Vulvar syringoma showing progesterone receptor positivity

Syringomatous dermatitis: a myth or an existing entity?

Syringoma is rare disease that in classical variant occurs mainly on lower eyelids. In previously published researches, there is increasing evidence that eruptive syringomas must be discussed as an inflammatory dermal reaction pattern. And there was a proposal to change a name from eruptive syringoma to reactive syringomatous proliferation in appropriate cases. We conduct retrospective study on histopathological archived material to study the histopathological findings in cases of eruptive syringomas and correlate it with hypothesis that eruptive syringomas is not true adnexal neoplasms "de novo" but a hyperplastic response of the acrosyringium to an inflammatory process.According to obtained data and literature correlation, we can conclude that there is apparent diversity in eruptive syringomas. Part of cases can be calculated as neoplastic lesions arising "de novo," and another part as reactive syringomatous proliferation due to preceding cutaneous inflammatory process. Thus, term "eruptive syringoma" may be changed in appropriate cases to a "reactive syringomatous proliferation."Clinical variants of eruptive syringoma with evidence of underlying inflammatory process may be more responsive on types of treatments used for inflammatory disorders. Thus, more global clinicopathological correlative researches should be conducted and classification with terminology should be appropriately changed.

An Unusual Case of Genital Lesion: A Vulvar Syringoma

Objective: Syringoma is a benign adnexal neoplasm of sweat gland, usually presenting as extra-genital lesions, while vulvar localization is rare. Moreover, syringoma is an uncommon vulvar neoplasms.

Case report: A 44-year-old woman with previous diagnosis of duodenal gastrointestinal stromal tumour, underwent a local surgical excision for an isolated, painful, vulvar lesion. The specimen was submitted for histological examination.

A vulvar syringoma was diagnosed.

Conclusion: We describe this case according on its rarity and atypical presentation as well; therefore, vulvar neoplasms encompass many differential diagnoses, among which the incidence rate of syringoma is very low. Although its rarity, syringoma should be included among the differential diagnosis for vulvar neoplasm.

Evaluation and management of the patient with multiple syringomas: A systematic review of the literature

Syringomas are benign adnexal tumors with distinct histopathologic features, including the characteristic comma ("tadpole") shaped tail comprised of dilated, cystic eccrine ducts. Clinically, syringomas typically present in adolescent females predominantly in the periorbital region. They may present as solitary or multiple lesions, and more rare sites of involvement include the genitals, palms, scalp, and the chest. Over the past 50 years, there have been >800 reported cases of syringoma either alone or in conjunction with a systemic syndrome, most commonly Down syndrome. The primary aim of this systematic review is to discuss the clinical features and associations of syringomas with a focus on the patient with multiple syringomas. Its secondary aims are to explore pathophysiology with a focus on multiple syringomas and provide comprehensive data on both traditional and novel treatments. Importantly, multiple syringomas present across a broad clinical spectrum. Though noted in many textbooks to be related to tumor syndromes, the association of syringomas with inherited tumor syndromes is only rarely reported in the literature. Despite multiple reported cases of syringoma, the pathophysiology remains poorly understood and treatment continues to pose a significant challenge.

Unilateral Ulcerating Clear-Cell Syringomas Involving Left Groin in a Non-Diabetic Woman - Report of a Rare Presentation

Clear-cell syringomas, a rare histologic variant of syringomas, frequently coexist with diabetes mellitus. Clinically, it presents as skin colored papules distributed symmetrically around periorbital region. However, asymmetrical distribution of syringomas is rare and much rarer is the ulceration in such syringomas. Ulceration in such asymmetrical syringomas has not been reported so far. Herein, we report ulceration of clear-cell syringomas involving left groin in a middle aged non-diabetic woman.

