A Rare Case of Atypical Chondroid Syringoma of the Lower Eyelid and Review of the Literature

A Unique Presentation Site of Pleomorphic Adenoma in a Young Woman: A Case Report

The expression "pleomorphic adenoma" has been used synonymously with mixed cutaneous tumors and chondroid syringomas. It originates from eccrine or apocrine skin, salivary glands, and lacrimal glands. Histologically, it comprises an epithelial-lined glandular component embedded in the cartilaginous, myxomatous, or fibrous stroma. These lesions are usually misdiagnosed because they are extremely rare. It commonly affects middle-aged men and has a slow-growing nature. The usual manifestation is a firm nodular lesion in the periorbital region, particularly at eyelid margins. A unique presentation of this tumor was described in a young woman. The tumor presented as a small, static, nontender lump located at the junction of the superior margin of the left eyebrow and forehead. After a thorough clinical assessment, she underwent a complete surgical excision of the lesion. The most probable preoperative clinical impression at that time was that of a sebaceous cyst. However, histopathological examination revealed it to be a pleomorphic adenoma, which, to our knowledge, has never been reported in the literature at this specific anatomical site. Two years after the procedure, the patient's follow-up was uneventful, and revealed no recurrence of the lesion. Although its incidence is exceptionally low, it should always be considered in the differential diagnosis of cutaneous lesions in the head, neck, and trunk. Complete surgical excision for histopathological assessment is recommended to rule out malignancy and avoid the frequent issue of local recurrence in cases of benign tumors.

Cutaneous pleomorphic adenoma of the periocular region - a case series

Mixed tumour of the skin is a rare entity also known as chondroid syringoma and pleomorphic adenoma. These usually present as slow-growing skin nodules with a smooth surface, clear boundaries, and no ulceration. Case series exist describing pleomorphic adenomas in the periocular region including the lids and orbit, separate to the more familiar lacrimal gland pleomorphic adenoma. These may arise from accessory or ectopic lacrimal gland tissue but in the eyelids are more likely to arise from sweat glands in the skin. Histopathological analysis of these lesions is important to identify complete excision, minimising recurrences and in identifying rare but potential malignant transformation. We describe the clinical features and outcomes in three cases of pleomorphic adenoma with two at the medial canthus (including one recurrence) and one in the brow region.

Isolated eyelid chondroid syringoma: a study of two cases

Chondroid syringoma is a benign mixed tumour arising from the sweat glands which can be apocrine (found throughout the surface of the eyelid) or eccrine with a mean age of presentation being 50 years. Here we report two cases of chondroid syringoma of the upper eyelid, one in a young male patient and the other in an elderly woman. Both cases had well-defined lesions involving upper eyelid in the sub-brow region, underwent excisional biopsy, and histopathological findings were consistent with an apocrine type of chondroid syringoma in one case and eccrine type of chondroid syringoma in the second case. It is important to be aware of this entity as a rare cause of eyelid lesion due to the fact that although it is a benign neoplasm, incomplete excision may be associated with recurrence or malignant transformation.

Atypical Facial Chondroid Syringoma, A Rare Clinical Entity: Case Report with Review of Literature

Chondroid syringoma (CS) is a rare mixed tumor of sweat gland origin with a reported incidence of less than 0.1%. The tumor is mostly benign and usually seen in males. It comprises of both epithelial and mesenchymal elements. The usual presentation and clinical course of this condition makes it liable to be confused with other commoner skin conditions. We hereby present a case of facial CS in a young female patient.

