bromochloroacetic-acid and Syringoma

Milium-like syringoma is a variant of syringoma first described in 1987. Only few cases have been reported in the literature. It may be misleading clinically, and its histogenesis has not been clarified.. We present a case of periorbital milium-like syringoma, with studies on the histopathologic, histochemical, and immunohistochemical features.. Histology showed a large keratin-filled cyst in the upper portion of the lesion approximating the epidermis. Serial sections revealed that the cyst connected with the underlying syringomatous epithelial strands. Melanin was absent in the wall of the cyst, as demonstrated by Fontana-Masson stain. Cytokeratin 7 was expressed neither in the milia nor in the solid epithelial parts. Carcinoembryonic antigen (CEA) reactivity was seen in the luminal cells of the keratinous cysts. However, in the largest keratin-filled cyst clinically suggesting a milium, only the lower half of the cyst was positive for CEA. These results proved that the milia were part of syringoma with eccrine duct differentiation. Fusion of the upper half of the largest cyst with the epidermis may explain the absence of CEA positivity in this part, analogous with eccrine duct milia. Review of the literature indicated that this variant of syringoma occurs more often in Asians.. We present evidence, and propose the histogenesis of milium-like syringoma, that it is a variant of syringoma with a prominent cystic component showing features of eccrine duct milia. Recognition of its nature is of therapeutic significance. Further studies are required to verify its clinical characteristics as compared with ordinary syringomas.

Topics: Adult; Biomarkers, Tumor; Cysts; Female; Humans; Keratins; Laser Therapy; Sweat Gland Neoplasms; Syringoma; Treatment Outcome

We report the first case, to our knowledge, of syringocystadenocarcinoma papilliferum with p63-verified squamous differentiation and extensive dermal invasion accompanying in situ components. An 86-year-old woman presented with a neoplasm on the neck, and the intralesional heterogeneity typical of these neoplasms led to an initial diagnosis on needle biopsy favoring squamous cell carcinoma. Excision illustrated diverse morphology, raising a broad differential diagnosis, including more common extracutaneous malignancies, such as breast, gastrointestinal, and ovarian primary tumors. Fortuitous sectioning revealed a focal connection to the skin surface with evidence of apocrine differentiation allowing final diagnosis as syringocystadenocarcinoma papilliferum. Our literature review shows the histologic and immunohistochemical features of syringocystadenocarcinoma papilliferum are not well defined outside of their clear morphologic overlap with syringocystadenoma papilliferum. We describe our findings and diagnostic pitfalls to help pathologists encountering this unusual apocrine neoplasm.

Topics: Aged, 80 and over; Biomarkers, Tumor; Carcinoma, Squamous Cell; Cell Nucleus; Cystadenocarcinoma, Papillary; Diagnosis, Differential; Female; Humans; Keratins; Membrane Proteins; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Sweat Gland Neoplasms; Syringoma

Topics: Actins; Aged; Biomarkers, Tumor; Breast Neoplasms; Carcinoma; Carcinosarcoma; Diagnosis, Differential; ErbB Receptors; Female; Hemangiosarcoma; Humans; Keratins; Membrane Proteins; Metaplasia; Neoplasm Proteins; Phyllodes Tumor; Stromal Cells; Syringoma

The purpose of our study was to describe clinical and histopathological features of sixty one patients with histological diagnosis of syringoma over four year period in our dermatology clinic in Korea. Female:male ratio was 6.6:1 with onset of age during 2nd and 3rd decades in more than half of the patients in our study. The most frequently involved site was eyelids (43 cases, 70.5%) and the most common color of lesion was skin-color (30 cases, 49.2%). In 34 cases, characteristic tad-pole appearances (55.7%) were observed. Basal hyperpigmentation was observed more frequently in brown-colored lesion (p=0.005). Fibrosis was observed more frequently in erythematous lesion (p=0.033). Keratin cyst was observed less frequently in genital involved group (p=0.006). We also performed immunohistochemical stain for the presence of progesterone receptor (PR) and estrogen receptor (ER) in fifty six cases with negative results.

