Eccrine spiradenoma

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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.