Tubular apocrine adenoma of the eyelid - A case report and literature review

Tubular apocrine adenoma is a rare benign adnexal neoplasm most commonly identified in the scalp, composed of a dermal proliferation of apocrine tubules in a background of hyalinized stroma. Tubular apocrine adenoma can be a component of various sweat gland tumors and can also morphologically overlap with other sweat gland neoplasms. Isolated tubular apocrine adenoma arising in the glands of Moll is exceedingly rare, with only 4 previously reported cases. We present a 63-year-old male with tubular apocrine adenoma of the left upper eyelid, which recurred following initial incomplete excision. Although the lesion showed focal morphologic similarity to the apocrine variant of pleomorphic adenoma (chondroid syringoma), the diagnosis of tubular apocrine adenoma was supported by fluorescence in situ hybridization studies, which demonstrated absence of PLAG1 and HMGA2 gene rearrangements seen in pleomorphic adenoma. This case illustrates the clinical, microscopic and immunohistochemical features of tubular apocrine adenoma. The recent advances in our understanding of the molecular genetics of tubular apocrine adenoma and related tumors, and how these advances shape the evolving classification of sweat gland tumors are reviewed.

Benign chondroid syringoma of the orbit: an atypical location

A 31-year-old male with no known medical illness presented with painless left eye protrusion for the past 2 years. Radiographic features were of an extraconal superior orbital mass with no invasion of adjacent structures. The patient underwent an excisional biopsy of the left superior extraconal mass a week later. The histopathological examination revealed a well-circumscribed lobulated mass with chondroid and myxoid stroma enveloping benign bland-appearing epithelial and myoepithelial cells. These pathological features were consistent with benign chondroid syringoma of the orbit. The patient had an uneventful recovery with no active ocular complaint post-operatively.Despite chondroid syringoma of the orbit being a rare tumour, it should be considered in the differential diagnosis of periorbital masses. Excision of the tumour remains the treatment of choice with histopathological examination as the gold standard of diagnosis. Regular follow-up is warranted in view of possible local recurrence or metastasis.

Benign chondroid syringoma affecting the upper lip: Report of a rare case and review of literature

Chondroid syringoma (CS) (mixed tumor of the skin) is a rare neoplasm of the sweat glands, which presents itself as a slow-growing, painless, nonulcerated, subcutaneous or intracutaneous mass often occurring in the head and neck region. The clinician may miss the diagnosis of this lesion due to its rarity. CS should be considered in the differential diagnosis of any subcutaneous nodules, especially in the head and neck region. The diagnosis of CS is mainly based on the histopathologic examination. This article presents a 35-year-old male with a mass on the upper lip that was histopathologically diagnosed as an apocrine variant of benign CS with squamous metaplasia after surgical excision. No sign of recurrence is evident till date during the follow-up. We report this case because of its rarity. A brief literature review and all the reported cases in the lip have been listed.

Pleomorphic Adenoma of the Eyelid with Apocrine Gland Origin; an Atypical Location

Purpose:

To describe the clinical presentation and treatment of a patient with a cutaneous pleomorphic adenoma of the eyelid.

Case Report:

A 73-year-old male patient presented with a nodular mass on the lateral third of his right upper eyelid, which had slowly enlarged over 10 years. Radiologic features were of an extra-conical mass, with no invasion of adjacent structures. An excisional biopsy of the lesion was performed. The histopathological examination revealed a biphasic tumor, composed of tubules with a double layer of epithelial cells arranged in a chondromyxoid stroma. The inner epithelial cells were positive for pancytokeratins AE1/AE3 and carcinoembryonic antigen. The outer epithelial cells and stromal component expressed vimentin and S100 protein. These pathologic findings were consistent with a palpebral pleomorphic adenoma, with an apocrine gland origin.

Conclusion:

Pleomorphic adenomas of the skin are rare tumors, and even less frequent as tumors of the ocular adnexa. These lesions should be considered in the differential diagnosis of palpebral nodular masses, and complete excision should be attempted due to the possibility of malignant transformation.

Giant Chondroid Syringoma of the Lower Eyelid

Chondroid syringoma is a benign mixed tumor characterized by sweat gland elements in a cartilaginous stroma. This rare tumor accounts for only 0.01% of all primary skin tumors and occurs only rarely in the periorbital region. Usually between 0.5 cm and 3.0 cm, risk of malignancy increases in chondroid syringomas greater than 3.0 cm in size. Here, the authors report a rare case of giant chondroid syringoma arising in the lower eyelid, characterized by keratinized stratified epithelium in a cartilaginous stroma. This case illustrates the importance of considering a possible diagnosis of chondroid syringoma in the evaluation of eyelid masses.

