Clinicopathological diversity of syringomas: A study on current clinical and histopathologic concepts

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.

Clinicopathological Spectrum of Syringoma: A Report of 50 Cases From a Tertiary Care Hospital in Eastern India

Background Syringoma is a benign adnexal neoplasm and is considered safe with very low malignant potential. However, multiple tiny lesions typically affect the face and exposed area, which may cause a cosmetic concern for the patient. After a clinical diagnosis, there are two methods to diagnose syringoma: fine needle aspiration cytology (FNAC) and histopathology. FNAC is generally used for the initial evaluation of syringoma, while histopathology is used as a confirmatory test to diagnose syringoma. In developing and resource-limited settings, the combination of FNAC and histopathology would cause a financial and logistics burden. Objective This study aimed to observe the cytological and histopathological features of cases clinically diagnosed as syringomas in a tertiary care hospital to suggest the use of either FNAC or histopathology for diagnosing syringoma. Materials and Methods This cross-sectional observational study was conducted in the Department of Dermatology and Department of Pathology of a tertiary care hospital in eastern India from November 2021 to April 2022. Any clinically provisionally diagnosed case of syringoma was recruited for the study after obtaining informed consent for voluntary participation. With aseptic precautions, the tissue aspirates and punch biopsy were obtained in the Department of Dermatology and the samples were sent to the Department of Pathology. Cytological and histological examination was conducted by a single expert pathologist. Result A total of 50 cases (36 female, 14 male) with a median age of 23 years (range 10-40 years) were included in the study. A total of 43 cases were presented with papular lesions and seven with nodules. In the majority of the cases (40%), the lesion was in the eyelid followed by 26% in the arm. In FNAC, 22 cases were found to be benign adnexal lesions, 16 were suggestive of syringoma, eight were diagnosed as xanthoma, two were diagnosed as warts, and two cases were inadequate for opinion. Histologically, 42 cases were confirmed as syringoma, six were diagnosed as xanthoma, and two cases were diagnosed as warts. There was a significant difference between diagnosis by FNAC and histopathology (McNemar χ² = 24.038, p-value = 0.0001). Conclusion We found that FNAC and histopathological diagnosis of syringoma may not be corroborative. Benign adnexal lesions are difficult to categorize by FNAC. Histopathological examination of clinically diagnosed cases of syringoma is of help for definitive diagnosis. Hence, FNAC may be avoided for saving time and discomfort for the patients and clinically diagnosed cases may be diagnosed by histopathological examination.

Incidental Clear Cell Syringoma of the Scalp in a Patient With Lichen Planopilaris

Syringomas are benign neoplasms of eccrine ducts; glycogen accumulation in the tumor cell cytoplasm results in a clear cell variant of syringoma. Syringoma and syringomatous proliferations (secondary to alteration of the eccrine sweat ducts) have been observed, albeit uncommonly, as an incidental finding in areas of alopecia on the scalp. A 71-year-old woman with scalp hair loss caused by lichen planopilaris had subclinical clear cell syringoma discovered as an incidental observation on evaluation of the biopsy specimen from an area of hair loss. Including our patient, scalp alopecia-associated syringoma or syringomatous proliferation has been described in a 47-year-old man and 16 women. The women ranged in age from 33 years to 83 years (median, 57 years). The duration of alopecia ranged from six months to 22 years; almost half of the patients (three of seven) had hair loss for 20 or more years. The frontal scalp was the most common location of alopecia; the parietal scalp and the entire scalp with diffuse hair loss were also frequent sites. Prior to biopsy, female pattern alopecia was the most common clinical diagnosis; lichen planopilaris and scarring alopecia were also frequent diagnoses. After the biopsy, pseudopelade was the most common diagnosis; lichen planopilaris and female pattern alopecia were also frequently observed. The pathogenesis of incidental syringomas and syringomatous proliferation in areas of scalp hair loss is postulated to be secondary to subclinical alopecia-related reactive changes.

Multiple Scrotal Cysts Composed of Combined Syringomas and Epidermal Inclusion Cysts: A Previously Unreported Association

Epidermal inclusion cyst (EIC) and syringoma are both benign lesions that are primarily asymptomatic and occur at various places on the body. Although both EIC and syringoma are common, their joint appearance has not been previously reported. These benign proliferations target different populations, and with differing clinical presentations. Syringomas tend to develop in young females as smaller multiple lesions, while EICs often present in older males as single or multiple variants that are typically larger in size. They also possess distinctive histopathological appearances that can used for their diagnosis. Furthermore, despite both having unclear etiologies, the involvement of the eccrine duct has been a proposed mechanism in the development of both lesions. Thus, further investigation of eccrine ducts in the pathology of these lesions can be the basis for assessing the association between EICs and syringomas. We report a unique case of a 16-year-old boy who presented to the clinic with multiple cysts (at least 20) on the scrotum, most of which consisted of both EIC and syringoma histologically. We are not aware of any previous reports of patients with multiple combined syringomas and EICs, and their potential association should be further explored.

Dermoscopy Of The Month: Dermoscopic Finding of Pigment Network in Lesions of Eruptive Syringoma

Syringoma is a benign adnexal tumor derived from intraepidermal eccrine ducts. The usual presentation of syringoma is a small smooth skin-colored, yellowish or brownish papule with flattened or rounded top. Eruptive syringoma is a rarely reported form, where lesions are numerous and occur in successive crops. A case of a 57-year-old Caucasian male with a twenty four-year history of multiple asymptomatic, erythematous and brownish papules, predominantly over the anterior aspect of the trunk is presented. All lesions appeared after prolonged sun exposures within a few days and persisted without further changes afterwards. Contact non-polarized dermoscopy showed a fine light brown, regular pigment network on a light pink background, being the same in all lesions. History of the disease, clinical finding and dermoscopy were inconclusive, and biopsy was performed. Histopathology revealed signs of syringoma. Dermoscopic finding was thought to be intriguing and therefore is discussed in this paper.

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.