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OJHAS Vol. 10, Issue 3:
(Jul-Sep 2011) |
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| Chondroid
Syringoma and Eccrine Spiradenoma |
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Kirana Pailoor, Jayaprakash CS, Ramesh Naik CN, Nisha J. Marla, Hilda Fernandes, Muktha R Pai,
Raphel Hart Lyngdoh,
Department of Pathology, Father Muller Medical College, Mangalore, India. |
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Address for Correspondence |
Assistant
Professor,
Department of Pathology,
Father Muller Medical College,
Mangalore-575002,
Karnataka, India.
E-mail:
dockirana@yahoo.co.uk |
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Pailoor K, Jayaprakash CS, Naik RCN, Marla NJ, Fernandes H,
Pai MR, Lyngdoh RH. Chondroid
Syringoma and Eccrine Spiradenoma. Online J Health Allied Scs.
2011;10(3):10 |
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Submitted: Jul 17,
2011; Accepted: Oct 12, 2011; Published: Nov 15, 2011 |
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| Abstract: |
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Background: Fine needle
aspiration cytology (FNAC) is a well established diagnostic tool. However,
most clinicians prefer to diagnose suspected skin tumors by excisional
biopsy as they are easily accessible and hence benign skin adnexal tumors
are rarely encountered on FNAC. There are only a very few case reports
describing the fine needle aspiration cytologic features of chondroid
syringoma and eccrine spiradenoma for diagnosis. Cases: First case was a 20 year old female who presented with firm,non-tender
swelling in the left little finger measuring 1 cm in diameter. Smears
showed clusters of round to plasmacytoid cells with moderate to abundant
cytoplasm embedded in a chondromyxoid ground substance . Hence, a diagnosis
of chondroid syringoma was made.
Another case was a 40 year old lady who presented with a painful
swelling on the anterior chest wall measuring approximately 0.8 cms
in diameter. Smears were moderately cellular with cohesive sheets and
clusters of bland cells of three different cell types. Hence, a probable
diagnosis of eccrine spiradenoma was made and both the cases were confirmed
histologically. Conclusion: Appropriate
knowledge of the cytologic features of chondroid syringoma and eccrine
spiradenoma helps in providing a definitive diagnosis and correct management
of the patient.
Key Words:
Chondroid syringoma; Eccrine spiradenoma; Cytology
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Tumors of the
epidermal appendages are classified according to their differentiation
towards hair follicle, sebaceous glands, apocrine glands and eccrine
glands.1,2 They are further divided into different groups
based on the degree of differentiation. We report here two cases, both
tumors of eccrine gland differentiation. In both the cases, the diagnosis
was made initially on fine needle aspiration cytology and confirmed
subsequently by histology.
Chondroid syringoma
is a rare benign skin adnexal tumor of eccrine/ apocrine origin, affecting
commonly the head and neck region although it may occur occasionally
in other parts of the body. Considering that the malignant form of this
tumor has been reported predominantly in the extremities, this tumor
must be kept in mind among masses occurring in the fingers. Eccrine
spiradenoma is also an uncommon benign cutaneous adnexal tumor arising
in eccrine sweat glands that was first described by Sutton in 1934 and
extensively described by Kersting et al in 1956.2,3 Although histologic features of this tumor have been well characterized,
the cytologic features on FNAC have been described only twice before.
Hence, here we report a case of eccrine spiradenoma occurring in the
anterior chest wall.
Fine needle
aspiration cytology (FNAC) was performed using 23 G needle with a 5
ml disposable plastic syringe. The wet smears were fixed in 95% alcohol
and processed for Papanicolaou stain. The air dried smears were subjected
for May-Grunwald-Giemsa stain. Following excision of the lesion, the
tissue was processed routinely and Hematoxylin-Eosin stained sections
were studied.
Chondroid
syringoma:
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A 20 year old
female presented to surgical out patient department with one year history
of a painless, progressively enlarging swelling in the region
of middle phalanx of little finger. On examination, it was firm, non
tender and measured approximately 1 cm in diameter. Overlying skin was
normal and the swelling was fixed to the skin and freely mobile over
the underlying structure. X-ray showed a homogenous soft tissue opacity.
Underlying bone was unremarkable. A clinical differential diagnosis
of dermoid cyst/ganglion was made and the case was subjected to FNAC.
Thick mucoid material was aspirated.
Cytomorphology: The smears
on microscopy showed clusters of round to plasmacytoid cells with moderate
to abundant cytoplasm embedded in a chondromyxoid ground substance.
The nuclei were monomorphic, centrally to eccentrically located and
had fine chromatin [Figure 1]. The combination of mesenchymal and epithelial
elements suggested a diagnosis of chondroid syringoma. The lesion was
excised and subjected to histopathological examination.
Histology:
The sections showed an encapsulated tumor with large areas of cartilaginous
differentiation along with a few small, ductular structures lined by
two layers of cells, luminal cuboidal and peripheral flattened, confirming
the diagnosis of chondroid syringoma. There was no evidence of extension
of the tumor beyond the capsule.
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Figure 1:
Cytomorphology suggesting chondroid syringoma.
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| Eccrine
spiradenoma: |
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A 40 year old
female presented with a firm, tender swelling located in the anterior
chest wall. It measured approximately 0.8cm in diameter. The clinician
thought it would be a neurofibroma and she was sent for FNAC of the
nodule. Aspiration yielded blood-tinged mucoid material.
