Giant vascular eccrine spiradenomas: a report of two cases with histology, immunohistology and electron microscopy

Successful surgical removal of a cutaneous lesion compatible with gigantic vascular eccrine spiradenoma: a rare case report

Giant vascular eccrine spiradenoma (GVES) is an uncommon type of eccrine spiradenoma (ES). Compared to an ES, this is characterized by a greater degree of vascularity and a bigger size overall. In clinical practice, it is frequently mistaken for a vascular or malignant tumor. To achieve an accurate diagnosis of GVES via biopsy and successfully perform the surgical removal of a cutaneous lesion in the left upper abdomen compatible with GVES. We present a 61-year-old female with the lesion accompanied by on-and-off pain, bloody discharge and skin changes surrounding the mass treated surgically. However, there was no fever, weight loss, trauma or family history of malignancy or cancer managed by surgical excision. The patient recovered well postoperatively and was discharged on the same day with a 2-week follow-up. The wound got healed, the clips were removed on Day 7 postoperatively, and there was no requirement for further follow-up.

Giant vascular eccrine spiradenoma: the first case in the scrotum and review of the literature author

Background

Giant vascular eccrine spiradenoma is a rare variant of eccrine spiradenoma. It is different from the eccrine spiradenoma in its larger size and greater degree of vascularity. It is often clinically confusedwith a vascular or malignant tumor.

Case presentation

Here, we report a case of a 67-year-old man who presented with a tumor in the scrotum scrotal region for 6 years. The tumor had begun as a small nodule and had grown slowly with over time. Surgical excision and pathological examination revealed that the lesion was the a giant vascular eccrine spiradenoma.

Conclusion

This study reports the first case of giant vascular eccrine spiradenoma in the scrotum.

MYB Translocations in Both Myoepithelial and Ductoglandular Epithelial Cells in Adenoid Cystic Carcinoma: A Histopathologic and Genetic Reappraisal in Six Primary Cutaneous Cases

ABSTRACT

Adenoid cystic carcinoma (ACC) is an infiltrating carcinoma composed of 2 cell types, myoepithelial and ductoglandular epithelial cells. Although approximately 70% of ACC exhibit translocations of the MYB proto-oncogene or MYB proto-oncogene like 1 (MYBL1), expression of MYB is known to be limited in myoepithelial cells. We investigated the histopathologic and genetic characteristics of ACC in 6 primary cutaneous cases. Histopathologically, 3 cases (50%) exhibited well-demarcated nodules composed of large nests, easily misdiagnosed as polymorphous sweat gland carcinoma. Two cases (33%) harbored large cystic structures resembling spiradenoma, hidradenoma, and digital papillary adenocarcinoma. A papillary pattern was focally observed in 2 cases (33%). A melting phenomenon within the myxoid stroma was seen in one case (17%). Fluorescence in situ hybridization (FISH) revealed MYB break-apart in 3 cases (50%). A combined FISH and immunohistochemical method revealed MYB break-apart signals in both p63-positive myoepithelial and p63-negative ductoglandular epithelial cells, suggesting that both cell types constitute elements of the tumor in ACC. Moreover, we established a well-circumscribed variant of ACC and proposed 3 new patterns of cystic, papillary, and melting in addition to the 3 patterns of cribriform, tubular, and solid growth.

Myoepithelial-Rich and Infiltrative Giant Vascular Eccrine Spiradenoma: A Unique Presentation of a Rare Adnexal Tumor

A rare variant of the eccrine spiradenoma, the giant vascular eccrine spiradenoma, has been characterized as a large circumscribed and sometimes hemorrhagic solitary tumor occurring in adults older than 50 years. Histopathologically, the lesion is comprised of distinct cell populations and cystic hemorrhagic glandular spaces. We present a 68-year-old Bengali man with a giant vascular eccrine spiradenoma and describe immunohistochemical features of this tumor. In addition, we highlight unique aspects of this case, including a rich myoepithelial component and focal pseudocapsular infiltration.

A rare case of Brooke-Spiegler syndrome: integrated surgical treatment of multiple giant eccrine spiradenomas of the head and neck in a young girl

INTRODUCTION

The authors present a "four-step" integrated surgical protocol to treat a rare case of multiple giant eccrine spiradenoma (ES) of the head and neck in a young patient.

