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Eccrine Squamous Syringometaplasia Associated With Lichen Sclerosus et Atrophicus. Am J Dermatopathol 2022; 44:590-593. [PMID: 35642980 DOI: 10.1097/dad.0000000000002226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Eccrine squamous syringometaplasia (ESS) has been associated with several conditions including morphea, linear scleroderma, and burns. It is yet to be reported in lichen sclerosus et atrophicus (LSA). We describe a bullous LSA plaque on the forearm of a woman with pre-existing genital LSA and vitiligo. Besides the histopathological findings of bullous LSA, numerous small irregular squamoid structures were present in the mid and upper dermis always above the normal eccrine glands. The histopathology, periodic acid-Schiff stain, and positive immunostains for P63, low molecular weight keratins 8&18, epithelial membrane antigen, and carcinoembryonic antigen supported the diagnosis of ESS. The pathogenesis of ESS in LSA may be related to ischemia, inflammation, and fibrosis.
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Shakshouk H, Johnson EF, Peters MS, Wieland CN, Comfere NI, Lehman JS. Cutaneous eccrine inflammation and necrosis: review of inflammatory disorders affecting the eccrine apparatus including new associations. Hum Pathol 2021; 118:71-85. [PMID: 34450084 DOI: 10.1016/j.humpath.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/30/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022]
Abstract
Despite being frequently overlooked during the examination of histopathological sections, eccrine sweat glands can offer clues for diagnosing various skin conditions. They provide important functions and can lead to several diseases when inflamed or injured. This review article provides information regarding eccrine physiology as well as well-established and novel entities that occur in association with eccrine gland pathology.
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Affiliation(s)
- Hadir Shakshouk
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Dermatology, Andrology and Venereology, Alexandria University, Alexandria, 21131, Egypt
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Margot S Peters
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nneka I Comfere
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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Kacerovska D, Portelli F, Michal M, Kazakov DV. Acquired elastotic hemangioma-like changes and eccrine sweat duct squamous metaplasia in lichen simplex chronicus/prurigo nodularis-like lesions of the knee and elbow. J Cutan Pathol 2017; 44:605-611. [DOI: 10.1111/cup.12945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Denisa Kacerovska
- Sikl's Department of Pathology; Charles University in Prague, Medical Faculty in Pilsen; Pilsen Czech Republic
- Bioptical Laboratory; Pilsen Czech Republic
| | - Francesca Portelli
- Department for Health Promotion and Mother and Child's Care G. D'Alessandro, Section of Pathology; University of Palermo; Palermo Italy
| | - Michal Michal
- Sikl's Department of Pathology; Charles University in Prague, Medical Faculty in Pilsen; Pilsen Czech Republic
- Bioptical Laboratory; Pilsen Czech Republic
| | - Dmitry V. Kazakov
- Sikl's Department of Pathology; Charles University in Prague, Medical Faculty in Pilsen; Pilsen Czech Republic
- Bioptical Laboratory; Pilsen Czech Republic
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Molina-Ruiz AM, Molina-Ruiz RM, Zulueta T, Barabash R, Requena L. Olanzapine-induced eccrine squamous syringometaplasia. Am J Dermatopathol 2012; 34:434-7. [PMID: 22257902 DOI: 10.1097/dad.0b013e31823812f1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Eccrine squamous syringometaplasia is a histopathologic pattern that has mainly been described in patients receiving chemotherapy. Its association to nonchemotherapeutic agents is rare, with very few cases reported in the literature. We present the case of a 55-year-old patient with schizophrenia, who developed a skin eruption 5 weeks after initiating treatment with olanzapine. The histopathologic study revealed squamous syringometaplasia of the dermal eccrine ducts.