Topics: Adolescent; Adult; Aged; Child; Eyelids; Female; Fibrosis; Humans; Hyperpigmentation; Immunohistochemistry; Keratins; Korea; Male; Middle Aged; Receptors, Estrogen; Receptors, Progesterone; Sweat Gland Neoplasms; Syringoma; Treatment Outcome

Syringomatous carcinoma (SC) has typically been observed in middle-aged and older patients. We report a case of SC mimicking an epidermoid cyst in a 23-year-old Asian man. Histopathologic examination results showed a dermal neoplasm consisting of nests of basaloid cells, focal areas of ductal differentiation, moderate dermal fibrosis, and moderate nuclear atypia consistent with a diagnosis of SC. No perineural involvement was noted. Results of 2005. immunohistochemical analysis revealed positivity for high- and low-molecular-weight cytokeratins, as well as for carcinoembryonic antigen (CEA). There was scattered immunoreactivity to S-100 protein. The tumor was completely excised Pennsylvania. using Mohs micrographic surgery (MS). This case demonstrates the importance of differentiating SC from other benign or malignant entities, the value of a prompt diagnosis of SC, and the effective treatment of SC with MMS.

Topics: Adult; Biomarkers, Tumor; Carcinoembryonic Antigen; Diagnosis, Differential; Epidermal Cyst; Humans; Immunohistochemistry; Keratins; Male; Mohs Surgery; Sweat Gland Neoplasms; Syringoma

Topics: Adenoma, Sweat Gland; Aged, 80 and over; Carcinoma in Situ; Cystadenocarcinoma, Papillary; Epidermis; Female; Humans; Keratin-7; Keratins; Paget Disease, Extramammary; Sweat Gland Neoplasms; Syringoma

While squamous cell carcinoma and pseudocarcinomatous hyperplasia have been documented as pre-existing lesions in cases of reactive eccrine syringofibroadenoma (ESFA), to the best of our knowledge carcinoma occurring in a solitary ESFA has not yet been reported. We present one such case in a 91-year-old female who had a dome-shaped, reddish tumor on the extensor side of the left forearm.. We review the histopathological, immunophenotypical and ultrastructural findings of this tumor, including the keratin expression profile.. Histopathologically, long, branching, anastomosing, thin and thick strands of small cuboidal epithelial cells were extending from the surface epidermis into the dermis. In the center of the tumor, there were irregular-shaped nests of atypical tumor cells invading downward into the dermis. Ultrastructurally, duct-like lumina lined with cuboidal tumor cells were present in the epithelial cords. From these findings, the present case was diagnosed as solitary eccrine syringofibroadenocarcinoma (ESFAC). Keratin expression studies revealed that cells of the thick strands, except for the luminal and basal cells, were positive for differentiation-specific keratins, keratins 1 and 10, and that cells of the thin strands were positive for keratins 5 and 14.. Histopathological, immunophenotypical and ultrastructural evidence, as well as the pattern of keratin expression, suggest differentiation of the present malignant tumor towards the eccrine dermal duct. This case is the first reported case of ESFAC as far as we know.

Topics: Aged; Aged, 80 and over; Biomarkers, Tumor; Carcinoma; Cell Transformation, Neoplastic; Eccrine Glands; Female; Fibroadenoma; Humans; Immunohistochemistry; Keratins; Sweat Gland Neoplasms; Syringoma; Treatment Outcome

Topics: Adult; Breast Neoplasms; Carcinoembryonic Antigen; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Keratins; Nipples; Pain; Sweat Gland Neoplasms; Syringoma

Eccrine syringofibroadenoma (ESFA) is a rare disorder which shows differentiation toward the eccrine sweat apparatus. There is a controversy concerning the pathogenesis and precise differentiation of this tumor. We report a case of ESFA and its differentiation pattern by an analysis of cytokeratin expression. Using paraffin-embedded materials, histopathological and immunohistochemical studies were performed. Staining patterns of the luminal, peripheral, and inner cells of the tumor strands closely matched or mimicked those of the luminal, outer and intermediate cells of the normal eccrine dermal duct, respectively. The case of ESFA reported revealed a pattern of differentiation suggestive of an eccrine duct origin.

