine needle aspiration cytology.

CONCLUSION

Fine needle aspirates of eccrine spiradenoma, a benign cutaneous adnexal tumor, may have findings that mimic those of adenoid cystic carcinoma. Both may have cell balls and rosettelike structures surrounding stromal matrix cores. Recognition of three cell types in eccrine spiradenomas, including epithelial cells, myoepithelial cells and lymphocytes, as compared to a single cell type in adenoid cystic carcinoma, is paramount in avoiding this potential pitfall in cytologic diagnosis.

Syringofibrocarcinoma versus squamous cell carcinoma involving syringofibroadenoma: is there a malignant counterpart of Mascaro's syringofibroadenoma?

Although a benign syringofibroadenoma has been recognized as an eccrine tumor exhibiting net-like ductal proliferation embedded in fibroma-like stroma, a malignant counterpart has not been described heretofore. An 82-year-old man with severely sun-damaged skin had a 3 cm plaque in the dorsum of his left hand. The clinical diagnosis was squamous cell carcinoma. Histologically, the lesion was a bowenoid squamous cell carcinoma, both in situ (Bowen's disease-like) and bluntly invasive, with a concurrent phase showing unequivocal and widespread ductal differentiation, local expression of carcinoembryonic antigen, and sclerotic stroma. This syringofibrocarcinoma also impinged laterally on a mature and benign syringofibroadenoma and occurred above a minute deep dermal trichoepithelioma. This report presents a probably unrecognized new malignant tumor, clearly distinct yet related to both squamous cell carcinoma and eccrine carcinoma. Because its organoid architecture and the resemblance to and impingement on syringofibroadenoma, the term syringofibrocarcinoma is proposed.

Dermal cylindroma and eccrine spiradenoma

Multiple dermal cylindromas on the scalp and back and eccrine spiradenoma on the face of a 59 year old woman are described. A case for a common origin is discussed.

Sebaceous adenoma in the region of the medial canthus causing proptosis

A case of sebaceous adenoma in the region of the medial canthus causing proptosis is presented along with a review of the medical literature. The clinicopathological aspects of the tumour are discussed. The mode of treatment was surgical excision. A six month follow-up showed a reduction in the proptosis with no recurrence.

Periungual eccrine porocarcinoma

An eccrine porocarcinoma originating in the lateral nailfold of the third finger of the right hand of a 77-year-old man is described. The tumor showed infiltrative growth into the bone of the distal phalanx. Eccrine porocarcinoma should be considered in the differential diagnosis of periungual malignancies.

Case report: infiltrating syringomatous adenoma of the breast--appearances on mammography and ultrasonography

Infiltrating syringomatous adenoma is a recently-recognized locally-invasive breast neoplasm which clinically may mimic carcinoma. We describe bilateral syringomatous adenomata in a screened patient, indistinguishable from carcinoma on mammography and ultrasound examination. The clinical and pathological features which suggest the diagnosis are discussed.

A unique case of extramammary Paget's disease. Derivation from eccrine porocarcinoma?

A unique case of extramammary Paget's disease is reported that may have derived from eccrine porocarcinoma. A palm-sized erythematous plaque on the patient's pubis spread to the lower abdominal wall. The center of the lesion contained a reddish tumor. Histologic findings of the erythematous plaque showed features of extra-mammary Paget's disease. Those of the reddish tumor, however, corresponded most closely to eccrine porocarcinoma, though we could not entirely rule out that the changes corresponded to larger nests of less differentiated Paget cells. The two distinct neoplastic areas showed continuity both clinically and histologically; our case differed from epidermotropic eccrine porocarcinoma in several clinicopathologic respects. Our case suggests the possibility that extramammary Paget's disease could arise from preexisting porocarcinoma.