Eccrine porocarcinoma shares dermoscopic characteristics with eccrine poroma: A report of three cases and review of the published work.

Eccrine porocarcinoma (EPC) is a rare malignant skin tumor presumably arising from the intraepidermal ductal portion of the sweat gland. EPC occasionally mimics eccrine poroma (EP), seborrhea keratosis (SK), basal cell carcinoma (BCC), pyogenic granuloma (PG) and amelanotic melanoma with its clinical appearance as a pink nodule. Dermoscopy is an invaluable technique in diagnosing skin tumors. However, few cases of EPC have been reported using dermoscopic images, and their details were not well examined. Here, we present three histopathologically proven cases of EPC and summarize their dermoscopic findings together with five previously reported cases. None of the eight cases showed dermoscopic evidence indicative of SK (comedo-like openings, milia-like cysts, fissures and ridges, and hairpin vessels with white halo), BCC (blue-gray ovoid nests, multiple blue-gray globules, wheel-like structures, shiny white areas, leaf-like areas and arborizing vessels) or PG (reddish homogeneous area with collarette and white rail lines). A milky red area, which was suggestive of amelanotic melanoma, was not detectable in any cases. Seven cases exhibited a polymorphous vascular pattern mainly consisting of hairpin, linear-irregular and dotted vessels. A combination of round-to-oval pink-white structureless areas and white-to-pink halo was observed in five of eight cases, with one case showing the white-to-pink halo alone. Our investigation revealed that the dermoscopic characteristic of EP was also observed in discrete areas of EPC lesions. Thus, it is possible that the histopathological architecture of EPC contains portions of benign EP-like components. Awareness of this dermoscopic aspect of EPC may be helpful when diagnosing pink nodules.

Differential considerations of skin tumours with florid vascularisation: report of a solitary giant vascular eccrine spiradenoma.

The authors report the case of an 81-year-old male who presented with a 3-year-history of a bluish, nodular tumour located on the extensor side of his right forearm. Subjective symptoms included tenderness upon palpation and spontaneous haemorrhage. In order to exclude malignant neoplasms, for example, nodular melanoma, metastatic melanoma or angiosarcoma, the tumour was surgically removed and tissue submitted for microscopic examination. Histologically, the authors diagnosed this as giant vascular eccrine spiradenoma, a rare variant of eccrine spiradenoma, which can easily be mistaken for angiomatous lesions due to the haemorrhagic features and florid vascularisation. It is our aim to help clarify the diagnosis and differentiate giant vascular eccrine spiradenoma from other painful cutaneous tumours exhibiting a high degree of vascularisation, for example, angiosarcoma or venous thrombosis, as this case represents one of only seven found in published literature.

Multiple vascular eccrine spiradenomas: a case report and published work review of multiple eccrine spiradenomas.

Eccrine spiradenoma (ES) usually occurs as a solitary small nodule. It presents rarely as multifocal or multiple localized tumors arranged in a linear, zosteriform or nevoid distribution. We present a rare case of a 55-year-old woman who had a 48-year history of multiple vascular eccrine spiradenomas (VES) localized on the left side of the submandibular region and neck. All five tumors were skin-colored or pinkish-purple, and ranged in size 1.5-2.5 cm. Histologically, each tumor was composed of two characteristic cell types and many dilated vascular spaces were noted in the stroma. Contrast-enhanced computed tomography showed irregularly shaped, enhanced areas at the center of the tumors. A published work search revealed 35 cases of multiple ES, but multiple VES was extremely rare. We summarized the features of previously reported multiple ES and discuss the clinical and histological classification of ES.

Dermoscopic features of nonpigmented eccrine poromas in association with their histopathological features.

BACKGROUND: Nonpigmented eccrine poromas (EPs) occasionally mimic various skin tumours, but their dermoscopic features have not been clarified. OBJECTIVES: To evaluate the dermoscopic features of nonpigmented EPs in association with their histopathological features. METHODS: Retrospective analysis of the dermoscopic features of 10 histopathologically proven cases of nonpigmented EP at the Department of Dermatology, Shinshu University Hospital (Matsumoto, Japan). RESULTS: Specific features in vascular structures were observed in five of 10 nonpigmented EPs. Three cases showed a polymorphous vascular pattern: two cases of a combination of hairpin and dotted vessels, and one case of a combination of hairpin, dotted and linear-irregular vessels. In addition, there were two cases of monomorphous vascular pattern: one case of linear-irregular vessels, and one case of hairpin vessels. We did not observe arborizing, crown or comma vessels. Comedo-like openings, milia-like cysts, cerebriform pattern and ulceration were observed in one case each. Furthermore, nine of 10 cases showed the characteristic feature, described as well-circumscribed reddish globule/lacuna-like structures with separation of mesh bands, which were reminiscent of frog eggs aggregation. This characteristic feature on dermoscopy was explained by the histopathological features of horizontal sections at a depth of 300-400 µm from the surface. Island-shaped oedematous stroma with numerous microvessels, which were surrounded by poroid cells in mesh-like forms, were seen. CONCLUSIONS: Vascular structures and 'frog eggs-like appearance' are important features on dermoscopic examination of nonpigmented EP. Further studies are required to evaluate their diagnostic accuracy to differentiate nonpigmented EP from other tumours.

