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Pathology of Spiradenoma

Dr Sampurna Roy MD

Dermatopathology Case 9

Diagnosis : Spiradenoma

 
Skin Appendage Tumour

     

http://www.   histopathology-india.net/SAClass.htm

March 2014
Benign sweat gland tumours

Cysts:

Hydrocystoma -Eccrine/Apocrine

Hamartomas:

Eccrine/Apocrine naevus

Eccrine Angiomatous Hamartoma

Porokeratotic eccrine ostial naevus

Benign Neoplasms:

Syringocystadenoma Papilliferum

Hidradenoma Papilliferum

Nipple Adenoma

Syringoma

Spiradenoma

Cylindroma

Chondroid  Syringoma (benign mixed tumour)

Poroma

Hidradenoma

Apocrine adenoma

Papillary eccrine adenoma

Syringofibroadenoma

Malignant sweat  gland tumour 

Low grade:

Microcystic adnexal carcinoma

Eccrine epithelioma

Adenoid cystic carcinoma

Mucinous carcinoma

Primary extramammary Pagetís disease

Intermediate grade:

Porocarcinoma

Digital papillary adenocarcinoma

High grade:

Hidradenocarcinoma

Apocrine adenocarcinoma

Eccrine ductal carcinoma

Spiradenocarcinoma

Malignant cylindroma

 

Sebaceous tumours

Fordyce's Spots

Steatocystoma

Nevus Sebaceous

Folliculosebaceous Cystic Hamartoma

Sebaceous Hyperplasia

Sebaceoma

Sebaceous Adenoma

Sebaceous  Carcinoma

Tumours of the Hair Follicle

Hair Germ Differentiation:

Trichoepithelioma

Desmoplastic  Trichoepithelioma

Trichofolliculoma

Trichoblastoma

Cutaneous  lymphadenoma

Infundibular differentiation:

Trichoadenoma

Dilated Pore of Winer

Pilar Sheath Acanthoma

Tumour of Follicular Infundibulum

Outer root sheath differentiation:
                    
Trichilemmoma

Trichilemmal Carcinoma

Proliferating Trichilemmal Cyst (Pilar Tumour)

Matrical differentiation:
                  
Pilomatrixoma and Pilomatrix Carcinoma

 

Foreign body granuloma

Rosacea

 

Spiradenoma is a benign dermal tumour occuring in adults.

This lesion often coexists with cylindromas.

Clinical presentation:

Usually presents as a painful or tender solitary nodule (less than 1cm in diameter).

May occasionally present as multiple lesions .

Giant variants, linear or zosteriform distribution have also been reported. 

Site:  Head & neck, sometimes on the scalp and on the trunk. Rarely on the extremities.

Microscopic features: 

        

Tumour consists of sharply demarcated lobules located in the dermis without connection to the epidermis ; 

Eosinophilic PAS positive basement membrane-like material may be present around the lobules ; 

Two cell types are present ; Small cells with dark nuclei are present at the periphery and the large paler cells are at the centre ;

Cells are arranged around small lumina ; 

Lumina contains small amounts of granular eosinophilic material that is PAS- positive and diastase resistant ;

Numerous small lymphocytes are present throughout the tumour lobules.

Tumour may show prominent degenerative changes, fibrosis and cyst formation ;

Ancient changes (dilated vessels rimmed by sclerosis) ; 

Larger tumours are partially or totally necrotic ; 

Immunohistochemistry: 

Strands of cells are cytokeratin positive and lumina are CEA positive.

Malignant transformation of spiradenoma (Spiradenocarcinoma) may occur in rare cases.

Brooke-Spiegler syndrome is a rare, autosomally dominant disease characterized by the development of multiple cylindromas, trichoepitheliomas, and occasional spiradenomas.

                            

Further reading:

Infiltrative Recurrent Eccrine Spiradenoma of the Anterior Neck Treated Using Mohs Micrographic Surgery.

Painful eccrine spiradenoma containing nerve fibers: a case report.

Neonatal spiradenoma.

Pediatric segmental eccrine spiradenomas: a case report and review of the literature.

Giant vascular eccrine spiradenoma.

Spiradenomas.

A rare case of multiple segmental eccrine spiradenomas.

Alteration of the β-catenin pathway in spiradenoma.

Eccrine spiradenoma arising in the breast misdiagnosed as an epidermal inclusion cyst.

Differential considerations of skin tumours with florid vascularisation: report of a solitary giant vascular eccrine spiradenoma.

Multiple vascular eccrine spiradenomas: a case report and published work review of multiple eccrine spiradenomas.

A case of eccrine spiradenoma in a patient with neurofibromatosis.

Eccrine spiradenoma with chondroid syringoma in Blaschkoid distribution.

An unusual case of congenital linear eccrine spiradenoma.

Eccrine spiradenoma: co-expression of cytokeratin and smooth muscle actin suggesting differentiation toward myoepithelial cells.J Eur Acad Dermatol Venereol. 2007 Jan;21(1):121-3.

Multiple linear spiradenoma with a linear distribution.Actas Dermosifiliogr. 2006 Jan-Feb;97(1):31-4.

Giant vascular eccrine spiradenoma: report of a case with immunohistochemical study.J Korean Med Sci. 2006 Feb;21(1):172-6.

Congenital blaschkoid eccrine spiradenoma on the face. Eur J Dermatol. 2005 ;15(2):73-4.

Brooke-Spiegler syndrome: report of a case with combined lesions containing cylindromatous, spiradenomatous, trichoblastomatous, and sebaceous differentiation.Am J Dermatopathol. 2005;27(1):27-33.

Two cases of multiple eccrine spiradenoma with linear or localized formation.J Dermatol. 2004;31(7):564-8.

Brooke-Spiegler syndrome associated with cylindroma, trichoepithelioma, spiradenoma, and syringoma.J Dermatol. 2004;31(1):32-8

Familial eccrine spiradenoma: a case report and review of the literature.Dermatol Surg. 2003;29(4):411-4.

Multiple eccrine spiradenomas on the hand, forearm and head.Dermatology. 2002;205(4):401-4.

Blaschkoid eccrine spiradenomas.Cutis. 2002;70(1):73-5.

Multiple linear eccrine spiradenomas with eyelid involvement.J Eur Acad Dermatol Venereol. 2001;15(2):163-6.

Cell proliferation in skin tumours with ductal differentiation: patterns and diagnostic application.J. Cutan Pathol  2000; (27): 292-7

Multiple eccrine spiradenomas in zosteriform distribution in a child.Pediatr Dermatol. 2000;17(5):384-6.

Spiradenocylindromas of the skin: tumors with morphological features of spiradenoma and cylindroma in the same lesion: report of 12 cases.Pathol Int. 1999;49(5):419-25.

Spiradenoma and dermal cylindroma comparative immunohistochemical analysis and histogenetic considerations. Am J Dermatopathol 1997 ; 19: 154-161.

Non-epithelial cellular components in eccrine spiradenoma: a histological and immunohistochemical study of 20 cases. Histopathology 1991 ; 18: 155-160 

Eccrine spiradenoma: clinical and pathologic study of 49 tumors.J Cutan Pathol. 1983;10(5):312-20.

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

 

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