Adenocarcinoma of sweat gland: case report and review of literature.

Sweat gland carcinoma is a rare malignant tumour, first described in 1865, with approximately 220 cases reported in last 30 years. Lower limbs are the most common site of involvement, followed by the upper extremities, and the head. Trunk is rarely involved. Five histological types have been described, most common being porocarcinomas followed by ductal carcinomas, adenoid cystic carcinomas, syringomatous carcinomas and mucinous carcinomas. These are aggressive tumours with potential for distant metastasis. Wide surgical excision is the treatment of choice and the overall prognosis is poor. Here we report another case of sweat gland adenocarcinoma with no evidence of metastasis

Siringomas: presentación de casosclínicos y revisión de la bibliografía / Syringomas: a clinical cases series and literature review

Los Siringomas son tumoraciones benignas que comprometen el epitelio ductal de la glándula sudorípara ecrina.La etiología es desconocida. El motivo de consulta suele ser por razones estéticas, sin embargo la afección en genitales genera cancerofobia o venerofobia. En la clasificación se incluyen variantes clínicas y asociación a diferentes enfermedades y síndromes.El diagnóstico es clínico e histopatológico. Existen múltiples opciones terapéuticas pero ninguna óptima.En este trabajo presentamos cuatro pacientes con manifestaciones clínicas diferentes y revisión de la literatura.

Syringomas are benign tumors of unknown etiology where the ductal epithelium from sudoriparous eccrine gland is compromised. Main complaint is due to the aesthetic nature, however the genital condition creates fear of cancer or venereal diseases. Classification includes clinical variants and association with different diseases and syndromes. Diagnosis is made by clinical and histopathological examination. Multiple treatment options are proposed with no effective outcome. Four cases with different clinical manifestations are reported and literature review is performed.

Two Clinically Unusual Cases of Folliculotropic Mycosis Fungoides: One with and the Other without Syringotropism

Mycosis fungoides is the most common form of cutaneous T-cell lymphoma, and it rarely exhibits predilection for hair follicle and eccrine gland infiltration. Here, we present 2 similar cases that display folliculotropism with varying amounts of follicular mucinosis, with and without syringotropism. The features observed in both cases were cystic, comedo-like, acneiform lesions; generalized involvement with loss of body hair; pruritus; and hidradenitis suppurativa-like lesions. Hypohidrosis as well as nail and palmoplantar involvement with lichen planopilaris-like clinical features were unique characteristics of the first case. Despite the well-known aggressive behavior of follicular mycosis fungoides, the presented cases had a subtle, slowly progressive, but persistent, clinical course. Folliculotropic and syringotropic mycosis fungoides are variants of cutaneous T-cell lymphoma. Clinical presentations might be challenging, and multiple, deep biopsy specimens containing adnexal structures are required for this critical diagnosis. Aggressive treatment may not be necessary in cases having an indolent course, especially in those with syringotropism.

Eccrine Angiomatous Hamartoma: A Review of Ten Cases

BACKGROUND: Eccrine angiomatous hamartoma (EAH) is a rare benign nodular lesion characterized by the proliferation of eccrine and vascular structures, generally capillaries, in the middle and deep dermis. It may be congenital or appear later in childhood, but rarely arises in adulthood. OBJECTIVE: To investigate the clinicopathologic features of EAH in Korean patients. METHODS: Ten cases of EAH diagnosed at Ajou University Hospital and Gangnam Severance Hospital in Korea from 2007 to 2010 were retrospectively reviewed. RESULTS: The age range of patients was between 5 and 66 years with an equal number of male and female patients. Apart from two congenital cases, the onset was late, ranging from 6 months to 65 years of age. All lesions were solitary and located on the distal extremities. Nine cases appeared as a yellow-brown nodule or plaque resembling a callus. Neither hyperhidrosis nor hypertrichosis was documented. Apart from the typical histological findings of EAH, prominent mucin deposition, fat component and nerve infiltration were observed. CONCLUSION: This is one of the largest single case series of EAH in the literature. Clinically, resemblance to callosities and the frequent occurrence in the adulthood were the unique features in our series.

A Case of Chondroid Syringoma with Small Tubular Lumina / 대한피부과학회지

Chondroid syringoma is a rare epithelial tumor with an adnexal gland origin, and it clinically presents as a slowly growing benign nodule. A 57-year-old woman presented with a 1-year history of 1x1 cm subcutaneous firm nodule on her scalp. The biopsy specimen showed a basophilic stroma and small tubular structures that were lined by a single layer of epithelium, small groups of epithelial cells and solitary epithelial cells. The tumor cells showed positive immunoreactivity for S-100. Herein, we report on a case of chondroid syringoma that histopathologically presented with small tubular lumina.