PRESENTATION OF CASE

An 18-year-old female patient presented with multiple swellings in the head and neck regions. The patient had a severe psychological trauma with a negative impact on her social life. Physical examination revealed multiple papulo-nodular swellings measuring between 5 cm × 8 cm and up to 10 cm × 20 cm in size with cerebriform aspect and soft consistency. Major lesions were located in the scalp, frontal area, neck, occipitotemporal, and retroauricular regions. Tissue biopsy found a benign composite adnexal neoplasm consisted in ES, trichoepithelioma, and cylindroma, a typical feature of Brooke-Spiegler Syndrome. A staged excision was planned, and available reconstructive options were considered. Scalp reconstruction included tissue expansions, advancement flaps, skin grafts, and dermal regeneration template (Integra^®). All treatments were successful, and no recurrence was observed. The patient returned to a normal social life, and a radical excision with satisfying aesthetic results was achieved.

DISCUSSION

Although adnexal tumors are benign in most of the cases, these lesions are prone to arise in the craniofacial region, thereby causing aesthetic discomfort associated with pain, hemorrhage, and infection to the patient every day. Furthermore, there is a potential risk of malignant transformation. These concerns demonstrate the need to establish a surgical protocol for the treatment of adnexal tumors.

CONCLUSIONS

Our integrated surgical approach showed excellent aesthetic and functional results with benefits to the patient's life and complete oncological excision.

Giant vascular eccrine spiradenoma

Giant vascular eccrine spiradenomas (GVESs) are a rare variant of the eccrine spiradenoma that develops from the sweat gland. It is different from the eccrine spiradenoma in its larger size and greater degree of vascularity. Bleeding and/or ulceration are common clinical features of this tumor, and are the reason why it is often clinically confused with a vascular or malignant tumor. Here, a rare case of GVES without bleeding or ulceration is reported.

Differential considerations of skin tumours with florid vascularisation: report of a solitary giant vascular eccrine spiradenoma

The authors report the case of an 81-year-old male who presented with a 3-year-history of a bluish, nodular tumour located on the extensor side of his right forearm. Subjective symptoms included tenderness upon palpation and spontaneous haemorrhage. In order to exclude malignant neoplasms, for example, nodular melanoma, metastatic melanoma or angiosarcoma, the tumour was surgically removed and tissue submitted for microscopic examination. Histologically, the authors diagnosed this as giant vascular eccrine spiradenoma, a rare variant of eccrine spiradenoma, which can easily be mistaken for angiomatous lesions due to the haemorrhagic features and florid vascularisation. It is our aim to help clarify the diagnosis and differentiate giant vascular eccrine spiradenoma from other painful cutaneous tumours exhibiting a high degree of vascularisation, for example, angiosarcoma or venous thrombosis, as this case represents one of only seven found in published literature.

Giant vascular eccrine spiradenoma: report of a case with immunohistochemical study

We report a rare case of giant vascular eccrine spiradenoma (GVES) which developed in 56-yr-old Korean woman. It is a rare variant of eccrine spiradenoma (ES), which might be mistaken for angiomatous lesions in view of its florid vascularity and hemorrhagic features. Histogenesis of GVES is not clearly elucidated although it is known that ES presumably originates in the eccrine glands. To clarify the histogenesis of GVES, immunohistochemical stainings using various monoclonal antibodies were also performed. The tumor was composed of three types of cells, namely pale epithelial cells, small basal cells, and myoepithelial cells. Therefore, we conclude that GVES originated from eccrine gland and mainly differentiates toward secretory portion of secretory coil.

Malignant eccrine spiradenoma

Malignant transformation of eccrine spiradenoma is extremely rare. We describe the case of a 70-year-old man with malignant eccrine spiradenoma of the forearm and metastases to the axillary lymph nodes. Surgical excision with adequate margins and lymph node dissection was performed. Tamoxifen therapy was instituted after obtaining positive immunostaining results for estrogen receptor. After 41 months of follow-up, there has been no recurrence or distant metastases. Wide local excision and close follow-up are crucial in the management of malignant eccrine spiradenoma. The role of other therapeutic modalities, including hormonal therapy, remains to be determined.

Brooke-Spiegler syndrome: treatment of cylindromas with CO2 laser

Brooke-Spiegler syndrome is an autosomal dominant inherited disease characterized by the development of multiple trichoepitheliomas and cylindromas. We report two patients with Brooke-Spiegler syndrome whose scalp cylindromas were treated with a high-energy continous wave CO2 laser after debulking with bipolar scissors in one of the patients. The special feature in our report is the coexistence of three adnexal skin neoplasms in one case, and the close association of cylindroma and eccrine spiradenoma in the same lesion. We also support that debulking with bipolar scissors prior to laser therapy can be a technique of great benefit in large tumors.

