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|Diagnosis in short|
Eccrine spiradenoma. H&E stain.
|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|
|Symptoms||pain - see painful skin lesions|
|Other||may be related to dermal cylindroma|
|Clin. DDx||painful skin lesions, others|
- One of the ANGEL tumours:
- A painful skin lesion.
- Many of these tumours have a prominent vascular component (think of blood vessels throbbing).
- 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 
- 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.
- Vascular component - large and small blood vessels.
- 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 will show
- attempts at hair bulbs,
- areas with more eosinophilic cytoplasm and
- characteristic peritumoral stroma
- Trichoepithelioma will show
- 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)
- IHC profile essentially identical to dermal cylindroma.
- URL: http://emedicine.medscape.com/article/1062079-overview. Accessed on: 9 May 2011.
- 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.
- 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.
- URL: http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=-1193575448. Accessed on: 29 November 2010.
- URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970191-7. Accessed on: 10 May 2011.
- 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.