Vulvar nonclear cell syringoma associated with pruritus and diabetes mellitus

Background. Syringoma is a benign eccrine sweat gland tumor, characterized by multiple skin colored or slightly yellowish papules. Vulvar syringoma without extragenital involvement is an extremely rare variant of syringoma. Mail Observations. Herein, we report a 40-year-old diabetic female patient who presented with only lichenified plaques on the vulvar region without any extragenital lesions. Diagnosis of vulvar syringoma was made depending on the characteristic double lined cystic enlargements and comma-like tails found in histopathological examination. Immunohistochemical stains for estrogen and progesterone receptors were negative. Conclusion. Vulvar syringoma may present with no obvious papules on lichenified plaques.

Vulvar Adnexal Lesions: A 32-Year, Single-Institution Review From Massachusetts General Hospital

Context.—Because the skin and modified mucosal surfaces of the vulvar region contain dense apocrine glands and anogenital mammary-like glands, in addition to eccrine glands and folliculosebaceous units, benign as well as malignant lesions derived from these adnexal structures are, not surprisingly, found in the vulva. However, their incidence occurring in the vulva has not been reported, to our knowledge.

Objective.—To determine the incidence of various vulvar adnexal lesions.

Design.—We performed a retrospective review (1978–2010) of the cases at our institution.

Results.—A total of 189 vulvar adnexal lesions were identified. Most of these lesions were benign (133 of 189; 70%), with hidradenoma papilliferum being the most common, followed by syringoma and various types of cysts. Rare cases of tubular adenoma, poroma, spiradenoma, hidradenoma, cylindroma, sebaceoma, and trichoepithelioma were identified. Malignant adnexal neoplasms comprised the remaining 30% (56 of 189) of the cases. Extramammary Paget disease was the most common (49 of 56), and 29% (14 of 49) demonstrated an invasive component. Rare cases of basal cell carcinoma, sebaceous carcinoma, apocrine carcinoma, adenoid cystic carcinoma, and spiradenocarcinoma were identified.

Conclusions.—In this retrospective review, we identified several benign entities that have not been previously reported on the vulva, namely pilomatricoma, poroma, spiradenoma, and sebaceoma. Hidradenoma papilliferum and extramammary Paget disease were the most common benign and malignant adnexal neoplasms, respectively. The spectrum of various vulvar adnexal lesions appears to reflect the frequency of the underlying glandular elements.

Syringoma: a clinicopathologic and immunohistologic study and results of treatment

The purpose of our study was to describe clinical and histopathological features of sixty one patients with histological diagnosis of syringoma over four year period in our dermatology clinic in Korea. Female:male ratio was 6.6:1 with onset of age during 2nd and 3rd decades in more than half of the patients in our study. The most frequently involved site was eyelids (43 cases, 70.5%) and the most common color of lesion was skin-color (30 cases, 49.2%). In 34 cases, characteristic tad-pole appearances (55.7%) were observed. Basal hyperpigmentation was observed more frequently in brown-colored lesion (p=0.005). Fibrosis was observed more frequently in erythematous lesion (p=0.033). Keratin cyst was observed less frequently in genital involved group (p=0.006). We also performed immunohistochemical stain for the presence of progesterone receptor (PR) and estrogen receptor (ER) in fifty six cases with negative results.

Siringomas periorbitários - excisão com tesoura de castroviejo: experiência em 38 pacientes e revisão da literatura

FUNDAMENTO: Siringoma é tumor anexial benigno do ducto sudoríparo écrino cujo tratamento é realizado por diversas modalidades cirúrgicas com resultados variáveis. OBJETIVO: 1. Relatar a experiência no tratamento cirúrgico de siringomas periorbitários mediante excisão com a tesoura oftalmológica de Castroviejo, seguida pela cicatrização por segunda intenção. 2. Apresentar revisão da literatura com enfoque no aspecto terapêutico. MATERIAL E MÉTODOS: Em 68 meses foram tratados 38 pacientes com siringomas periorbitários. Realizada a exérese cirúrgica com tesoura oftalmológica de Castroviejo seguida pela cicatrização por segunda intenção. Realizadas avaliações sete, 30 e 90 dias após a cirurgia. O seguimento variou entre três e 62 meses, com média de 33 meses. RESULTADOS: Dos 38 pacientes tratados, 63,1% tiveram resultado ótimo, 31,6% bom e 5,3% regular. A única complicação imediata observada foi edema, e as tardias foram: hipocromia (12 casos), cicatriz deprimida (um caso) e hipertrófica (um caso). Não ocorreram recidivas no período observado. CONCLUSÕES: O tratamento dos siringomas periorbitários mediante exérese cirúrgica com tesoura oftalmológica de Castroviejo, seguida pela cicatrização por segunda intenção, constitui procedimento ambulatorial de baixo custo e fácil execução. Proporciona resultados satisfatórios, sem recidivas, apesar da possibilidade de ocorrer hipocromia transitória.

