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 » Introduction
 » Case Report
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  Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 54  |  Issue : 4  |  Page : 695-696
 

Eccrine spiradenoma: A rare adnexal tumor


Department of Pathology, 166 Military Hospital, Jammu, Jammu and Kashmir, India

Date of Web Publication30-Jul-2018

Correspondence Address:
Dr. Singh Kanwaljeet
Department of Pathology, 166 Military Hospital, Jammu, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_301_17

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 » Abstract 


Eccrine spiradenoma is one of the rare adnexal tumors with eccrine differentiation; however, it is considered to have apocrine differentiation. Around 50 cases of eccrine spiradenoma have been reported in the literature. Due to vascularity and painful symptoms, it is often confused with the painful lesions of skin such as glomus tumor and angioleiomyoma. Surgical excision is considered the gold standard for the treatment of these cases, with low rates of recurrence. Here, we present a 52-year-old male who presented with a nodular lesion in the left side of chest for the past 4 years. Surgical excision was performed and the tissue was sent for histopathological examination. Eccrine Spiradenoma may present congenitally or spontaneously as tumor of the sweat glands with unclear etiology. Early accurate diagnosis is very important in preventing chances of recurrence and more importantly identifying onset of malignant transformation.


Keywords: Adnexal, basaloid, eccrine spiradenoma, malignant spiradenoma


How to cite this article:
Kanwaljeet S, Chatterjee T. Eccrine spiradenoma: A rare adnexal tumor. Indian J Cancer 2017;54:695-6

How to cite this URL:
Kanwaljeet S, Chatterjee T. Eccrine spiradenoma: A rare adnexal tumor. Indian J Cancer [serial online] 2017 [cited 2020 Sep 27];54:695-6. Available from: http://www.indianjcancer.com/text.asp?2017/54/4/695/237889





 » Introduction Top


In 1956, a rare benign adnexal tumor originating from sweat glands was described as eccrine spiradenoma by Kersting and Helwig.[1] It presents commonly as a small and painful nodular lesion on the ventral aspect of the upper body. There is no sex predilection and it can affect any age group.[2]

Few noteworthy points that make the early definitive diagnosis of Eccrine spiradenoma (ES) of utmost importance are: firstly, it is well documented in the literature for its recurrence and secondly, its ability to transform into malignant counterpart. While eccrine spiradenomas are rare malignant spiradenoma is still rarer. Rate of malignant transformation of this benign tumor is very low with a metastasis rate of 50% which can prove fatal for the patient.

We report a case of the eccrine spiradenoma in the left side of chest, with prime focus on its clinical presentation, characteristic histopathological features, and differentiating it from other painful subcutaneous tumors that exhibit a similar presentation. An early diagnosis and precise surgical intervention are warranted to minimize the changes of recurrence and malignant transformation.


 » Case Report Top


A 52-year-old male presented to the skin outpatient department, 166 Military Hospital Jammu with the chief complaints of painful swelling in the left side of chest for the past 4 years. The swelling mildly increased in size gradually over this period. No history of itching and increased pigmentation was noted. A family history and medical history were insignificant. On examination, a single soft and tender nonulcerated nodule measuring 1.2 cm × 1.0 cm was noted. Few satellite lesions were noted, surrounding the nodule [Figure 1]a. Hematological and biochemical profile were within normal limits. Ultrasonography revealed enhancing exophytic soft tissue mass with the absence of extension into subcutaneous fat. With the provisional diagnosis of possibly benign soft tissue tumor, various painful lesions of skin adnexa were considered in differential diagnosis, and excision biopsy was performed. Hematoxylin and Eosin stained sections from the lesion show skin tissue lined by keratinized stratified squamous epithelium without ulceration. Dermis shows the presence of variable sized lobules of tumor cells [Figure 1]b consisting of dual population of cells: larger, pale cells with ovoid nuclei and another type of cells were small and dark with hyperchromatic nuclei [Figure 2]a. At places presence of tubular formations with Periodic Acid-Schiff positive eosinophilic amorphous material noted in lumina [Figure 2]b. Few thick-walled vessels were noted. No evidence of increased mitotic activity and hemorrhage/necrosis noted. Based on these findings and correlating with clinical and imaging findings, final diagnosis of benign eccrine spiradenoma was made.
Figure 1: (a) Clinical image showing 1.2 cm X 0.8 cm nodular lesion with few surrounding satellite lesions in skin. (b) Dermis shows variable sized tumor cells in lobules (H and E, ×20)

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Figure 2: (a) Tumor island consisting of dual population of cells (larger pale cells and small dark cells with hyperchromatic nuclei) (H and E, ×20). (b) Presence of tubular formations with PAS positive eosinophilic amorphous material noted in lumina (PAS, ×40)

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 » Discussion Top


Eccrine spiradenoma is a benign adnexal tumor that presents as a small, typically tender, and bluish nodular lesion mainly in the upper body. It presents as solitary lesions in 97% of all the cases multiple tumors have been reported on the chest, upper extremities of the forehead, and scalp.[3] In our case, this tumor was present on the right side of chest.