The Effect of Ultrasound Assisted Liposuction for Axillary Osmidrosis on Apocrine and Eccrine Glands

PURPOSE: Axillary osmidrosis is a distressing disorder characterized by unpleasant odor from axillary area and it is mainly associated with apocrine glands but also associated with eccrine glands. For surgical treatment of osmidrosis, recently ultrasound assisted liposuction(UAL) had been performed for many patients. According to the recent studies about ultrasound assisted liposuction for the treatment of osmidrosis, histologic studies about apocrine gland had been applied for 35 cases, but there were rare mention about eccrine gland and the relationship between two glands. The purpose of this article is to evaluate the effect of ultrasound assisted liposuction for the treatment of axillary osmidrosis on apocrine and eccrine glands. METHODS: From January 2004 to January 2007, 35 patients underwent ultrasound assisted liposuction for the treatment of osmidrosis and 5 patients underwent histologic studies. Histologic examinations were performed before and after ultrasound assisted liposuction and each biopsy was performed in central axillary area. The volume ratio of both glands, presence of degeneration were examined. And in aspirates, distribution and density of both glands and their morphological changes were examined. RESULTS: Preoperative biopsy results showed average volume ratio of apocrine glands to eccrine glands was 65:35. According to the postoperative biopsy results, the volume of apocrine glands in dermis were significantly reduced and glands were degenerated, but the volume of eccrine glands were slightly reduced and glands were mildly damaged. And the average volume ratio of two glands was 20:80. According to biopsy results of aspirates, the volume ratio of two glands was 85:15 and apocrine glands had significantly greater proportion. CONCLUSION: By comparison of each biopsy result, apocrine glands were more significantly reduced and degenerated than eccrine glands in all 5 cases. However, further studies with large sample sizes and close examinations are required.

A Case of Primary Mucinous Adenocarcinoma of the Upper Eyelid

PURPOSE: We report a case of a recurrent, non-tender mass on the right upper eyelid, which was completely excised and histologically diagnosed as mucinous adenocarcinoma from the eccrine gland. METHODS: A 67-year-old man presented with a non-tender subcutaneous mass on the right upper eyelid, which had developed 6 months prior to presentation. A similar eyelid mass had also been removed one year earlier. We surgically removed some skin and the mass and conducted a biopsy. During the operation, the biopsy revealed it to be mucinous adenocarcinomas, and thus it was removed by Mohs' excision technique with a clean margin. RESULTS: A mucinous adenocarcinoma from the eccrine gland was diagnosed by a histologic examination of the removed mass. A whole-body examination was conducted to determine if the lesion was primary or metastatic, and the results indicated it was primary lesion. There was no evidence of other malignant lesions, and a 21-month follow-up is currently being conducted in case of recurrence. CONCLUSIONS: Primary mucinous adenocarcinoma occuring on an eyelids is a very rare malignant tumor. Complete mass removal is well known to be the best treatment. For differential diagnosis, various examinations of the entire body are required in case the lesion had metastasized from the breast, gastrointestinal tract, kidneys, ovaries, lacrimal glands and so on. Periodical postoperative examinations must be thoroughly performed, since the probability of recurrence is about 30%.

A Case of Giant Malignant Clear Cell Hidradenoma / 대한이비인후과학회지

Originating in the eccrine gland and occurring mostly in those above 50 years-old, malignant clear cell hidradenoma is a very rare type of tumor, compared to the common benign hidradenoma. To the author's knowledge, there have been only 4 cases reported worldwide of the malignant transformation, especially in nodular hidradenomas. Clinical manifestation of malignant clear cell hidradenoma includes an appearance of a single tumor generally in either extremities or head, which prevails for a long period and then suddenly enlarges from external stimuli, such as trauma, electrical cauterization or incomplete excision. With its aggressive behavior, it frequently recurs after surgical excision and has high tendency for regional and distant metastasis. We report on our experience on a 75 year-old woman with a 15*7*8 cm malignant clear cell hidradenoma, a malignant tranformation in the long standing nodular hidradenoma, in the right postauricular region and the parotid gland region.

Two Cases of Herpetic Syringitis / 대한피부과학회지

The histology of herpes virus infection of the skin is characterized as an intraepidermal vesicle formed as the result of acantholysis and ballooning degeneration of kerationocytes. Dermal changes is limited to polymorphous inflammatory cells infiltrate, leukocytoclastic vasculitis, and herpetic folliculitis. Involvement of eccrine epithelium is very rare finding. We report two cases of herpes zoster with prominent viral infection of the eccrine sweat glands.