Vulvar syringomas in a 9-year-old child with review of the literature

Syringomas are benign tumors of the eccrine sweat gland that are most common to the periorbital location. Less common and under-recognized is their potential involvement of the vulvar skin, where they may cause significant pruritus. In this location, lesions often develop just prior to or during puberty, with symptoms of pruritus sometimes correlating with pregnancy or menstruation. A hormonal influence has thus been postulated. Reported treatments for symptomatic patients include topical corticosteroids, systemic and topical antihistamines, laser and excisional surgery, cryotherapy, and topical atropine, with variable results. We report a 9-year-old girl who had severe pruritus secondary to syringomas of the vaginal labia, and review the literature on this unusual disorder. Awareness of this condition is important in order that patients receive appropriate evaluation and management of their symptoms.

Vulvar syringoma: a clinicopathologic and immunohistologic study of 18 patients and results of treatment

BACKGROUND

Syringoma of the vulva has been rarely reported. No effective treatment modality has been documented.

OBJECTIVE

The purpose of this study was to describe the clinicopathologic features of vulvar syringoma, to investigate the hormonal influence on its growth, and to establish an effective treatment modality.

METHODS

A total of 18 cases of vulvar syringoma were selected from the surgical pathologic file at Chang Gung Memorial Hospital. In all, 15 formalin-fixed, paraffin-embedded specimens were examined by immunohistochemical staining for estrogen receptor and progesterone receptor.

RESULTS

The age of first presentation at our vulvar clinic ranged from 21 to 60 years with a median age of 29.5 years. Of patients, 13 (72%) had vulvar pruritus and 7 noticed aggravation during summer or during menstruation. The most common clinical appearance was multiple flesh-colored or brownish papules on bilateral sides of the vulva (9 of 18). One third of our series was found to have coexisting eyelid syringoma and 4 of them also had a family history of periorbital syringoma. Immunohistochemical stainings for estrogen receptor and progesterone receptor were all negative on the 15 cases studied. Of our patients, 7 with intense pruritus were treated with carbon dioxide laser vaporization. Their lesions resolved and pruritus subsided.

CONCLUSION

Vulvar syringoma is not very rare and should be considered in the differential diagnosis of vulvar pruritus. In our study, estrogen receptor and progesterone receptor were not detected in vulvar syringoma. Carbon dioxide laser was an effective therapeutic modality in treating patients with intractable symptoms.

'Eruptive syringoma': a misnomer for a reactive eccrine gland ductal proliferation?

BACKGROUND

Syringomas have traditionally been categorized as benign neoplasms of the eccrine gland ductal epithelium. However, the variety of clinical presentations reported in the literature and some cases recently observed by the authors cast doubt upon the neoplastic nature of eruptive syringomas. Our goal is to challenge the traditional notion that eruptive syringomas are neoplastic lesions.

RESULTS

We observed two patients who presented with an eczematous process, which resolved leaving residual lesions. Biopsies of the late lesions showed features of eccrine syringoma. Yet a biopsy obtained from an incipient lesion in one of the cases showed a lymphocytic inflammatory reaction of the superficial portion of the eccrine duct resulting in tortuous hyperplastic changes.

CONCLUSION

Based on our observations, some of the so-called 'eruptive syringoma' may represent a hyperplastic response of the eccrine duct to an inflammatory reaction rather than a true adnexal neoplasm. We proposed the term 'syringomatous dermatitis' for such cases.