About 50 cases of eccrine spiradenoma have been reported in the literature to date.[4] Eccrine spiradenoma are usually benign and mostly occur in patients aged 15–35 years though any age group can be affected. To date, about 15 cases of linear/zosteriform/nevoid multiple spiradenomas have been reported.[5],[6]

The definitive diagnosis of eccrine spiradenoma is based on characteristic histopathological examination findings as discussed above. Tubular differentiation of tumor cells was also demonstrated which would be expected in an apocrine neoplasm.[7],[8] This is in line with findings in our case.

In patients with long-standing benign eccrine spiradenoma, malignant transformation is known to occur and presents as rapid enlargement of the nodule, increase in number, and change in color or with appearance of few symptoms such as pain and ulceration.[9] Malignant spiradenoma shows increased mitosis, pattern less proliferation, foci of necrosis, and the extension of the tumor cells along the line of the fibrous capsule.[10] These findings were not found in our case.

Histologically, it is very important to differentiate eccrine spiradenoma from glomus tumor and cylindroma due to considerable overlap in their histopathological features. Even the histological results of eccrine spiradenoma have been observed to be consistent with those of cylindroma within the same biopsy. With correlation of detailed clinical evaluation and investigations with biopsy findings, correct diagnosis can be achieved. Treatment for spiradenoma has not yet been clearly established, but surgical excision is the gold standard with low rates of recurrence.


 » Conclusion Top


Eccrine Spiradenoma may present congenitally or spontaneously as tumor of the sweat glands with unclear etiology. Early accurate diagnosis is very important in preventing chances of recurrence and more importantly identifying onset of malignant transformation. Adding on the case reports describing interesting and variable clinical presentations, in the literature is the need of recent times for better understanding and setting up standard therapeutic protocols for this rare tumor.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 » References Top

1.
Kersting DW, Helwig EB. Eccrine spiradenoma. AMA Arch Derm 1956;73:199-227.  Back to cited text no. 1
    
2.
Nath AK, Kumari R, Thappa DM. Eccrine spiradenoma with chondroid syringoma in Blaschkoid distribution. Indian J Dermatol Venereol Leprol 2009;75:600-2.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Revis P, Chyu J, Medenica M. Multiple eccrine spiradenoma: Case report and review. J Cutan Pathol 1988;15:226-9.  Back to cited text no. 3
    
4.
Dhua S, Sekhar DR. A rare case of eccrine spiradenoma-treatment and management. Eur J Plast Surg 2016;39:143-146.  Back to cited text no. 4
    
5.
Ekmekci TR, Koslu A, Sakiz D. Congenital blaschkoid eccrine spiradenoma on the face. Eur J Dermatol 2005;15:73-4.  Back to cited text no. 5
    
6.
Scheinfeld NS, Tarlow MM, Burgin S. Blaschkoid eccrine spiradenomas. Cutis 2002;70:73-5.  Back to cited text no. 6
    
7.
Wong TY, Suster S, Cheek RF, Mihm MC Jr. Benign cutaneous adnexal tumors with combined folliculosebaceous, apocrine, and eccrine differentiation: Clinicopathologic and immunohistochemical study of eight cases. Am J Dermatopathol 1996;18:124-36.  Back to cited text no. 7
    
8.
Lian F, Cockerell CJ. Cutaneous appendage tumors: Familial cylindromatosis and associated tumors update. Adv Dermatol 2005;21:217-34.  Back to cited text no. 8
    
9.
Braun-Falco M, Bonel H, Ring J, Hein R. Linear spiradenoma with focal malignant transformation. J Eur Acad Dermatol Venereol 2003;17:308-12.  Back to cited text no. 9
    
10.
Tanese K, Sato T, Ishiko A. Malignant eccrine spiradenoma: Case report and review of the literature, including 15 Japanese cases. Clin Exp Dermatol 2010;35:51-5.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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