Tubulopapillary hidradenoma-like tumor of the mandible: Two case reports of an underrecognized entity.

Tubulopapillary hidradenoma-like tumor of the mandible is extremely rare, with only 3 cases published in the English-language literature. The clinicopathological characteristics and histogenesis of this tumor are unclear. Few pathologists and perhaps fewer clinicians are familiar with this entity, and it is likely underrecognized and under-reported. Herein, we present two additional cases, both misdiagnosed as malignancies preoperatively and postoperatively by different unwary pathologists. Awareness and knowledge of this enigmatic entity and its clinical and radiographic features, together with careful morphological assessment should enable the correct diagnosis and prevent unnecessary treatment.

Hidradenoma papilliferum: an unusual benign perianal tumour.

Hidradenoma papilliferum is an uncommon benign tumour that is located in the anogenital region of middle-aged women. They are usually only diagnosed after excision and are thought to arise from anogenital mammary-like glands. We present the case of a young woman who noticed a slow growing perianal lump which caused minimal symptoms.

Eccrine spiradenoma mimicking a painful traumatic neuroma: case report.

Diagnosing and treating patients with persistent neuropathic pain associated with peripheral nerve lesions can be challenging. The authors report the rare case of a painful eccrine spiradenoma treated as a traumatic neuroma for many years because of a history of acute trauma, the presence of a tender palpable mass, and symptoms of allodynia. Surgical excision of the neoplasm completely relieved the pain and hypersensitivity that 2 prior surgeries and other nonsurgical treatments failed to resolve. The diagnosis of eccrine spiradenoma was not established until resection and histopathological analysis of the tissue. This case highlights the need to develop and consider an extensive list of differential diagnoses, including eccrine spiradenoma, for peripheral nerve lesions that fail to respond to treatment.

Multiple eccrine spiradenomas in a zosteriform pattern.

Eccrine spiradenoma (ES) typically presents as a solitary tender lesion. Multiple ES is a rare variant of ES and can present in a segmental, linear, blaschkoid, or zosteriform pattern. The etiology of multiple ES is unknown, but several theories have been suggested including a multipotent stem cell origin. We report the case of a 30-year-old woman with multiple painful ES in a zosteriform pattern on the mid-back and abdomen. Skin biopsy of a representative lesion demonstrated a circumscribed tumor nodule encapsulated by a fibrous capsule with diffuse dense basophilic proliferation located in the dermis. The lesions were then excised on two separate sessions without recurrence.

Multiple Eccrine Syringofibroadenoma of Mascaro of the Lower Extremity.

Eccrine syringofibroadenoma (ESFA) is a rare benign lesion of ductal and secretory differentiation exhibiting multiple cutaneous polymorphic presentations with an unknown etiology. We present a case of ESFA that uniquely exhibited large, thick, verrucous-like hyperplastic growths as well as superficial shiny mosaic plaques and deep ulcerations in three different anatomical locations in the same patient. The diagnosis of ESFA was confirmed histologically after biopsies were performed on all of the affected areas. In addition to a case report and literature review, we also present classification, clinical, and histologic aspects of ESFA.

Retalho fasciocutâneo torácico lateral para reconstrução de defeitos axilares após ressecção de hidradenite supurativa: série de 10 casos / Lateral thoracic fasciocutaneous flap for reconstruction of axillary defects after resection of hidradenitis suppurativa: a series of 10 cases