[Dermoscopic features of eccrine poroma]. / Características dermatoscópicas del poroma ecrino.

Eccrine poroma is a benign adnexal neoplasm that clinically may mimic malignant skin tumors such as squamous cell carcinoma and amelanotic melanoma. The dermoscopic features of pigmented and nonpigmented eccrine poroma have recently been described. We present 2 cases of eccrine poroma, with their dermoscopic features. The lesions were characterized by multiple red lacunes and a polymorphous vascular pattern in both cases. Dermoscopy can improve the clinical diagnosis of this benign adnexal skin tumor.

Características dermatoscópicas del poroma ecrino / Dermoscopic Features of Eccrine Poroma

El poroma ecrino (PE) es una neoplasia anexial benigna que puede simular clínicamente tumores cutáneos malignos como el carcinoma epidermoide o el melanoma amelanótico. Recientemente se han descrito las características dermatoscópicas del PE pigmentado y no pigmentado. Presentamos 2 casos de PE con sus características dermatoscópicas. Ambos casos se caracterizan por presentar múltiples lagunas rojas y un patrón vascular polimorfo. La dermatoscopia puede mejorar el diagnóstico clínico de estas tumoraciones anexiales benignas (AU)

Eccrine poroma is a benign adnexal neoplasm that clinically may mimic malignant skin tumors such as squamous cell carcinoma and amelanotic melanoma. The dermoscopic features of pigmented and nonpigmented eccrine poroma have recently been described. We present 2 cases of eccrine poroma, with their dermoscopic features. The lesions were characterized by multiple red lacunes and a polymorphous vascular pattern in both cases. Dermoscopy can improve the clinical diagnosis of this benign adnexal skin tumor (AU)

Giant vascular eccrine spiradenoma: report of a case with immunohistochemical study.

We report a rare case of giant vascular eccrine spiradenoma (GVES) which developed in 56-yr-old Korean woman. It is a rare variant of eccrine spiradenoma (ES), which might be mistaken for angiomatous lesions in view of its florid vascularity and hemorrhagic features. Histogenesis of GVES is not clearly elucidated although it is known that ES presumably originates in the eccrine glands. To clarify the histogenesis of GVES, immunohistochemical stainings using various monoclonal antibodies were also performed. The tumor was composed of three types of cells, namely pale epithelial cells, small basal cells, and myoepithelial cells. Therefore, we conclude that GVES originated from eccrine gland and mainly differentiates toward secretory portion of secretory coil.

Giant Vascular Eccrine Spiradenoma: Report of a Case with Immunohistochemical Study

We report a rare case of giant vascular eccrine spiradenoma (GVES) which developed in 56-yr-old Korean woman. It is a rare variant of eccrine spiradenoma (ES), which might be mistaken for angiomatous lesions in view of its florid vascularity and hemorrhagic features. Histogenesis of GVES is not clearly elucidated although it is known that ES presumably originates in the eccrine glands. To clarify the histogenesis of GVES, immunohistochemical stainings using various monoclonal antibodies were also performed. The tumor was composed of three types of cells, namely pale epithelial cells, small basal cells, and myoepithelial cells. Therefore, we conclude that GVES originated from eccrine gland and mainly differentiates toward secretory portion of secretory coil.

A unique case of eccrine porocarcinoma with pulmonary lymphangitis and pericardial involvement: biological characterization and clinical aggressiveness.

A unique case of eccrine porocarcinoma with pulmonary lymphangitis and pericardial involvement is reported. The clinical course was aggressive, leading to the death of the patient a few months after diagnosis. Certain pathologial markers of clinical aggressiveness were retrospectively investigated: p53 and Ki-67 expression were determined by means of immunohistochemistry. Angiogenesis was assessed by determination of intratumor microvessel density at the vascular 'hot spot' with the anti-CD34 monoclonal antibody and quantitative analysis using computerized image analyzer. Both primary tumor and metastatic lymph node presented immunostaining for p53 and Ki-67, with a higher degree of vascularization in the secondary lesions compared to the primary tumor. Our findings suggest a correlation between tumor vascularization and clinicopathological parameters of aggressiveness in malignant eccrine porocarcinoma. Taking into account the disappointing results of current treatments for metastatic eccrine porocarcinoma, the assay of microvessel density may be helpful in selecting the patients of high risk for recurrence or death who may benefit of anti-angiogenic therapies.