Topics: Adenoma, Sweat Gland; Aged; Aged, 80 and over; Eccrine Glands; Fibroadenoma; Humans; Immunohistochemistry; Keratins; Male; Skin Neoplasms; Sweat Gland Neoplasms; Syringoma

Sclerosing sweat-duct carcinoma or malignant syringoma is a rare eyelid tumor. The authors report the first patient with sclerosing sweat-duct carcinoma involving the upper eyelid and present its immunohistochemical and ultrastructural features. The clinical features and the histopathologic and ultrastructural findings that distinguish this tumor from its benign counterparts are discussed. Sclerosing sweat-duct carcinomas are slow growing but locally invasive neoplasms that have a propensity to recur. Wide and deep surgical excision with frozen section evaluation of margins is recommended.

Topics: Biomarkers, Tumor; Biopsy; Carcinoembryonic Antigen; Eyelid Neoplasms; Eyelids; Humans; Immunoenzyme Techniques; Keratins; Male; Middle Aged; Mucin-1; Sweat Gland Neoplasms; Sweat Glands; Syringoma

Immunophenotypes, especially expression of cytokeratins, in 9 cases of clear cell syringoma were examined using antibodies against epithelial membrane antigen (EMA), and 17 kinds of monoclonal anti-keratin antibodies to investigate its histogenesis. In addition, 7 cases of conventional syringoma were selected for parallel assessment. Conventional syringoma expressed CK1 and CK10, which exists in the acrosyringium and the transitional portion between the acrosyringium and the dermal duct. Based on immunostaining with RCK102 and 35 beta H11, syringoma was thought to express CK5. Because expression of CK5 was observed in the basal cells of sweat duct ridge (lower acrosyringium) and the outer cells of the dermal duct, but not in the acrosyringium located at upper epidermis, we speculated that syringoma differentiated toward the transitional portion between the acrosyringium and the dermal duct. A comparative study of keratin expression between conventional and clear cell syringoma showed that there was no difference in the immunoreactivities. Based on the above observations, we confirmed that clear cell syringoma is a metabolic variant of conventional syringoma, and differentiates into the transitional portion between the acrosyringium and the dermal duct.

Topics: Adolescent; Adult; Eccrine Glands; Female; Humans; Immunohistochemistry; Keratins; Male; Middle Aged; Mucin-1; Retrospective Studies; Sweat Gland Neoplasms; Syringoma

We report a case of syringoid eccrine carcinoma, a rare syringomatous tumor of the skin, occurring in a 70-year-old woman. Histological and immunohistochemical criteria are given to differentiate this neoplasm from other primary carcinomas of the skin as well as from skin metastases of internal malignancies.

Topics: Aged; Apolipoproteins; Apolipoproteins D; Biomarkers, Tumor; Carcinoembryonic Antigen; Carcinoma; Carrier Proteins; Cell Nucleus; Chromatin; Coloring Agents; Cytoplasm; Eccrine Glands; Female; Glycoproteins; Humans; Immunoenzyme Techniques; Keratins; Membrane Transport Proteins; Neoplasm Proteins; Periodic Acid-Schiff Reaction; S100 Proteins; Skin Neoplasms; Sweat Gland Neoplasms; Syringoma; Vimentin

We report a case of syringoma clinically presenting as milia in the perianal region. Milium-like syringoma is an unusual clinical variant of the tumor, and this is, to our knowledge, the first reported case occurring perianally.

Topics: Adult; Anus Neoplasms; Cytoplasm; Diagnosis, Differential; Epidermal Cyst; Epithelium; Female; Humans; Keratins; Skin Diseases; Sweat Gland Neoplasms; Syringoma