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Affiliation(s)
- Ana María Molina-Ruiz
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
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Chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia: Reappraisal of epidemiological, clinical, and pathological features. J Am Acad Dermatol 2011; 64:1092-103. [DOI: 10.1016/j.jaad.2010.04.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Revised: 03/24/2010] [Accepted: 04/12/2010] [Indexed: 11/24/2022]
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García-Río I, Pérez-Gala S, Fraga J, García-Díez A, Fernández-Herrera J. Eccrine squamous syringometaplasia in a patient with systemic lupus erythematosus. J Eur Acad Dermatol Venereol 2006; 20:608-10. [PMID: 16684297 DOI: 10.1111/j.1468-3083.2006.01488.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Van de Voorde K, De Raeve H, Van Regenmortel N, Lambert J. Imatinib-induced eccrine squamous syringometaplasia. J Am Acad Dermatol 2006; 55:S58-9. [PMID: 16843129 DOI: 10.1016/j.jaad.2005.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Revised: 12/01/2005] [Accepted: 12/02/2005] [Indexed: 10/24/2022]
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Alonso V, Ramón D, Monteagudo C, Llombart B, Martín JM, García L, Jordá E. Eccrine squamous syringometaplasia mimicking a herpetic infection. Int J Dermatol 2006; 45:762-3. [PMID: 16796646 DOI: 10.1111/j.1365-4632.2004.02440.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Vicent Alonso
- Department of Dermatology, Hospital Clínic Universitari, Valencia, Spain.
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Bordel MT, Miranda A. [Eccrine squamous syringometaplasia from chemotherapy extravasation]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 96:462-4. [PMID: 16476276 DOI: 10.1016/s0001-7310(05)73113-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Eccrine squamous syringometaplasia is a rare entity that occurs in patients who have received chemotherapy treatment. It also occurs in association with chronic ulcers, skin tumors, and after the ingestion of drugs, exposure to toxic agents and inflammatory processes. We present the case of a 47-year-old male diagnosed with microcytic lung carcinoma and superior vena cava syndrome. After receiving the third cycle of chemotherapy, and after accidental extravasation, he presented with an erythematous plaque. The histopathological study revealed eccrine squamous syringometaplasia together with interphase dermatitis and epidermal changes that may be responsible for the epidermal necrosis.
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Affiliation(s)
- María Teresa Bordel
- Servicio de Dermatología, Hospital Clínico Universitario de Valladolid, Facultad de Medicina de Valladolid, Spain.
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Baysse L, Boralevi F, Lepreux S, Boyer A, Morel C, Léauté-Labrèze C, Taïeb A. [Eccrine squamous syringometaplasia and cytomegalovirus infection]. Rev Med Interne 2003; 24:394-8. [PMID: 12814829 DOI: 10.1016/s0248-8663(03)00112-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Eccrine squamous syringometaplasia has been reported in some cases as an Herpeviridae complication. We report a case of eccrine squamous syringometaplasia associated with a severe cytomegalovirus infection in an immunocompromised patient, and we discuss about potential viral or drug triggering factors. METHODS A 22 years-old man was hospitalized in an intensive care unit for rejection of a renal graft associated with a disseminated cytomegalovirus infection. A papular and papulopustular eruption appeared on the trunk and the limbs. RESULTS Histological examination of a skin sample showed eccrine squamous syringometaplasia, with evidence of cytomegalovirus genomic sequences using PCR. Two weeks later, the patient developed toxic epidermal necrolysis, with fatal issue. CONCLUSIONS Eccrine squamous syringometaplasia is a rare condition, without specific clinical features. Numerous local affections have been reported to induce eccrine syringometaplasia (ulcer, scar, pyoderma gangrenosum, drug injection.), drugs (cytotoxic agents, non steroidal anti inflammatory therapies) and in cases of infection due to cytomegalovirus or herpes simplex virus. The potential implication of cytomegalovirus or foscarnet as triggering factors in our case is discussed. This observation and other similar reported cases lead to the conclusion that eccrine squamous syringometaplasia may be an underestimated complication of cytomegalovirus infections in immunocompromised patients.