INTRODUÇÃO: A hidradenite supurativa (HS) é uma inflamação folicular crônica que apresenta quadro clínico variado, desde pequenos nódulos isolados até diversas lesões abscedadas, com formação de fístulas e cicatrizes. A região axilar é uma das áreas mais frequentemente acometidas. O objetivo é analisar uma série de casos acometidos por HS na região axilar, submetidos à exérese cirúrgica ampliada e reconstrução com retalho fasciocutâneo torácico lateral. MÉTODOS: Análise retrospectiva dos prontuários dos pacientes submetidos a tratamento no período entre 2010 e 2012. RESULTADOS: Dez pacientes foram operados, sendo que em dois havia acometimento bilateral, totalizando 12 procedimentos. Foi observado um tempo médio de evolução antes da indicação cirúrgica de 38 meses. O defeito médio observado após a ressecção foi de 10 x 9 cm. O tamanho médio dos retalhos foi de 15 x 10 cm. Em relação às complicações precoces, foram observados dois casos de deiscência (região axilar) e um caso de epiteliólise parcial (segmento distal do retalho). CONCLUSÃO: Observamos que a dissecção deste retalho não é tecnicamente difícil e que não apresenta sequelas funcionais ou estéticas significativas na área doadora, sendo uma opção confiável e versátil para reconstrução de defeitos axilares de maior porte.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic follicular inflammation that presents varied clinical features, from isolated small nodules to several abscessed lesions, with formation of fistulas and scars. The axillary region is one of the most frequently affected areas. The objective is to evaluate a series of patients with HS in the axillary region who underwent extensive surgical excision and reconstruction with a lateral thoracic fasciocutaneous flap. METHODS: A retrospective analysis of the medical records of patients who underwent treatment between 2010 and 2012 was conducted. RESULTS: Ten patients were operated, of whom two had bilateral involvement, totaling 12 procedures. The mean progression time before the surgical indication was 38 months. The mean defect size after the resection was 10 x 9 cm. The mean size of the flaps was 15 x 10 cm. With regard to early complications, two cases of dehiscence (axillary region) and one case of partial epitheliolysis (distal segment of the flap) were observed. CONCLUSION: We observed that dissection of lateral thoracic fasciocutaneous flaps is not technically difficult and does not present significant functional or aesthetic sequelae in the donor area, making it a reliable and versatile option for reconstruction of larger axillary defects.

Abordagem de hidrocistomas palpebrais écrinos por incisão de blefaroplastia inferior / Excision of eyelid eccrine hidrocystomas via lower blepharoplasty incision

INTRODUÇÃO: O hidrocistoma palpebral écrino corresponde a lesão cística rara, usualmente de pequenas dimensões, não ultrapassando o diâmetro de 10 mm. Sua abordagem usualmente é por excisão simples e biópsia. É alto o índice de recidiva local. MÉTODOS: Paciente com múltiplos hidrocistomas bilaterais, vários maiores que 10 mm. Sob anestesia local, foi realizada incisão infraciliar tradicionalmente usada para blefaroplastia inferior e retirada dos hidrocistomas com cápsula íntegra. RESULTADOS: Paciente com excelentes resultados estéticos e sem recidivas até o presente momento, mais de seis meses após o procedimento. CONCLUSÃO: A incisão infraciliar de blefaroplastia inferior é uma técnica promissora para exérese de hidrocistomas maiores que 10 mm. Mais estudos devem ser realizados para confirmação do bom resultado estético-funcional desta técnica.

INTRODUCTION: Eccrine eyelid hidrocystoma is a rare cystic lesion, usually small and not exceeding 10 mm in diameter. Its treatment is usually by simple excision and biopsy. The rate of local recurrence is high. METHODS: A patient presented with multiple bilateral hidrocystomas, several larger than 10 mm. Under local anesthesia, an infraciliary incision traditionally used for lower blepharoplasty was performed, and hidrocystomas with intact capsules were withdrawn. RESULTS: The patient had excellent esthetic results, with no recurrence for more than six months after the procedure. CONCLUSION: The infraciliary lower blepharoplasty incision is a promising technique for excising hidrocystomas larger than 10 mm. More studies should be conducted to confirm the good esthetic and functional outcomes of this technique.

A malignant eccrine spiradenoma of the scalp.

Malignant eccrine spiradenoma (MES) is an extremely rare but aggressive tumour, resulting in high mortality. We report the first case in the UK of metastatic MES on the scalp of a 37-year-old man who initially presented with a raised nodular mass which had grown rapidly over a few months. Excision biopsy of the lesion was performed and histology confirmed MES with evidence of cytological atypia and necrosis. A further wide local excision of the lesion with a 1 cm surgical margin was performed and full clearance was achieved. At 10-month follow-up another similar lesion had developed close to the previously excised area. A CT scan demonstrated metastatic lesions in the lungs, liver and pelvis, and subsequently chemotherapy was initiated. Although MES is uncommon, it has a high propensity to metastasise, therefore prompt identification, treatment and close follow-up of these tumours is essential.

Agminated syringocystadenoma papilliferum: a new clinical presentation of a rare benign adnexal neoplasm.