Immunohistochemical Expression of CD44 Isoforms in Eccrine Gland Tumors / 대한피부과학회지

BACKGROUND: CD44 is the principal cell surface receptor for hyaluronate and exists as multiple isoforms generated by the alternative splicing of up to 10 variant exons. Although certain isofroms may play a role in tumor progression and metastasis formation, the precise function and expression of the variant isoforms are less clear. Since on normal eccrine glands CD44 standard isoform(CD44s) is expressed only in eccrine coil secretory cells, it can be considered as a possible marker of this type of differentiation. However little is known about the expression of CD44 variant isofroms(CD44v) in eccrine gland tumors. OBJECTIVE: The purpose of this study was to investigate the immunohistochemical expression of different CD44 isoforms(CD44s, CD44v4, CD44v6) in the eccrine gland tumors. METHODS: Formalin-fixed and paraffin-embedded tissues from 2 cases of eccrine hidrocystoma, 5 cases of syringoma, 2 cases of eccrine poroma, 2 cases of syringofibroadenoma, 2 cases of nodular hidradenoma were immunolabelled with monoclonal antibody directed CD44s, CD44v4, and CD44v6. RESULTS: Except for syringofibroadenoma, the most tumors cells with eccrine ductal differentiation showed negative staining for CD44s, and positive staining for CD44v4 and CD44v6. Syringofibroadenoma exhibited positive staining for CD44s and CD44v4, but negative staining for CD44v6. Eccrine poroma showed negative staining for CD44s, positive staining for CD44v4, and variable intensity of staining for CD44v6 in different areas of the tumors. In case of nodular hidradenoma, small tubular lumina and clear cells were positive for CD44s. CONCLUSION: Our results suggest that CD44 isoforms can not be a useful marker for an eccrine gland tumor with specific differentiation, but its characteristic pattern of distribution might reflect the variety of functional roles of CD44 isoforms in tumorigenesis of eccrine gland tumors.

Prenatal Development of Eccrine Sweat Gland: Morphologic and Morphometric Analysis

To elucidate the developmental sequence of the eccrine sweat gland, a morphologic and a morphometric observation were done using developing human embryos and fetuses. Five embryos and sixty four fetuses from the 9th to the 38th week of the gestational age were studied. The skin was sampled in eight different areas, i.e., scalp, forehead, face, chest, abdomen, back, palm and sole. Routine histological sections were made for histological evaluation and morphometric analysis. The results obtained were as follows : The primordia of the eccrine sweat glands appeared first as regular undulation of the basal cells in the palm and the sole in the 13th week of getation. Subsequently, elongation and coiling of the cell cords were noted from the 16th to the 18th weeks. Intraductal lumen formation was first noted in the 20th week. Secretory segment of the eccrine sweat glands were noted from the distal part of the coiling intradermal sweat duct in the 22nd week of the gestational age. The eccrine sweat glands became fully developed by the 28th week of gestation and this included the clear cell, the dark cell and the myoepithelial cell. In the morphometric analysis, the number of eccrine epithelial buddings were decreased with aging and the highest were in the palm and the sole. The diameter of the eccrine sweat duct showed no significant change by gestational age or in the different sites observed. Straight and coiled eccrine sweat ducts or glands were lengthened into the deep reticular dermis and upper portion of the subcutaneous adipose tissue with an increase of the gestational age. The above results suggest that developmental stage and the number of eccrine glands of the skin in the fetal stage is different from other areas of the body, especially in the palm and the sole.

Prenatal Development of Eccrine Sweat Gland: Morphologic and Morphometric Analysis

To elucidate the developmental sequence of the eccrine sweat gland, a morphologic and a morphometric observation were done using developing human embryos and fetuses. Five embryos and sixty four fetuses from the 9th to the 38th week of the gestational age were studied. The skin was sampled in eight different areas, i.e., scalp, forehead, face, chest, abdomen, back, palm and sole. Routine histological sections were made for histological evaluation and morphometric analysis. The results obtained were as follows : The primordia of the eccrine sweat glands appeared first as regular undulation of the basal cells in the palm and the sole in the 13th week of getation. Subsequently, elongation and coiling of the cell cords were noted from the 16th to the 18th weeks. Intraductal lumen formation was first noted in the 20th week. Secretory segment of the eccrine sweat glands were noted from the distal part of the coiling intradermal sweat duct in the 22nd week of the gestational age. The eccrine sweat glands became fully developed by the 28th week of gestation and this included the clear cell, the dark cell and the myoepithelial cell. In the morphometric analysis, the number of eccrine epithelial buddings were decreased with aging and the highest were in the palm and the sole. The diameter of the eccrine sweat duct showed no significant change by gestational age or in the different sites observed. Straight and coiled eccrine sweat ducts or glands were lengthened into the deep reticular dermis and upper portion of the subcutaneous adipose tissue with an increase of the gestational age. The above results suggest that developmental stage and the number of eccrine glands of the skin in the fetal stage is different from other areas of the body, especially in the palm and the sole.