Extensive naevoid eccrine spiradenoma

We describe a 19-year-old girl with a painful naevoid eccrine spiradenoma affecting the right side of the body. This represents an extremely rare variant of this benign eccrine sweat gland tumour, and is the most extensive lesion described in the U.K. to date.

Spiradenoma and dermal cylindroma: comparative immunohistochemical analysis and histogenetic considerations

We carried out an immunohistochemical analysis of nine spiradenomas and seven cylindromas. Our findings underscore the histomorphological similarities of the two adnexal neoplasms-namely, the expression of S-100 protein ascribed to eccrine differentiation within the tubular and large, pale-staining cells of both entities. Human milk fat globulin (HMFG) and lysozyme, two markers associated with apocrine differentiation, are expressed by tubular cells in spiradenomas and cylindromas. Lysozyme is also expressed in cylindromas by large, pale-staining cells. In addition, antibodies to alpha-smooth muscle actin strongly characterized the small basaloid cells of both types of neoplasm. Both spiradenomas and cylindromas expressed identical cytokeratin patterns. As with the various regions of eccrine and apocrine units, the expression by spiradenomas and cylindromas of keratins 7, 8, and 18 indicates differentiation toward the secretory tissue, whereas the expression of keratin 14 in some of the neoplastic cells points toward ductal differentiation. Malformed ductal and glandular structures in continuity with evolving spiradenomas and cylindromas in two of our cases also suggest that these tumors might arise from abortive adenxal anlagen.

Sweat gland adenomas: immunohistochemical study with emphasis on myoepithelial differentiation

Thirty-one dermal appendage tumors of sweat gland differentiation including 7 spiradenomas (SPA), 8 cylindromas (CYL), 8 acrospiromas (ACS), and 8 chondroid syringomas (CS) were analyzed using antibodies to epithelial membrane antigen (EMA), cytokeratin (AE1, AE3, CAM 5.2, 34BE12), S-100 protein, actin (ACT), and desmin (DES) to characterize the immunocytochemical profile of benign sweat gland tumors. Cytokeratin expression was variable; AE1, 34BE12, AE3, and CAM 5.2 were present in 31, 24, 23, and 22 tumors respectively; 29 tumors contained EMA. Seventeen tumors, (6 SPA, 8 CYL, 2 ACS, 1 CS) stained with antibody to alpha smooth muscle actin, and 26 (7 SPA, 7 CYL, 4 ACS, 8 CS) expressed S-100 protein. Although some prior studies had reported actin filaments on electron microscopy in both spiradenoma and cylindroma, these tumors have previously been considered to be negative for myoepithelial differentiation. All spiradenomas and cylindromas we studied demonstrated actin and/or S-100 protein positivity in basal epithelial cells, consistent with myoepithelial differentiation. The organization of actin and S-100 protein positivity displayed by the spiradenomas and cylindromas we studied suggests that the tumors are differentiated towards the secretory portion of the eccrine sweat gland.

Non-epithelial cellular components in eccrine spiradenoma: a histological and immunohistochemical study of 20 cases

In this study, 20 cases of eccrine spiradenoma have been examined using monoclonal antibodies to identify the nature of the epithelial, as well as the non-epithelial, cellular components of this tumour. The results indicate that there is striking similarity between the epithelial cells of eccrine spiradenoma and the normal cells lining eccrine apparatus. An interesting finding was the presence of abundant T-lymphocytes and Langerhans' cells within the tumour lobules. Additionally, endothelial-lined vascular channels and neurofibrils were prominent in larger lesions.

Eccrine spiradenoma occurring in infancy mimicking mesenchymal tumor

Eccrine spiradenoma (ES) rarely (less than 1%) occurs in infancy. These tumors differ from the conventional ES by the presence of superficial dermal nodules which display a less distinct two-cell pattern of immature adnexal epithelial cells and rarely ductule formation. These tumors may be mistaken for mesenchymal neoplasms involving the skin and subcutis of infants and young adults. Recognition of the histopathologic features and immunostains are required to make a definite diagnosis. We describe 2 cases of ES occurring in patients younger than one year. Detailed histopathologic and histochemical differential features of these tumors and mesenchymal neoplasms of the skin and subcutis commonly occurring in infants and young adults are discussed. The biologic behavior of infantile ES is benign, but complete excision is recommended to prevent recurrence. We speculate that these tumors may represent congenital hamartomatous growths.