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Affiliation(s)
- L Baysse
- Service de dermatologie, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 cedex, Bordeaux, France
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Carlos de la Torre Fraga J. Estudio clínico y patológico de las reacciones cutáneas crónicas por picadura de espina de erizo de mar (Paracentrotus lividus, Lamarck). ACTAS DERMO-SIFILIOGRAFICAS 2002. [DOI: 10.1016/s0001-7310(02)79165-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Romero Gómez J, Vera Casaño Á, Martínez García S, Crespo Erchiga V, Sanz Trelles A, Acha García T. Siringometaplasia escamosa ecrina como expresión del fenómeno de evocación. ACTAS DERMO-SIFILIOGRAFICAS 2002. [DOI: 10.1016/s0001-7310(02)76646-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
BACKGROUND Sea-urchin granuloma is a chronic granulomatous skin lesion caused by injury with sea-urchin spines. Frequently these lesions occur on the hands and develop several months after the initial injury. Classified as an allergic foreign-body reaction, their most common histological pattern resembles sarcoid. The purpose of this study was to evaluate the light microscopic features of biopsies from lesions clinically diagnosed of sea-urchin granolomas. METHODS We retrospectively reviewed 50 biopsy specimens corresponding to 35 patients with sea-urchin granulomas. These lesions were caused by injuries with the spines of the sea-urchin Paracentrotus lividus. Data were collected between 1990 and 1999 from patients in the seashore of Galicia (NW Atlantic coast, Spain). RESULTS The cohort consisted of 35 patients (31 males, 4 females), with a median age of 35 years (range 14-60 years). The median duration of the disease was 7.5 months (range 2-60 months). We identified different histopathologic patterns. A granulomatous reaction was observed in 39 biopsies (78%). In 70% corresponding to 35 biopsies this granulomatous reaction was predominant. Foreign-body, sarcoidal, tuberculoid, necrobiotic and suppurative granulomas were identified. The remaining 15 biopsies (30%) showed a predominant inflammatory reaction with features of non-specific chronic inflammation or suppurative dermatitis. A panel of histopathologic features, including epidermal and dermal changes were evaluated. Presence of focal necrosis and microabscesses were common findings. In 50% of our specimens we found umbilication and/or perforation. Additional features included the presence of inclusion epidermoid cysts in four cases and squamous syringometaplasia in one case. CONCLUSIONS Our observations suggest that sea-urchin granuloma span a wide morphologic spectrum. A granulomatous inflammatory reaction was predominant, with the foreign body and sarcoidal types the most frequent patterns. Other histopathologic patterns with non granulomatous inflammation can be noted. Some features, such as the frequency of perforation and the presence of necrobiotic granulomas have not previously been recognized in the literature.
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Affiliation(s)
- C De La Torre
- Service of Dermatology, Complejo Hospitalario de Pontevedra, Pontevedra, Spain.
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Affiliation(s)
- S Jerasutus
- Suphannahong Dermatology Clinic, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
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Vargas-Díez E, Valks R, Fraga J, Fernández-Herrera J, García-Díez A. Eccrine squamous syringometaplasia in a patient with phytophotodermatosis. Int J Dermatol 1998; 37:715-7. [PMID: 9762831 DOI: 10.1046/j.1365-4362.1998.00444.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Corredor F, Cohen PR, Tschen JA. Syringomatous changes of eccrine sweat ducts associated with prurigo nodularis. Am J Dermatopathol 1998; 20:296-301. [PMID: 9650706 DOI: 10.1097/00000372-199806000-00014] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Alteration of the eccrine sweat ducts has been observed in association with an expanding list of conditions. To our knowledge, this phenomenon has not been described in association with prurigo nodularis. We report on a 68-year-old man with a fibrotic nodule on his chin that had been present for 8 months. Microscopic examination showed marked hyperkeratosis overlying the epithelium. There was also hypergranulosis, marked acanthosis, and irregular elongation of the rete ridges. These findings were consistent with prurigo nodularis. In addition, within the reticular dermis, there was marked fibrosis and a proliferation of eccrine sweat ducts. The ducts were enlarged and varied from cystic to rarely solid structures. Rare ducts formed a tadpole-shaped tail, reminiscent of syringoma. The duct lining demonstrated a multilayered epithelium that was three to eight cells thick, yielding a solid component to some of the cysts. Although some of these features were similar to those of a syringoma, the typical small gland proliferation and bilayered lining was not evident. This case (a) demonstrates the association of syringomatous changes of eccrine sweat ducts with yet another condition, prurigo nodularis, and (b) emphasizes the importance of differentiating this benign reactive process from the malignant neoplasms microcystic adnexal carcinoma and squamous cell carcinoma.
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Affiliation(s)
- F Corredor
- Department of Pathology, University of Texas-Houston Medical School, 77030, USA
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Abstract
Eccrine glands are uniquely susceptible to a variety of pathologic processes. Alteration in the rate of sweat secretion manifests as hypohidrosis and hyperhidrosis. Obstruction of the eccrine duct leads to miliaria. The excretion of drugs into eccrine sweat may be a contributory factor in neutrophilic eccrine hidradenitis (NEH), syringosquamous metaplasia (SSM), coma bulla, and erythema multiforme (EM). Alterations in the electrolyte composition of eccrine sweat can be observed in several systemic diseases, most notably cystic fibrosis. This article summarizes current knowledge of eccrine gland pathophysiology.
