Characterizing the nature of eccrine syringofibroadenoma: illustration with a case showing spontaneous involution

Erythematous Plaque with Crusting on the Lower Leg: A Quiz

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Longstanding Eccrine Syringofibroadenoma With Evidence of Carcinomatous Transformation

Eccrine syringofibroadenoma (ESFA) is a cutaneous proliferation of eccrine ducts, mainly encountered in association with other dermatoses or skin tumors. Although a benign condition, either considered as a hamartoma or a reactive hyperplasia rather than a real neoplasm, some evidence suggests that longstanding ESFA can undergo malignant change. The recognition of such opportunity could have important therapeutic implications. We present a case of ESFA showing areas of carcinomatous transformation, discussing its morphological and immunohistochemical findings.

Current Diagnosis and Treatment Options for Cutaneous Adnexal Neoplasms with Apocrine and Eccrine Differentiation

Adnexal tumors of the skin are a rare group of benign and malignant neoplasms that exhibit morphological differentiation toward one or more of the adnexal epithelium types present in normal skin. Tumors deriving from apocrine or eccrine glands are highly heterogeneous and represent various histological entities. Macroscopic and dermatoscopic features of these tumors are unspecific; therefore, a specialized pathological examination is required to correctly diagnose patients. Limited treatment guidelines of adnexal tumor cases are available; thus, therapy is still challenging. Patients should be referred to high-volume skin cancer centers to receive an appropriate multidisciplinary treatment, affecting their outcome. The purpose of this review is to summarize currently available data on pathogenesis, diagnosis, and treatment approach for apocrine and eccrine tumors.

Eccrine Syringofibroadenoma in Association With Acquired Epidermodysplasia Verruciformis

A 75-year-old man with human immunodeficiency virus infection and numerous biopsy-proven warts for 10 years, refractory to cryosurgery, cimetidine, and topical imiquimod, presented with numerous pink to hypopigmented verrucous papules and plaques involving the face, trunk, buttocks, and groin. Laboratory evaluation revealed a CD4 T-cell count of 62 cells per microliter and human immunodeficiency virus viral load of <117 copies per milliliter. Biopsy of a plaque groin lesion was performed. Histopathology revealed vertically oriented anastomosing strands of basaloid epithelium arising from multiple points along the epidermis in a background fibrovascular stroma. Ductal differentiation was identified. Areas of epidermis showed compact orthokeratosis, coarse hypergranulosis, and keratinocytes with abundant steel-blue-gray cytoplasm, indicative of viral cytopathic changes. Cytologic atypia was not identified. Human papillomavirus (HPV) genotyping of this lesion was positive for types 5 and 14. Overall, the findings were consistent with epidermodysplasia verruciformis in association with eccrine syringofibroadenoma (ESFA). The patient was subsequently treated with acitretin and showed clinical improvement. ESFA is an uncommon benign adnexal tumor with unknown pathogenesis. Although its association with HPV has rarely been reported, ESFA in the setting of acquired epidermodysplasia verruciformis has not been described. The development of ESFA in this case may be the result of HPV-induced cellular transformation.

A case report of reactive solitary eccrine syringofibroadenoma

Eccrine syringofibroadenoma is a very rare benign tumour of acrosyringium of eccrine sweat duct. Based on the evidences of known etiological factors, two forms have been proposed; reactive and nonreactive. Reactive forms are rarer, and on even rarer occasions, trauma complicated by secondary nonspecific infections may lead to the development of reactive eccrine syringofibroadenoma, as in our case. Here, we are documenting a case of reactive solitary eccrine syringofibroadenoma in a 65-year-old male presenting with coalescing, firm, pinkish, verrucous nodules and painful deep ulceration on the right sole preceded by trauma and secondary infection. Histopathologic revelation of distinctive microscopic findings confirmed the diagnosis in our case.

Eccrine Syringofibroadenoma in a Patient with Long-Standing Exfoliative Dermatitis

Eccrine syringofibroadenoma (ESFA) is a rare benign cutaneous adnexal lesion characterized by a hyperplastic epithelium and eccrine ductal differentiation. In the present case, a 73-year-old Korean male presented with symmetrical numerous widespread, pinkish nodules with a cobblestone appearance over both legs for 2 years. He had a history of generalized erythematous scaly patches over his entire body for 20 years. On histopathologic findings, diagnosis of ESFA was confirmed. Our unusual and interesting case emphasizes the first report described one case in which multiple cobblestone like ESFAs arising from long-standing exfoliative dermatitis.