Applying immunohistochemical procedures for the detection of eight different cytokeratin (CK) polypeptides and other differentiation markers, we compared the staining patterns of normal cutaneous structures with those of benign adnexal tumors (n = 65). Syringomas exhibited a marker pattern highly reminiscent of that seen in normal dermal eccrine ducts (EMA in peripheral cells, CK 10 in intermediate cells, and CK 6, CK 19, and CEA in luminal cells). Nodular hidradenomas exhibited complex patterns suggesting relationship between tumor cells, including clear cells, and normal secretory coil cells (CK 7, CK 8, CK 19, and EMA); however, dermal-duct and epidermoid differentiation were also detectable. In both cylindromas and spiradenomas, zonal staining patterns were apparent: modified myoepithelial cells were positive for smooth-muscle-type actin, while the luminal cells mainly expressed ductal markers (CK 6 and CK 19) and, less prominently, secretory-coil markers including CK 7. Eccrine poromas exhibited a widespread reaction for CK 5/6 and EMA, analogous to peripheral dermal duct cells, but focal maturation toward inner-ductal and secretory-coil cells was also demonstrable. The staining pattern observed in trichoepitheliomas resembled that of the outer but not the inner root sheath. In conclusion, the detailed marker profiles obtained in the present study have broadened our understanding of the differentiation and nature of these highly singular tumor types.

Topics: Adenoma; Adenoma, Sweat Gland; Antibodies, Monoclonal; Binding, Competitive; Biomarkers, Tumor; Carcinoma, Adenoid Cystic; Cell Differentiation; Epidermal Cells; Epidermis; Humans; Immunohistochemistry; Keratins; Neoplasms, Basal Cell; Reference Values; Skin Neoplasms; Sweat Glands; Syringoma

The luminal cell layer of acrosyringia contains heterogeneous globular keratohyalin granules, some of which contain basophilic and eosinophilic components. Using immunoelectron microscopy we found that the majority of the granules, which are basophilic, are strongly reactive to an anti-filaggrin antibody, while the minority, which are eosinophilic, are not. Similar heterogeneous keratohyalin granules were observed in syringomas and in an eccrine syringofibroadenoma. Since such granules are not normally observed in other human cutaneous epithelia, it is suggested that these composite keratohyalin granules with partial filaggrin immunoreactivity might serve as a useful marker for acrosyringial differentiation in both normal and pathological material.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Cytoplasmic Granules; Eccrine Glands; Epidermis; Extremities; Female; Fibroadenoma; Filaggrin Proteins; Humans; Hyalin; Immunohistochemistry; Intermediate Filament Proteins; Keratins; Male; Microscopy, Electron; Microscopy, Immunoelectron; Middle Aged; Skin Diseases; Sweat Gland Neoplasms; Syringoma

Thirty-one dermal appendage tumors of sweat gland differentiation including 7 spiradenomas (SPA), 8 cylindromas (CYL), 8 acrospiromas (ACS), and 8 chondroid syringomas (CS) were analyzed using antibodies to epithelial membrane antigen (EMA), cytokeratin (AE1, AE3, CAM 5.2, 34BE12), S-100 protein, actin (ACT), and desmin (DES) to characterize the immunocytochemical profile of benign sweat gland tumors. Cytokeratin expression was variable; AE1, 34BE12, AE3, and CAM 5.2 were present in 31, 24, 23, and 22 tumors respectively; 29 tumors contained EMA. Seventeen tumors, (6 SPA, 8 CYL, 2 ACS, 1 CS) stained with antibody to alpha smooth muscle actin, and 26 (7 SPA, 7 CYL, 4 ACS, 8 CS) expressed S-100 protein. Although some prior studies had reported actin filaments on electron microscopy in both spiradenoma and cylindroma, these tumors have previously been considered to be negative for myoepithelial differentiation. All spiradenomas and cylindromas we studied demonstrated actin and/or S-100 protein positivity in basal epithelial cells, consistent with myoepithelial differentiation. The organization of actin and S-100 protein positivity displayed by the spiradenomas and cylindromas we studied suggests that the tumors are differentiated towards the secretory portion of the eccrine sweat gland.

Topics: Acrospiroma; Actins; Adenoma, Sweat Gland; Cell Transformation, Neoplastic; Desmin; Epithelium; Humans; Immune Sera; Immunohistochemistry; Keratins; Membrane Glycoproteins; Mucin-1; S100 Proteins; Sweat Gland Neoplasms; Syringoma