Apocrine mixed tumor of the eyelid: a case report

Background

Apocrine mixed tumor is usually found in parotid glands. Its cutaneous counterpart is rare and its occurrence in the eyelids is even rarer.

Case presentation

This study reports an apocrine mixed tumor of the upper left eyelid in a 68 year-old lady with a history of breast cancer. This mass appeared about 3 years ago, as a slowly growing small nodule, and was completely excised. On microscopic examination, an encapsulated mass with epithelial and mesenchymal features was seen. The epithelial component presented tubular, cystic and infundibular structures while the mesenchymal component was fibrous in some areas and myxoid in others. Plasmacytoid hyaline cells, lipomatous change and focal calcification were appreciated focally. Immunohistochemical studies showed stromal staining for CD10, S-100, α-SMA and p63. Luminal cell layer of the epithelial component was positive for EMA, CK-7 and GCDFP-15 markers. The capsule was unbreached and no satellite lesions were appreciated. No evidence of relapse was evident after 16 months of follow-up.

Conclusions

The diagnosis of eyelid tumors of adnexal origin can be challenging because they are rare and display a wide range of morphological patterns, as the tumor cells might differentiate along any line of the folliculosebaceous-apocrine system. Immunohistochemistry helps improve the accuracy of assessment.

[Cutaneous chondroid syringoma]

INTRODUCTION

Chondroid syringoma (CS) is a rare cutaneous tumor characterized by mixte epithelial and mesenchymal component. The confident histological diagnosis can be obtained by immuno-histochemistry study. Here we present 10 new cases with their clinico-hystological characteristics.

METHODS

The 10 cases were observed between January 2000 and august 2013, in Fort-de-France and Louis-Mourier universitary hospitals. For all the cases a controlled histological study was performed by a dermatopathologist expert and immuno-histochemistry was added. Clinical and immuno-histological data were analyzed.

RESULTS

The lesions were almost localized on the face (3/10) and the extremities (3/10). The size was about 1.2 to 5.2cm. Every case was treated by surgery, no malignant case was diagnosed. Histologically, all the 10 cases presented as a well-limited dermic tumor with a mixte epithelial and mesenchymal component. The stroma was myxo-chondroid, and the epithelial component consisted in epithelial cavities lined by one or two cell layers with eccrine (4/10) or apocrine (5/10) features. Immuno-chemistry study reveals positivity for EMA, ACE and CK7 for the internal cells, and positivity for S100 protein and vimentin of the extern cell layer.

DISCUSSION

Chondroid syringoma is characterized by a mixte epithelial with eccrine and apocrine cells and a myxo-chondroid stroma. Our study has some clinical and histological particularities (lesions on the extremities, epidermic connecting…). The main differentials diagnoses are the other annexial tumors. The treatment is surgical.

CONCLUSION

The histological diagnosis of CS is quite easy, but in case of doubt, immuno-chemistry will help, showing a double mesenchymal and epithelial differentiation.

Benign chondroid syringoma (mixed tumor of skin) on the flank with satellites: case report and literature review

BACKGROUND

Mixed tumor of skin (chondroid syringoma) is a rare skin tumor.

METHODS

We report on the rare occasion of an atypical mixed tumor of skin (chondroid syringoma) in a 71-year old Caucasian male patient.

RESULTS

The tumor presented as a firm subcutaneous nodule on his flank. Histopathologic investigations revealed a focally increased proliferative activity and satellites in the adipose tissue. This is in accordance with the diagnosis of an atypical chondroid syringoma. The differential diagnosis to malignant chondroid syringoma is discussed. The tumor was removed by delayed Mohs surgery.

CONCLUSIONS

Atypical chondroid syringoma is a very rare subtype of mixed tumor of skin. It is an important differential diagnosis to malignant chondroid syringoma of skin.