Reactive Eccrine Syringofibroadenoma Associated with Neuropathy, Venous Stasis, and Diabetic Foot Ulcer

Eccrine syringofibroadenoma (ESFA) is an uncommon benign adnexal neoplasm which derives from cells of the acrosyringium of eccrine sweat glands. The clinical appearance is nonspecific but the histological features are typical. Five clinical subtypes of ESFA exist: (1) solitary ESFA; (2) multiple ESFA associated with ectodermal dysplasia; (3) multiple ESFA without cutaneous features; (4) unilateral linear ESFA (nevoid), and (5) reactive ESFA associated with inflammatory or neoplastic dermatoses. We report the case of a 42-year-old man with long-standing diabetes and neuropathy, presenting with a 4-year history of asymptomatic erythematous plaques on a background of brown hyperpigmentation on the left foot. The clinical presentation and histopathological findings are compatible with reactive ESFA.

Eccrine Syringofibroadenomatosis of the Soles

Eccrine syringofibroadenoma is a rare adnexal tumor with acrosyringeal differentiation. It was first described by Mascaro in 1963. Its clinical presentation varies from a solitary nodule, keratotic papule, verrucous plaque, or palmoplantar keratoderma to multiple lesions with linear or diffuse distributions. Age at onset ranges from 16 to 80 years. Lesion distribution is wide and includes the face, back, abdomen, buttocks, extremities, and, rarely, nails. There are five subtypes of eccrine syringofibroadenoma. Histologically, eccrine syringofibroadenoma, independent of the subtype, is characterized by anastomosing cords of acrosyringeal cells forming ductal structures in a fibrovascular stroma and attached to the undersurface of the epidermis in multiple foci. In this article, we describe a 51-year-old woman diagnosed as having eccrine syringofibroadenomatosis.

Reactive Eccrine Syringofibroadenomatosis Presenting as Bilateral Plantar Hyperkeratosis

Eccrine syringofibroadenoma (ESFA) is a rare cutaneous tumor with eccrine differentiation with varied clinical manifestations. We report a case of reactive eccrine syringofibroadenomatosis associated with chronic bilateral plantar ulcers in a patient with diabetes mellitus presenting as plantar hyperkeratosis and verrucous growth at margins.

Reactive eccrine syringofibroadenomatosis secondary to primary cutaneous amyloidosis: a novel association

We report the unprecedented case of reactive eccrine syringofibroadenoma (ESFA) secondary to primary cutaneous amyloidosis. A 62-year-old woman of Asian ethnicity presented with a pruritic rash on the back of long-standing duration. Physical examination revealed diffuse hyperpigmentation localized to the interscapular region; there were a multitude of hyperpigmented macules merged in a rippled pattern intermixed with scattered papules and cobblestone-like areas. A punch biopsy from a papule was taken. Histopathological examination revealed a network of epithelial strands and cords hanging from the epidermis and harboring foci of ductal differentiation. Eosinophilic collections of amorphous material were found between the epithelial strands, obscuring the superficial dermis. The microscopic picture was consistent with primary cutaneous amyloidosis associated with reactive ESFA. Results of histochemical and immunohistochemical staining confirmed the diagnosis. We speculate that pathogenetic mechanisms intrinsic to primary cutaneous amyloidosis, in addition to unknown genetic factors, resulted in clinical changes of lichen amyloidosus associated with an abnormal hyperplastic epithelial response with histopathological features of ESFA rather than the common epidermal change of acanthosis and hyperkeratosis.

Clear cell acanthoma with changes of eccrine syringofibroadenoma: reactive change or clue to etiology?

We observed two patients with solitary lesions showing features of clear cell acanthoma with underlying eccrine syringofibroadenoma-like changes. The pathogenesis of these entities has been debated since their original descriptions, with most recent literature suggesting that both may represent reactive phenomena rather than true neoplasms. Our observation prompted us to perform a retrospective review of clear cell acanthoma cases to determine the frequency of such associated eccrine syringofibroadenoma changes. Of 47 examined cases of clear cell acanthoma, 9 (19%) showed associated changes of eccrine syringofibroadenoma. Immunohistochemical evaluation performed on a subset of cases identified similar but slightly divergent differentiation patterns within the lesions. While epithelial membrane antigen and PAS expression were similar in both components (although slightly different in intensity), the regions resembling eccrine syringofibroadenoma displayed additional immunoreactivities, supporting the presence of two distinct components. We have found that the concurrence of clear cell acanthoma with syringofibroadenomatous changes is more frequent than generally appreciated and suggest that these entities may share derivation from the eccrine apparatus.

A case of reactive eccrine syringofibroadenoma

Eccrine syringofibroadenoma is a rare adnexal tumor of eccrine ductal differentiation with variable clinical features. It manifests as either a solitary or multiple papules and nodules arranged in a symmetrical or linear pattern. The anatomical distribution is wide and includes the face, trunk, extremities, and rarely the nails. Histopathological findings show anastomosing cords and strands of uniform cuboidal cells surrounded by fibrovascular stroma. Herein, we report a case of reactive eccrine syringofibroadenoma which developed on the foot of a 37-year-old woman, after self-paring of tissue and subsequent infection and ulceration.