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Pathology of Spiradenoma

Dr Sampurna Roy MD

Dermatopathology Case 9

Diagnosis : Spiradenoma

Skin Appendage Tumour



March 2014
Benign sweat gland tumours


Hydrocystoma -Eccrine/Apocrine


Eccrine/Apocrine naevus

Eccrine Angiomatous Hamartoma

Porokeratotic eccrine ostial naevus

Benign Neoplasms:

Syringocystadenoma Papilliferum

Hidradenoma Papilliferum

Nipple Adenoma




Chondroid  Syringoma (benign mixed tumour)



Apocrine adenoma

Papillary eccrine adenoma


Malignant sweat  gland tumour 

Low grade:

Microcystic adnexal carcinoma

Eccrine epithelioma

Adenoid cystic carcinoma

Mucinous carcinoma

Primary extramammary Pagetís disease

Intermediate grade:


Digital papillary adenocarcinoma

High grade:


Apocrine adenocarcinoma

Eccrine ductal carcinoma


Malignant cylindroma


Sebaceous tumours

Fordyce's Spots


Nevus Sebaceous

Folliculosebaceous Cystic Hamartoma

Sebaceous Hyperplasia


Sebaceous Adenoma

Sebaceous  Carcinoma

Tumours of the Hair Follicle

Hair Germ Differentiation:


Desmoplastic  Trichoepithelioma



Cutaneous  lymphadenoma

Infundibular differentiation:


Dilated Pore of Winer

Pilar Sheath Acanthoma

Tumour of Follicular Infundibulum

Outer root sheath differentiation:

Trichilemmal Carcinoma

Proliferating Trichilemmal Cyst (Pilar Tumour)

Matrical differentiation:
Pilomatrixoma and Pilomatrix Carcinoma


Foreign body granuloma



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 ; 


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.


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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