Cytomorphology:
The smears were moderately cellular and contained cohesive sheets and
clusters of bland cells of variable size. These cells were also present
singly in the background along with smaller lymphocyte-like cells, granular proteineceous material and numerous red
cells. Three main cell types were
recognized: large epithelial cells which were occasionally seen. The
other two cell types such as intermediate sized myoepithelial cells
which had small round to oval nuclei with regular contours and scant
cytoplasm and the small lymphocytelike cells with round dark nuclei
and scant cytoplasm predominated the smears. Some of the cells were
arranged around a central globule of amorphous material [Figure 2].
Histology:
The resected mass was 0.7cm well circumscribed, round, subcutaneous
nodule surrounded by a thin fibrous capsule. It was composed of closely
packed cells arranged in sheets, cords and trabeculae along branching,
hyalinised stromal matrix. In some areas, a pseudorosette pattern was
formed by cells surrounding irregular, rounded globules of this stroma.
There were three main cell types within the tumor. The largest cells,
which were epithelial, were arranged as cords and trabeculae lining
hyalinised stromal matrix and small, duct-like lumina. A second, intermediate
cell type were arranged around hyalinised stroma, forming a pseudorosette appearance.
These cells were seen in the more sclerotic, peripheral regions of the
nodule. The third cell type which was lymphocyte-like in appearance,
was scattered diffusely throughout the mass.
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Figure 2 |
Chondroid
syringoma
Chondroid syringoma
is a rare benign skin adnexal tumor of eccrine/apocrine origin affecting
commonly the head and neck region.4,5 The term introduced
by Hirsch and Helwig in 1961, has now been widely accepted to replace
the older term mixed tumor of the skin.1,6,7 It is thought
to originate from both secretory and ductal segments of the sweat glands
and both eccrine and apocrine variants have been described. It usually
affects middle aged or older age male patients. In our case, chondroid
syringoma was diagnosed in a 20 year old female. Clinically, it presents
as a slow growing, painless, firm, subcutaneous or intra-cutaneous nodule.
The lesion measures 0.5 3cm in diameter. The sites of predilection
are on the head and neck region, particularly, cheek, nose or lip. But,
it can also rarely develop on the scalp, eyelid, orbit, auditory canal,
hand, foot, forehead, axillary region, abdomen, penis, vulva and scrotum.8,9
Fine needle
aspirate yields thick, mucoid and gelatinous material as in this case. Microscopically, there are two distinct components, an epithelial and
a mesenchymal, which easily render the diagnosis. The epitheial
cells are in flat monolayered sheets or as single cells. The nuclei
are monomorphic with finely dispersed nuclear chromatin. Some
of the nuclei are eccentrically placed like plasmacytoid cells. They have moderate amount of dense cytoplasm with well defined cell
borders. These cells are seen against a background of fibrillary
chondromyxoid substance. Immunohistochemical markers such as
epithelial membrane antigen, which is used as an epithelial marker
and Vimentin, S-100 protein, Neuron specific enolase are used to demonstrate
the myoepithelial component. The differential diagnosis includes basal
cell carcinoma with stromal hyalinization and malignant mixed tumor
of the skin. If the mesenchymal component predominates, the possibility of a soft tissue tumor can be
considered.
If the cellular
component predominates, the differential diagnosis includes carcinomas
with a myxoid component, myoepithelial tumors due to the plasmacytoid
appearance of the cells and spindle cell tumors.1,2,410
Eccrine
spiradenoma
Eccrine spiradenoma
is an uncommon benign cutaneous adnexal tumor arising in eccrine sweat
glands that was first described by Sutton in 1934 and extensively described
by Kersting et al in 1956. Head and neck is a common location
but it may also occur on the trunk, extremities and in various other
sites. It usually occurs in young adults. The lesion is
mostly solitary and is one among the painful tumors of the skin.3,5,10
Fine needle
aspirate yields a mucoid, yellow material. Cytologically, three
main cell types are identified large epithelial cells, intermediate
sized myoepithelial cells and small lymphocyte like cells. Some
of the cells are arranged in a cribriform pattern with rosette like
structures and cell balls or acini surrounding cores of amorphous
matter. Identification of the three cell types in this tumor is
of paramount importance to differentiate it from adenoid cystic carcinoma
which is composed of single, monotonous cell type. Immunohistochemically,
epithelial cells show positivity for keratin; myoepithelial cells are
weakly positive for keratin and small lymphocyte like cells are positive
for CD3.2,3,5,1013
There was a
good cytohistologic correlation in both the cases. Cutaneous adnexal
tumors are rarely encountered on FNA. Hence, knowing the cytologic
features of primary skin neoplasms helps distinguish them from tumors
metastatic to the skin. Cytologic features, along with a detailed
clinical history and physical findings are essential to make an exact
diagnosis of skin tumors for appropriate management of the patient.
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JD, Seykora JT. Tumors of the epidermal appendages. In
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TT, Schwartz MR. Eccrine spiradenoma mimicking adenoid cystic carcinoma
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syringoma diagnosed by Fine needle aspiration cytology. Diagnostic Cytopathol
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MF. Cytology of soft tissue, bone and skin. In: Comprehensive Cytopathology.
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NM. Fine Needle Aspiration Cytology of Chondroid Syringoma Report
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LH, Thappa DM, Smile R. Diagnosis of Chondroid Syringoma by Fine Needle
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P. Cytologic features of Chondroid Syringoma in Fine Needle Aspiration
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S, Glick T. Chondroid syringoma diagnosed by fine needle aspiration:
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Dey P, Das A, Srinivasan
R, Nijhawan R. Cytology of Primary Skin Tumors. Acta Cytol 1996;40:708-713.
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Janaki VR, Sentamilselvi G, Kiruba Mohan. Eccrine spiradenoma. Indian
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Galanopoulou A, Statiropoulou P, Papapetrou S, Pandazis I, Markidou
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