Indian Dermatology Online Journal

CASE REPORT
Year
: 2015  |  Volume : 6  |  Issue : 7  |  Page : 30--32

Zosteriform spiradenoma with spiradenocarcinoma: A rare entity


Satish A Adulkar1, Atul M Dongre1, Uday S Khopkar1, Raghuram Maddala2, Prachi V Gole1, Siddhi Chikhalkar1,  
1 Department of DVL, Seth GS Hospital, Mumbai, India
2 Department of DVL, J.L.N H and RC, Bhilai, Chhattisgarh, India

Correspondence Address:
Satish A Adulkar
Plot 12 B, Dhangavalinagar Pipla Road, Hudkeshwar, Nagpur - 440 034, Maharashtra
India

Abstract

Eccrine spiradenoma (ES) is an uncommon well-differentiated benign tumor originating from the sweat glands. It usually occurs as a single lesion in adults. Multiple ES in a linear or zosteriform distribution are rare. Spiradenomacarcinoma is an extremely rare tumor, which develops in an existing benign spiradenoma of several years of duration. We report a case of a 23-year-old- female patient with multiple spiradenomas arranged in zosteriform pattern and malignant transformation occurred in one of the lesions over a period of 10 years.



How to cite this article:
Adulkar SA, Dongre AM, Khopkar US, Maddala R, Gole PV, Chikhalkar S. Zosteriform spiradenoma with spiradenocarcinoma: A rare entity.Indian Dermatol Online J 2015;6:30-32


How to cite this URL:
Adulkar SA, Dongre AM, Khopkar US, Maddala R, Gole PV, Chikhalkar S. Zosteriform spiradenoma with spiradenocarcinoma: A rare entity. Indian Dermatol Online J [serial online] 2015 [cited 2020 Oct 24 ];6:30-32
Available from: https://www.idoj.in/text.asp?2015/6/7/30/171057


Full Text

 Introduction



Eccrine spiradenoma (ES) is a slow growing well-differentiated tumor. Although it is uncommon the malignant counterpart is extremely rare, and our case is peculiar in its distribution pattern also with typical histopathology.

 Case Report



A 23-year-old- female patient presented with multiple small asymptomatic skin colored to reddish raised lesions over the chest and back of 10 years of duration. Lesions appeared first when she was 13 years old. These lesions gradually increased in number and size over a period of 10 years. Two months ago one of the nodules on the left scapular area started growing rapidly in size accompanied with pain.

Examination revealed multiple skin colored, erythematous, grouped, non-tender firm papules, and nodules varying in size from 0.5 to 5 cm over left chest and back in segmental pattern [Figure 1]. A few of the lesions showed bluish tinge over the surface. An erythematous tender nodule of approximate size 4 cm × 5 cm was noted on the back on left side of body [Figure 2]. There was no regional lymphadenopathy or hepatosplenomegaly.{Figure 1}{Figure 2}

Histopathological examination of the small nodules on the back revealed multiple well-circumscribed basophilic tumor islands located in dermis and subcutaneous tissue [Figure 3]. The nodules were composed of basophilic cells. On higher magnification two types of cells were seen. Dark, basaloid cells with hyperchromatic nuclei and cells with large pale vesicular and ovoid nuclei were seen. A few tubules were also seen [Figure 4]. These features were suggestive of benign spiradenoma.{Figure 3}{Figure 4}

However, biopsy from large erythematous painful nodule over back showed large aggregates of tumor cells with mild to moderate nuclear atypia, abnormal mitotic figures, and necrosis en masse [Figure 5]. At places features of benign component and gradual transformation into a malignant one were noted suggestive of spiradenocarcinoma. She was investigated further to detect any metastases, which were absent. She had undergone a wide surgical excision without any adjuvant therapy.{Figure 5}

 Discussion



ES is an uncommon well-differentiated benign tumor originating from the sweat glands.[1] It usually occurs as a single lesion in adults. Multiple ES in a linear or zosteriform distribution are rare.[2] ES is uncommon slowly growing well-differentiated benign adnexal neoplasm that has been historically designated as tumor of eccrine lineage, however some reviews indicate an apocrine origin.[3],[4] It classically presents as single, firm, or soft skin-colored or bluish nodule, ranging in size from 0.5 to 5 cm in diameter. The most striking clinical feature of ES is the presence of pain or tenderness.[3] There is no male or female preponderance.[5] ES may occur with other tumors such ascylindroma and trichoepithelioma as seen in Brooke-Spiegler syndrome.[6] Histopathologically, eccrine spiradenoma consist of one or more large, sharply defined basophilic nodules in the dermis without any connections to the epidermis and sometimes it may extend into the subcutis. They consist of groups of cells in cords or islands or sheets. Two types of cells are found in these nodules. These are small, dark, basaloid cells with hyperchromatic nuclei and cells with large pale vesicular and ovoid nuclei. Pale nuclei tend to be at the center of the lesions.[7]

Malignant eccrine spiradenomas (MES) is a rare tumor that was first described by Dabska in 1972.[8] MES generally arises as malignant transformation in long-standing benign ES and rarely can arise de novo.[9],[10] Clinical features of MES reported in the literature include a previously stable lesion of more than 2 years of duration to more than 12 years duration.[11] There is no age, gender, or site predilection.[12],[13] Majority of reported cases have occurred on the extremities (upper > lower) or trunk and very rare cases have been reported on the head and neck.[8] The tumor size ranges from 0.5-10 cm. All spiradenocarcinomas contain areas of benign precursor lesion. Apart from that, two different histologic patterns can be observed: (1) gradual transition from benign to malignant where the dual cell population of the spiradenoma imperceptibly merges with the monomorphous cell population of the carcinoma and poorly defined cell nests and cords replace the structural pattern of spiradenoma. (2) No transition from benign to malignant, the malignant areas are adjacent to and demarcated from spiradenoma.

Advanced stages of both patterns display necrosis, hemorrhage, and infiltrative growth pattern.[7] On immunohistochemistry tumor cells of MES express cytokeratin, epithelial membrane antigen, and p53.[7]

The clinical course of MES is aggressive. Multiple local recurrences and widespread metastases are common. Lymph nodes, bones, and lungs are the organs frequently affected.[14],[15] Management is primarily wide local excision. The role of prophylactic lymph node dissection, post-operative radiotherapy, and chemotheraphy is uncertain. If there is an absence of distant metastasis and presence of regional lymph node metastasis, lymph node dissection should be undertaken.[16]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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