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Affiliation(s)
- F G Wenzel
- Department of Dermatology, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
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Sommer B, Hagedorn M, Wood F, Heenan P. Eccrine squamous syringometaplasia in the skin of children after burns. J Cutan Pathol 1998; 25:56-8. [PMID: 9508345 DOI: 10.1111/j.1600-0560.1998.tb01690.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report 3 cases of severe burns in children in which eccrine squamous syringometaplasia (ESS) was found in skin biopsies taken 10 days after the trauma occurred. Microscopic examination showed partial or total necrosis of the epidermis, focal dermal necrosis and squamous metaplasia in eccrine ducts. These cases appear to be the first reported instances of ESS as an early consequence of severe burns.
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Affiliation(s)
- B Sommer
- Department of Dermatology, Darmstadt Hospital, Germany
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Muñoz E, Valks R, Fernández-Herrera J, Fraga J. Herpetic syringitis associated with eccrine squamous syringometaplasia in HIV-positive patients. J Cutan Pathol 1997; 24:425-8. [PMID: 9274960 DOI: 10.1111/j.1600-0560.1997.tb00817.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Herpetic syringitis has been described as a rare manifestation of herpes virus infection in patients with an immunodeficiency, usually secondary to human immunodeficiency virus (HIV) infection. Eccrine squamous syringometaplasia (ESS) is an infrequent alteration of the eccrine duct epithelium reported in association with several conditions, including chronic ulcers, inflammatory processes, and patients receiving chemotherapy. The association of herpetic syringitis with ESS has not been reported before. We identified 3 cases of herpetic syringitis associated with ESS in patients with the acquired immunodeficiency syndrome. In 2 of 3 cases the signs of herpetic syringitis were limited to the metaplastic duct epithelium, but in 1 case there were also herpetic alterations without ESS. The histological features of herpetic infection in HIV-positive patients may be atypical and lack the typical epidermal alterations, observing only an extensive epidermal necrosis. In those cases, the alterations of the eccrine ducts may be a diagnostic clue in the diagnosis of herpetic infection. ESS of the ductal epithelium is probably secondary to the herpetic infection, although it might also stimulate the extension of the herpetic infection. Further studies are needed to elucidate the association of ESS and herpes virus infection.
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Affiliation(s)
- E Muñoz
- Department of Pathology, Hospital Universitario de la Princesa, Madrid, Spain
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Valks R, Buezo GF, Daudén E, Fraga J, García-Díez A. Eccrine squamous syringometaplasia in intertriginous areas. Br J Dermatol 1996; 134:984-6. [PMID: 8736357 DOI: 10.1111/j.1365-2133.1996.tb06347.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Bell GW, Loukota RA. Necrotizing sialometaplasia coincident with ipsilateral infarcted antral polyps. Br J Oral Maxillofac Surg 1996; 34:129-31. [PMID: 8645669 DOI: 10.1016/s0266-4356(96)90171-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Squamous syringometaplasia (SS) is defined as a mature squamous metaplasia of the eccrine ducts. We prospectively evaluated its frequency and clinical and pathological features in a series of 21 patients. SS was found in association with several diseases, chiefly chronic ulcers. The patient' ages ranged between 20 and 80 years and there was no sex predominance. The involved eccrine ducts were usually located in the superficial and mid dermis and displayed inner keratinization. The stimulus required for SS is unknown. Differential diagnosis between SS and well-differentiated squamous cell carcinoma (SCC) depends on the preservation of a lobular configuration and the absence of epithelial dysplasia or invasion.
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Affiliation(s)
- T Serrano
- Department of Pathology, Hospital Princeps d'Espanya, Barcelona
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Abstract
Necrotizing sialometaplasia is a benign condition first described in minor salivary glands of the soft palate with morphological changes which can be misinterpreted as squamous-cell carcinoma. Similar lesions have been subsequently reported in other locations including major salivary glands, lip, breast and skin (the term syringometaplasia has been applied for the latter). We report three cases of such a process involving submucosal glands in the trachea following prolonged translaryngeal intubation.
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Affiliation(s)
- V Romagosa
- Department of Pathology, Hospital Princeps d'Espanya, Ciutat Sanitaria de Bellvitge, Barcelona, Spain
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