|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 4 | Page : 546-547
Sunil Yogiraj Swami, Panchal Shriniwas, Kachru T Dalve
Department of Pathology, Swami Ramanand Teerth Rural Medical College, Ambajogai, Maharashtra, India
|Date of Web Publication||12-Jul-2016|
Sunil Yogiraj Swami
Bhagwanbaba Chowk, Gitta Road, Shepwadi, Ambajogai - 431 517, Beed, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Swami SY, Shriniwas P, Dalve KT. Eccrine spiradenoma. Med J DY Patil Univ 2016;9:546-7
Eccrine spiradenoma (ES), first described in 1956, is an uncommon, benign, dermal tumor of apocrine differentiation derived from cutaneous sweat glands. It usually presents as a solitary, intradermal, and painful nodule, the most common sites being the chest and face.
A 40-year-old female presented with a swelling over the medial aspect of the left forearm just above the elbow joint since 5-6 years. There was a history of increase in size with pain in the swelling since 3 months. Local examination showed a single nodule of size 2 cm × 2 cm, hard, tender, and mobile over the medial aspect of the left forearm just above the elbow joint. Fine-needle aspiration cytology (FNAC) revealed uniformly sized cuboid cells with scant cytoplasm, round to oval bland nucleus, and inconspicuous nucleoli arranged as tight multilayered clusters. Furthermore, there were many eosinophilic globules surrounded by neoplastic cells in a pseudorosette fashion [Figure 1]. The presence of scattered naked nuclei, spindle-shaped myoepithelial cells and the dense lymphocytic infiltrate in our case distinguishes this tumor cytologically from other eccrine tumors.
|Figure 1: Eosinophilic globules surrounded by neoplastic cells in a pseudorosette fashion (Pap, ×40)|
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Histopathology [Figure 2] showed well-circumscribed aggregates of basaloid cells involving the full thickness of the dermis, extending into the subcutaneous fat. The intervening stroma was edematous with ectatic vessels. Another characteristic finding was the presence of abundant lymphocytes scattered within the tumor nodules. At higher magnification, two distinct populations of neoplastic epithelial cells were seen, dark and pale with evidence of a focal area of squamous differentiation [Figure 3].
|Figure 2: Well circumscribed aggregates of basaloid cells involving the dermis (H and E, ×40)|
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|Figure 3: Two distinct populations of epithelial cells with focus of squamous differentiation (H and E, ×40)|
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Immunoprofile: The tumor cells were immunopositive for cytokeratins (CK5, CK6, CK7) [Figure 4], focally immunoreactive for CD10, and immunonegative for CD34.
In our case, the cytological and histopathological findings were consistent with ES with final confirmation on immunohistopathology.
ES are benign tumors of the skin found at the site of eccrine sweat glands.
It belongs to the group of the painful tumors of the skin, also known as the acronym BLEND AN EGG. This group includes blue rubber bleb nevus, leiomyoma, ES, neuroma, dermatofibroma, angiolipoma, neurilemmoma, endometrioma, glomangioma, and granular cell tumor.
ES may easily be mistaken for glomus lesions or angioleiomyoma due to its painfulness and florid vascularization. The pain due to an ES is related to the presence of small unmyelinated axons in the context of the connective tissue around the tumor, or to the expansion of the cysts. In contrast, the pain arising from an adenoid cystic carcinoma is related to its infiltrative growth and tendency for perineural invasion.
ES can cytologically simulate an adenoid cystic carcinoma on FNAC because both tumors contain hyaline globules.
Histologically, the tumor is lobular, with two types of cells in the islands. Larger, paler cells are grouped around lumina and smaller, darker cells form the periphery. Unlike cylindroma, lobules of ES are not surrounded by a rim of densely eosinophilic periodic acid-Schiff-positive basement membrane material.
Malignant degeneration of spiradenoma usually appears in long-standing tumors and is clinically revealed by a rapidly enlarging tumor mass. In these cases, the diagnosis of spiroadenocarcinoma is made only if a residual benign component is identified.
One must correlate clinical, cytological, and histopathological examinations along with immunohistochemistry to arrive at an accurate diagnosis of ES.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]