Immunohistochemical Study of Cytokeratin Polypeptides in Eccrine Gland Tumors / 대한피부과학회지

BACKGROUND: Different distributions of cytokeratins (CKs) have been found in various layers of the epidermis and in the structure of cutaneous appendages. Benign tumors of the epidermis or cutaneous appendages usually retain the characteristic distribution of CKs of their origin. OBJECTIVE AND METHOD: To elucidate the nature and differentiation of various eccrine gland tumors, we performed immunohistochemical staining using a panel of monoclonal antibodies against CKs in a normal eccrire gland, syringoma, eccrine hidrocystoma, eccrine poroma and clear cell hidradenoma. The tissue distribution of various keratins in the normal eccrine gland was compared with that in varioas eccrine gland tumors. RESULTS: With regard to CKs expression, the results indicated that syringoma represents a tumor differentiating toward both the uppermost part of the dermal duct and the lower intraepidermal duct, and eccrine hidrocystoma represents a tumor differentiating toward the luminal cell of the dermal duct of the eccrine gland. Eccrine poroma cells seemed to be most closed related to the uppermost dermal duct of eccrine gland. We also found that analyse distribution of CKs was insufficient to elucidate the histogenesis of clear cell hidradenoma. CONCLUSION: Analysing CKs is helpful in the analysis of epidermal neoplasms with differentiation toward the eccrine gland.

Immunohistochemical Study of Cytokeratin Polypeptides in Eccrine Gland Tumors / 대한피부과학회지

BACKGROUND: Different distributions of cytokeratins (CKs) have been found in various layers of the epidermis and in the structure of cutaneous appendages. Benign tumors of the epidermis or cutaneous appendages usually retain the characteristic distribution of CKs of their origin. OBJECTIVE AND METHOD: To elucidate the nature and differentiation of various eccrine gland tumors, we performed immunohistochemical staining using a panel of monoclonal antibodies against CKs in a normal eccrire gland, syringoma, eccrine hidrocystoma, eccrine poroma and clear cell hidradenoma. The tissue distribution of various keratins in the normal eccrine gland was compared with that in varioas eccrine gland tumors. RESULTS: With regard to CKs expression, the results indicated that syringoma represents a tumor differentiating toward both the uppermost part of the dermal duct and the lower intraepidermal duct, and eccrine hidrocystoma represents a tumor differentiating toward the luminal cell of the dermal duct of the eccrine gland. Eccrine poroma cells seemed to be most closed related to the uppermost dermal duct of eccrine gland. We also found that analyse distribution of CKs was insufficient to elucidate the histogenesis of clear cell hidradenoma. CONCLUSION: Analysing CKs is helpful in the analysis of epidermal neoplasms with differentiation toward the eccrine gland.

Microcystic Adnexal Carcinoma: Report of a case

Microcystic adenxal carcinoma is an unusual, locally aggressive neoplasm that has recently been recongized as a clincopathologic entity. Its histologic appearance includes both pilar and eccrine differentiation. Microscopically, the tumor consisted of small cysts and gland-like structures in superficial portion. In other area, basaloid cell nests and abortive hair follicles in the sclerotic stroma were seen. The cysts were filled with secretory eosinophilic material, which was positively stained with Periodic acid-Schiff and carcinoembryonic antigen. Immuno-peroxidase staining for carcinoembryonic antigen supported the dual differnetiation of this neoplasm. Despite the benign histologic appearance, there was deep and extensive infiltration of the subcutaneous tissue.

Malignant Eccrine Acrospiroma: A case report

A case of malignant eccrine acrospiroma of the anterior chest wall is reported. This mass had been present for 20 years and during rescent 5 years it showed frequent ulceration and bleeding suggesting malignant transformation. Microscopically, several foci malignant transformation from preexisting benign eccrine acrospiroma are seen and in immunohistochemical staining, the tumor cells both benign and malignant portion, show positive reaction to cytokeratin.

Eccrine Poroma: A report of five cases

The eccrine poroma was described first by Pinkus et al. in 1956 as a subgroup of benign solid hidradenoma with the histologic structure resembling acrosyringium. The histologic appearance of eccrine poroma greatly resembles that of seborrheic keratosis and basal cell carcinoma. But the clinical lesion is fairly unique and the tumor is most commonly found almost exclusively on the foot, in the skin of the plantar surface. During the past four years, the authors experienced five cases of eccrine poroma which were diagnosed by histopathological examination of the tumor mass. All the cases occurred in the sole and lateral sides of the foot as well. Clinical and pathological features were reviewed and a brief review of the literatures was done.