Syringocystadenoma papilliferum is a rare adnexal tumor that often occurs as a solitary tumor in the head and neck region, although occurrences on other anatomical locations have been described. Linear configurations have been described, but an agminated form is a more rare and underreported variant of this tumor. We describe a case of a healthy 10-year old female with agminated syringocystadenoma papilliferum occurring on her left supraclavicular region, with the clinical appearance of grouped molluscum contagiosum papules.Case synopsis A healthy 10-year-old girl was referred for the treatment of a "collection of molluscum contagiosum" of the left supra clavicular region of several years duration. The lesions were asymptomatic and refractory to cryotherapy. The patient was a healthy girl with no significant systemic findings. Cutaneous exam revealed a clustered group of pink, dome shaped, umbilicated papules over a 1.5 x 1 cm area within the left supraclavicular fossa (Figure 1a). An excisional biopsy was performed. Routine H&E stained sections revealed cystic epidermal invaginations with papillary projections. The superficial portions of the cyst were lined by stratified keratinizing epithelium, whereas the deeper papillated portion exhibited a double layer of basal-like cells and luminal eosinophilic columnar cells with focal decapitation secretion. The papillary structures contained fibrovascular cores and lymphoplasmacytic infiltrates. A component of hamartomatous follicular growth was not identified (Figure 1b-d.). A diagnosis was made of agminated syringocystadenoma papilliferum.

Malignant spiradenoma/cylindroma of the vulva.

Malignant spiradenoma/cylindroma of the vulva is an extremely rare adnexal tumor. We report the clinicopathological features of a 58-year-old woman who presented with malignant spiradenoma/cylindroma originating in the vulva and metastasized to the inguinal lymph nodes. Surgical excision with adequate margins and lymph node dissection was performed. Sections from the case were stained with Periodic Acid Schiff stain before and after diastase. Immunohistochemical study of the case using antibodies to carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), cytokeratin5/6 (CK 5/6), p63, cytokeratin7 (CK 7), smooth muscle actin (SMA), and S100 were performed. Microscopic examination revealed that spiradenoma nodules were positive to EMA and CEA. However, the cylindroma lobules showed strong immunoreactivity to p63 and CK5/6, whereas both tumor components were negative to S100, SMA, and CK7. Malignant spiradenoma/cylindroma is a rare tumor with controversial histogenesis that should be considered in the differential diagnosis of primary adnexal carcinoma and secondary metastatic tumors in the vulva. Further studies on a wider cohort should be encouraged.

Painful eccrine spiradenoma containing nerve fibers: a case report.

An eccrine spiradenoma is a rare benign tumor most often seen in the head, neck and upper trunk of young adults. Although spontaneous pain or tenderness is a typical symptom of eccrine spiradenomas, the underlying mechanism has not been fully elucidated. Here, we report the case of a 47- year-old woman who had a spiradenoma in the subcutaneous tissue of her posterior neck accompanied by agonizing pain which was triggered by pressure. Multiple nodular lesions were excised and the typical histopathological findings of spiradenoma were seen. The histopathological architecture of a disorganized nerve fiber encasing the tumor nodules appeared to correlate with the unique clinical symptom of pain.

Hidradenoma papilliferum with mixed histopathologic features of syringocystadenoma papilliferum and anogenital mammary-like glands: report of a case and review of the literature.

Hidradenoma papilliferum of the anogenital region was previously believed to originate from apocrine glands but has recently been accepted as originating from anogenital mammary-like glands. We describe a case of hidradenoma papilliferum with mixed features of syringocystadenoma papilliferum and mammary-like glands from the left labia majora of a 25-year-old woman. Histopathologically, the lesion showed an epithelial lining with apocrine secretion, and like syringocystadenoma papilliferum, the lesion extended from the epithelium as invaginations into the dermis. Adjacent to this lesion were ductal and glandular structures resembling normal mammary tissue. This review of the literature highlights the heterogeneity and complexity of lesions arising from anogenital mammary-like glands, and this case serves as further documentation of the association between anogenital mammary-like glands and hidradenoma papilliferum.

Carcinosarcoma ex eccrine spiradenoma of the vulva: report of the first case.

Carcinosarcoma is exceedingly rare in the vulva. We describe a case of carcinosarcoma in a 67-year-old female patient who presented with recent enlargement and pain of a vulval nodule noted for 15 years. The excised tumor showed intermixed carcinomatous (adenocarcinoma and anaplastic carcinoma) and sarcomatous elements (osteosarcoma, chondrosarcoma, and leiomyosarcoma), which focally merged with several lobules of typical eccrine spiradenoma. The inguinal lymph nodes showed metastasis of the carcinomatous component only. This case represents the first reported case of vulval carcinosarcoma of the skin adnexal origin, and has to be distinguished from sarcomatoid carcinoma of epidermal origin because of a probable more aggressive behavior.