Giant vascular eccrine spiradenoma.

A 60-year-old man suffering from cardiac insufficiency consulted the Dermatology Department, Inönü University Turgut Ozal Medical Center, because of a bleeding tumor on his right hypochondrium. The tumor had begun as a small nodule approximately 5 years before, and had grown slowly with time. A small, superficial ulcer had appeared on the lesion approximately 6 months previously, and slight bleeding had occasionally occurred. The patient had no pain and no other complaint except bleeding. Dermatologic examination revealed a violaceous, ulcerated, and bleeding tumoral lesion below the mid-portion of the right costochondral line. The tumor was a non-tender, hemispheric mass, approximately 3-4 cm in size, adherent to the epidermis, but movable on the underlying tissue. An incisional biopsy was performed with diagnoses of dermatofibrosarcoma protuberans and desmoid tumor. Histopathologic examination revealed prominent blood-filled vascular spaces and clearly delimited cords, showing two types of cell. The vascular spaces contained a periodic acid-Schiff (PAS)-positive, granular, eosinophilic material. There was no malignant transformation. The lesion was totally excised and primarily sutured.

Perivascular spaces in eccrine spiradenoma. A clue to its histological diagnosis.

Perivascular spaces were found to represent a useful histological clue to the diagnosis of eccrine spiradenoma. They were observed in eight of nine eccrine spiradenomas but not in syringomas, nodular basal cell carcinomas, or glomangiomas. Perivascular spaces in spiradenomas consisted of variably sized spaces around one or more central blood vessels, bordered at the periphery by a palisade of tumor cells and lined at both sides by basement membrane collagen type IV. Perivascular spaces contained variable numbers of T lymphocytes in all cases and could undergo fibrosis, cystic dilatation, or hyalinization. In analogy to similar structures in thymomas, we suggest that perivascular spaces in spiradenomas are involved in the traffic of lymphocytes toward the tumor.

[Vascular eccrine giant spiradenoma--a case report with histology and immunohistology of a rare variant of benign sweat gland tumors]. / Vaskuläres ekkrines Riesen-Spiradenom--Fallbericht mit Histologie und Immunhistologie über eine seltene Variante gutartiger Schweissdrüsentumoren.

Giant vascular eccrine spiradenoma (GVES) is a rare variant of benign tumors of the sweat glands, which differs from common eccrine spiradenoma in both its size and vascularity. Clinically as well as macroscopically, this intradermal or subcutaneous encapsulated tumor might be mistaken for an angiomatous lesion or thrombosis. Histological examination reveals clearly delimited "cords" showing two types of cells, prominent blood-filled cavities and extensive hemorrhages. According to immunohistochemical findings, the epithelial cells contain cytokeratin, protein S-100 and carcino-embryonal antigen (CEA). Like the endothelial cells of vessels, some of the luminal epithelial cells also bind Ulex europaeus lectin; however, they do not show factor VIII-associated antigen.

Eccrine-pilar angiomatous nevus.

A clinical and histological study was made of a congenital lesion on the knee of a 3-year-old boy showing a peculiar combination of eccrine, pilar and angiomatous structures with the characteristics of organoid nevus. A discussion is made of different questions related to eccrine hamartomas with respect to the clinical picture, the association of other hamartomatous components, the alterations that these induce in other cutaneous structures and their histogenesis.

Giant vascular eccrine spiradenomas: a report of two cases with histology, immunohistology and electron microscopy.

Two examples of a variant of benign spiradenoma are reported, both characterized by their large size and high degree of vascularity. The results of studies using light microscopy, transmission electron microscopy and immunohistology are described. The relationship of this unusual variant to other spiradenomas and their eccrine sweat gland origin is discussed. The possible misdiagnosis of this rare type of spiradenoma is emphasized.

Ceruminous gland adenocarcinoma: a light and electron microscopic study.

Tumors of ceruminous gland origin in the external auditory canal are rare in man. A case is described in which such a tumor presented as an invasive vascular temporal bone neoplasm, mimicking a glomus jugulare tumor. Light and electron microscopic study of this tumor confirmed a diagnosis of ceruminous gland adenocarcinoma. Tumors of ceruminous gland origin appear to have a distinctive clinical behavior by virtue of their unique anatomical location in the external auditory canal. Our experience with this case establishes another clinical picture characterizing the histologic type of ceruminoma designated as a ceruminous gland adenocarcinoma. We feel that the generic term "ceruminoma," with its implied histologic subgroups, is useful to the clinician when he encounters a tumor arising from the modified sweat glands of the external auditory canal.