Eccrine spiradenoma

From Libre Pathology
Jump to navigation Jump to search
The printable version is no longer supported and may have rendering errors. Please update your browser bookmarks and please use the default browser print function instead.
Eccrine spiradenoma
Diagnosis in short

Eccrine spiradenoma. H&E stain.

Synonyms spiradenoma

LM dense nests of cells in the dermis ("dermal blue balls"), mixed cell population (epithelial, myoepithelial, +/-lymphocytes)
LM DDx dermal cylindroma, trichoepithelioma
IHC S100 +ve, CK7 +ve, CK18 +ve
Site skin

Symptoms pain - see painful skin lesions
Prevalence uncommon
Prognosis benign
Other may be related to dermal cylindroma
Clin. DDx painful skin lesions, others
Treatment excision

Eccrine spiradenoma, also spiradenoma,[1] is (usually) a benign, painful skin thingy. There is case series of malignant ones.[2]

General

  • One of the ANGEL tumours:
    • A painful skin lesion.
    • Many of these tumours have a prominent vascular component (think of blood vessels throbbing).
  • Benign.
  • Usually solitary, circumscribed and dermal.
  • Most common on the head.
  • Multiple lesions, early in life suggest a genetic syndrome.
    • Brooke-Spiegler syndrome - spiradenomas, cylindromas and trichoepitheliomas
  • Generally considered to be an 'eccrine' tumor but some hypothesize a pilar origin [3]

Microscopic

Features:[4][5]

  • Dense nests of cells in the dermis; "dermal blue balls".
  • Biphasic cell population:
    • outer dark cells with small hyperchromatic nuclei and minimal cytoplasm.
    • inner larger cells with vesicular nuclei and more cytoplasm.
    • In some areas the two cell types mix together with dispersed hyaline droplets.
  • Ductal differentiation.
  • These cells form lobules that are surrounded by a hyaline or reticulin sheath.
  • +/-Lymphocytes.
  • Vascular component - large and small blood vessels.

DDx:

  • Dermal cylindroma.
    • These two tumors are very closely related and overlap.
    • Many tumors have areas of both spiradenoma and cylindroma.
    • The lobules of cylindroma are small
      • more consistently discrete,
      • show more a more consistent arrangement of the light and dark cells and are
      • often surrounded by prominent hyaline material.
    • Individual lobules of cylindroma fit together like pieces of a puzzle.
    • Lobules of spiradenoma are larger
      • may run together and fuse,
      • may not have a prominent hyaline surround and
      • may show more disorganization and mixing of the two cell types
  • Trichoepithelioma.
    • Trichoepithelioma will show
      • attempts at hair bulbs,
      • areas with more eosinophilic cytoplasm and
      • characteristic peritumoral stroma
  • Glomus tumour, hemangioma or hemangiopericytoma (vascular spiradenomas).
    • The location often speaks against glomus tumour.
  • Basal cell carcinoma
    • Spiradenoma is deeper, without connection to the epidermis
    • Spiradenoma lacks clefting artefact.
    • Spiradenoma lacks mitoses and prominent apoptosis.
    • BCC lacks ducts
    • BCC lobules lack a prominent surrounding hyaline membrane
  • Lymphoid aggregate (spiradenoma will be cytokeratin positive)

Images

www:

IHC

Features:[6]

  • S100 +ve.
  • Keratins 7, 8, and 18 +ve.
  • Ductules are EMA and CEA positive.

Notes:

  • IHC profile essentially identical to dermal cylindroma.[6]

See also

References

  1. URL: http://emedicine.medscape.com/article/1062079-overview. Accessed on: 9 May 2011.
  2. Andreoli, MT.; Itani, KM. (May 2011). "Malignant eccrine spiradenoma: a meta-analysis of reported cases.". Am J Surg 201 (5): 688-92. doi:10.1016/j.amjsurg.2010.04.015. PMID 20851376.
  3. Kazakov, DV.; Soukup, R.; Mukensnabl, P.; Boudova, L.; Michal, M. (Feb 2005). "Brooke-Spiegler syndrome: report of a case with combined lesions containing cylindromatous, spiradenomatous, trichoblastomatous, and sebaceous differentiation.". Am J Dermatopathol 27 (1): 27-33. PMID 15677973.
  4. 4.0 4.1 URL: http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=-1193575448. Accessed on: 29 November 2010.
  5. URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970191-7. Accessed on: 10 May 2011.
  6. 6.0 6.1 Meybehm, M.; Fischer, HP. (Apr 1997). "Spiradenoma and dermal cylindroma: comparative immunohistochemical analysis and histogenetic considerations.". Am J Dermatopathol 19 (2): 154-61. PMID 9129700.