Pathology of Spiradenocarcinoma - Dr Sampurna Roy MD

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Pathology of Spiradenocarcinoma

Dr Sampurna Roy MD 2022

Spiradenocarcinoma is a rare dermal appendage carcinoma believed to arise from transformation of a long-standing benign spiradenoma.

It is an exceedingly rare malignant neoplasm with ductal differentiation.

The tumour was first described by Dabska in 1972.

This tumour demonstrates highly malignant biologic behavior with a high recurrence rate, frequent lymph node metastases , and overall poor survival.

Many consider it to be an eccrine neoplasm, and others favour apocrine differentiation.

Clinical presentation: Usually there is a history of increase in size of the mass, change in colour or ulceration of the overlying skin. Size of the lesion ranges between 0.5–15 cm.

Site: Most lesions usually arises on the lower extremities and rarely on the trunk.

Microscopic features:

There are two distinct components, typical spiradenoma and carcinoma with areas of transition ;

Tumour displays monotonous basaloid cells with occasional ductular differentiation ;

Luminal aspect of the tumour cells stain positively with PAS ;

Tumour infiltrates into the deep dermis and extends into the subcutaneous fat;

Focal areas of necrosis and mononuclear reactive inflammatory cell infiltration.

Immunohistochemistry:

Tumour cells express cytokeratin , epithelial membrane antigen and p53.

Differential diagnosis:

Merkel cell carcinoma : Immunohistochemical stains are performed (low molecular weight cytokeratin, neurofilament, chromogranin, neuron specific enolase and EMA).

In malignant spiradenoma the tumour cells show diffuse cytoplasmic staining with cytokeratin.

The clinical course is characterised by local recurrences and metastasis.

The usual sites of metastasis are regional nodes, bone, lung and liver.

Dermatopathology Quiz Case 19

Further reading:
Spiradenocarcinoma with low-grade basal cell adenocarcinoma pattern: report of a case with varied morphology and wild type TP53..

Spiradenocarcinoma of the eyelid: a case report.

Not all stubbed toes are innocuous--A case report of rare malignant eccrine spiradenoma (spiradenocarcinoma) of the toe.

Spiradenocylindrocarcinoma. Report of a case with a low-grade component of spiradenocarcinoma and an immunohistochemical study.

Spiradenocarcinoma arising from a spiradenocylindroma: unusual case with lymphoepithelioma-like areas.

Morphologic diversity of malignant neoplasms arising in preexisting spiradenoma, cylindroma, and spiradenocylindroma based on the study of 24 cases, sporadic or occurring in the setting of Brooke-Spiegler syndrome.

Spiradenocarcinoma with low-grade basal cell adenocarcinoma pattern: report of a case with varied morphology and wild type TP53.

Spiradenocylindrocarcinoma: a malignant hybrid tumor.

Spiradenocarcinoma of the breast arising in a long-standing spiradenoma.

Malignant eccrine spiradenoma: a case report and review of the literature.