Metaplastic spiradenocarcinoma: Report of two cases with sarcomatous differentiation.

Spiradenocarcinoma (SC) is a very rare malignant skin adnexal tumor with sweat gland differentiation that develops from a pre-existing spiradenoma, cylindroma, or hybrid tumor called spiradenocylindroma, or arises de novo. We present two exceptionally rare SC cases showing sarcomatous differentiation; we also discuss the clinicopathologic features of SC, as well as its differential diagnoses and available therapeutic modalities. Given the aggressive behavior of SC, rapid diagnosis and complete removal of the tumor with tumor-free margins is mandatory. Owing to the marked morphological heterogeneity of individual SC cases, dermatopathologists must be familiar with the different possible histopathologic manifestations of this neoplasm.

Nodular hidradenoma arising on the site of a BCG scar.

Hidradenomas are tumours that arise from the adnexal structures, both eccrine and apocrine and are histologically benign. The tumours that arise from eccrine differentiation are known as poroid hidradenomas and when they arise from the apocrine glands they are called nodular hidradenomas. In our centre a 13-year-old boy presented with a slow-growing, painless erythematous fungating nodule on the left upper arm over a period of 18 months at the site of the BCG vaccination. The nodule was surgically excised and sent for histopathological examination, leading to a diagnosis of nodular hidradenoma. This case is presented to highlight its rarity, together with its clinical features that were suggestive of malignancy but proved ultimately to be benign.

A chronic, bleeding, and painful nodule on the chest.

An 81-year-old man presented to the dermatology clinic with a painful lesion on his chest. The nodule would occasionally bleed and leak serous fluid for 10 years. Physical examination revealed an unspecified nodule with two superimposed nodules. A deep shave biopsy of the lesion was obtained and expressed a solid-cystic dermal neoplasm that was comprised of an admixture of cell types. Through the presenting clinical and histological features seen, a final diagnosis of nodular hidradenoma was made.

A periclitoral mass as a cause of persistent genital arousal disorder.

INTRODUCTION: Persistent genital arousal disorder (PGAD) is an intrusive and unremitting disorder for which several possible etiologies and treatments have been suggested. AIM: To describe a woman who developed PGAD in association with a periclitoral mass, a potential physical cause of the disorder that has not been previously described in the medical literature. METHODS: A postmenopausal woman presented with 6 months of persistent, unrelenting genital arousal and clitoral pain that was unrelated to sexual stimuli. Careful examination revealed a tender, firm, mobile, left-sided mass that appeared to compress the dorsal nerve of the clitoris. RESULTS: Complete excision of the mass resulted in full resolution of her symptoms over several weeks. CONCLUSION: Localized causes of persistent genital arousal, though rare, should be included in the differential diagnosis PGAD as detection and treatment can lead to a complete recovery.

The squamous variant of eccrine porocarcinoma: a clinicopathological study of 21 cases.

AIM: Squamous differentiation in eccrine porocarcinoma (EPC) is an unusual phenomenon that has rarely been reported in the literature. This study describes the clinical and pathological findings in a series of 21 cases of EPC showing extensive squamous differentiation. METHODS: The H&E-stained sections, epithelial membrane antigen and carcinoembryonic antigen immunohistochemical stains were reviewed for each case. The following variables were examined: age, gender, race, site and size of the EPC. The prevalence of other cutaneous lesions and/or underlying systemic disease was also documented. RESULTS: There was an almost equal gender distribution. Mean age was 61.5 years and the average tumour size was 46.5 mm. An inordinately large number (10/21, 48%) of EPCs occurred in black patients. The tumours were located at various sites with the extremities predominating (10/19, 53%). Seven patients developed other sun-induced skin tumours, three patients were renal transplant recipients, and two patients were HIV-positive, one of whom also suffered from albinism. Six of the 11 patients in whom follow-up was available had an adverse outcome: local recurrence developed in one patient, one patient developed nodal metastases, and one patient experienced both local recurrence and nodal metastases, and of the three patients who died of disease, two developed distant metastases. CONCLUSION: The findings suggest a possible role for ultraviolet radiation and chronic immunosuppression in the induction of malignant squamous differentiation in a subset of EPCs. Further reports on this histological variant of EPC are required to determine whether a pathogenetic link does indeed exist or whether these tumours simply represent a unique variant of squamous cell carcinoma with divergent acrosyringial differentiation.

Malignant eccrine hidradenoma of neck causing acute heart failure.

Tumours of eccrine sweat glands are uncommon, with complex classification and different terms used even for the same tumour. Therefore, for practical purposes, it may be sufficient to differentiate between benign and malignant. Malignant eccrine hidradenoma has a predilection for head and neck, with high incidence of recurrence following surgical excision and also regional and distant metastases. We describe a case, which presented as a medical emergency with symptoms of severe anaemia and acute heart failure secondary to intermittent bleeding from a huge ulcerative neck lesion, which was subsequently diagnosed as eccrine hidradenocarcinoma. The tumour was successfully treated with complete surgical excision and reconstruction followed by radiotherapy. Two years postoperatively, the patient is very well with no sign of recurrence.

Trichoblastoma arising within an apocrine poroma.

A poroma is a benign neoplasm composed of poroid and cuticular cells and is thought to derive from the eccrine duct. Several recent reports have described cases with sebaceous, follicular, and apocrine differentiation, suggesting a possible apocrine origin, however. Trichoblastoma is a rare benign tumor composed of germinative cells related to the folliculosebaceous-apocrine unit. We report a unique case of a trichoblastoma arising within a poroma with apocrine and sebaceous differentiation. To our knowledge, this exceptional association has not been described previously and may support the theory of the apocrine origin of poromas.

[A woman with an advanced malignant clear cell hidradenoma]. / Een vrouw met een voortgeschreden maligne 'clear cell'-hidradenoma.

A 67-year-old patient was admitted for diabetes mellitus. Incidentally a large ulcerating tumour was found on the right upper leg. The patient had been suffering from the lesion for six years but had never dared to show it to her physician. Notwithstanding negative outcome of thin needle aspiration oncological dissection was carried out. Histopathological examination proved the tumour to be a malignant clear cell hidradenoma, which is a rare eccrine tumour. This tumour is known to be aggressive and easily spreads to locoregional lymph nodes. Even though it is a rare disease, the aggressive behaviour and the poor prognosis warrant alertness to this neoplasm.