|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 6 | Page : 546-547
An uncommon presentation of eccrine poroma
Private Consultant, Kasturmahal Polyclinic, Mumbai, Maharashtra, India
|Date of Web Publication||11-Nov-2016|
B21, 6th Floor, Krishnalaya Building, N S Mankikar Marg, Chunabhatti-West, Mumbai - 400 022, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Desai C. An uncommon presentation of eccrine poroma. Indian Dermatol Online J 2016;7:546-7
Eccrine poromas are solitary tumors that originate in epidermal part of sweat duct. A 52-year-old male patient nondiabetic and nonhypertensive came with complaints of a nodular growth on left calf region. This lesion was asymptomatic and increased in size over a period of one and half years. On clinical examination, the tumor was hyperpigmented and ulcerated on the summit with dimensions of 6 × 4 cm [Figure 1]. No discharge was visible. On palpation the tumor was immobile, firm in consistency with no rise in local temperature. There was no discharge of any pus, blood, or serum. A provisional diagnosis of deep fungal infection, cutaneous tuberculosis, nodular vasculitis, carbuncle, dermato-fibrosarcoma protuberans, and epitheloid sarcoma was kept. Skin biopsy from the lesion was taken for histopathological examination. His blood cell counts and biochemical parameters were within normal limits.
|Figure 1: Single hyperpigmented firm nodular lesion on left calf with ulcer on its summit|
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On histopathology the specimen showed an epithelial neoplasm that was connected with surface epidermis at many points forming interconnecting tumor islands. The islands consisted of poroid cells that were smaller and darker stained and cuticular cells that were pink in color and larger. Both types of cells were monomorphous with rounded nuclei. Moderate amount of melanin pigment was present within the epithelial component. The stroma shows abundant mucin, edema and dilated capillaries [Figure 2] and [Figure 3]. Thus, a final diagnosis of poroma was arrived based on clinicopathological correlation. The patient was referred to surgery department where a complete excision of the lesion was done.
|Figure 2: Neoplasm comprising of both poroid and cuticular cells with vessels surrounded by hyalinised stroma (H and E, ×10)|
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|Figure 3: Tumor showing cuboidal cells with basophilic rounded nuclei and few eccrine ducts (H and E, ×40)|
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Poroma is a benign adnexal tumor with acrosyringeal differentiation. It was first described in 1956 by Goldman and Pinkus. It usually occurs as solitary tumor over the sole or on either sides of feet. The lesion is usually small less than 5 cm in size. Multiple lesions over palms and soles, pedunculated lesions are other rare variants.
Histopathology of eccrine poromas typically displays a neoplasm arising from the lower portion of the epidermis, which grows downward into the dermis and the tumor mass consists of multiple interconnecting anatomizing bands comprising of epithelial cells. The tumor cells are smaller than the epidermal cells with cuboidal appearance and a rounded deeply basophilic nucleus. Usually, no keratinisation is observed within the tumour mass. However, in certain circumstances where the normal overlying epidermis has been replaced by the tumour cells keratinisation may be noted at the surface. The border between the tumor and the stroma is sharply dermarcated with no palisading of peripheral tumoral cells. The tumor cells contain significant quantity of glycogen, which is associated with cytoplasmic clearing. Melanocytes and melanin are present in tumors arising in darker-skinned individuals. In majority of eccrine poromas, the tumor bands contain narrow ductal lumina and cystic spaces.
Poromas are benign neoplasms, hence complete surgical excision is the best modality of treatment. Other options include carbondioxide laser-assisted removal and electrosurgical destruction.
Malignant eccrine poroma can either arise from a long-standing benign poroma or as a de novo lesion. Our case had interesting presentation of relatively large size poroma at an uncommon location wherein index of suspicion may be low.
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| References|| |
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McCalmont TH. Adnexal neoplasms. In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. 2nd
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[Figure 1], [Figure 2], [Figure 3]