Background. Eccrine spiradenoma is a well-differentiated benign tumor of the sweat glands. Malignant change arising within eccrine spiradenoma is rare.

Objective. We describe a patient with malignant eccrine spiradenoma exhibiting both carcinomatous and sarcomatous differentiation.

Methods. Case report and literature review.

Results. A 37-year-old woman noted enlargement of a left axillary tumor that had been present for 20 years. The tumor was resected and the specimen, measuring 3.0 cm × 1.5 cm, revealed an encapsulated benign eccrine spiradenoma as well as an undifferentiated carcinoma possessing both carcinomatous and sarcomatous components. A transition zone was evident between the benign eccrine spiradenoma and the undifferentiated carcinoma, suggesting that the latter had arisen from the benign tumor. The malignant areas consisted principally of undifferentiated carcinoma (70%), although squamous cell carcinoma (10%), adenocarcinoma (10%), and chondrosarcomatous (10%) components were also present. Numerous mitotic figures were noted within the areas of malignant change, suggesting that the tumor was aggressive in nature. The patient died of systemic metastases 7 months after diagnosis.

Conclusion. Although eccrine spiradenomas are usually benign, they can, on rare occasions, undergo malignant transformation. This case report describes one such occurrence of malignant transformation of a benign eccrine spiradenoma that unfortunately resulted in the patient's death from systemic metastases 7 months after diagnosis.

Malignant eccrine spiradenoma : A case report and review of the literature

An 88-year-old Caucasian man presented to the dermatology clinic at the Palo Alto Veterans Association hospital with a 3month history of a left forehead growth. The patient reported that the lesion grew over the course of 1 week and then remained stable in size. He denied any associated pain, previous trauma to that site, or preexisting lesions of the forehead (confirmed by family members and recent photography). Upon minimal contact, the lesion bled profusely.

De novo malignant eccrine spiradenoma: a case report and review of the literature.

This chapter on cutaneous appendageal tumours covers the spectrum of lesions displaying eccrine, apocrine, sebaceous and follicular differentiation. It includes cysts, hamartomas and benign and malignant tumours. Traditionally, appendageal tumours have been classified according to rigid criteria separating lesions with eccrine, apocrine, sebaceous and follicular differentiation. This separation is clearly artificial and it is now acknowledged that lesions regarded as strictly eccrine may well have apocrine differentiation and lesions classified as purely follicular may exhibit apocrine differentiation reflecting the close embryological relationship between the pilosebaceous unit and the apocrine gland.


Keywords:

hamartoma;
appendageal tumours;
sweat gland tumours;
follicular tumours;
adnexal tumours;
sebaceous tumours;
adnexal neoplasms

Tumours of Skin Appendages

Tumors of the sweat glands

Eccrine spiradenoma is a benign adnexal neoplasm that has been historically designated as a tumor of eccrine differentiation, although current reconsideration indicates an apocrine process. It usually presents on the trunk and extremities as a tender dermal or subcutaneous papule or nodule frequently with a pink or blue hue. The clinical picture is often not distinct and biopsy is required for diagnosis. Eccrine spiradenoma can present in a variety of ways, including as tumors arranged in zosteriform/dermatomal and/or blaschkoid distributions, often precluding a straightforward diagnosis. Proper diagnosis of eccrine spiradenoma is important due to the occurrence of potentially life-threatening malignant transformation. This article illustrates a rare presentation of eccrine spiradenoma with a concise review for the dermatologist.

A Rare Case of Multiple Segmental Eccrine Spiradenomas

A 9-year-old boy presented with asymptomatic papulonodular lesions on the left half of the chin of 3-years duration. On examination he had small papular lesions on the left chin varying in size from 1 to 5 mm. An additional lesion on the margin of the lip was 14 mm in diameter. The overlying skin was normal. Lesions were firm, nontender, and fixed to the skin. Histopathologic examination of the biopsy specimen revealed characteristic features of eccrine spiradenoma. A literature search produced reports of 10 cases of linear/zosteriform spiradenoma. Of these, five were in children or adolescents. We report this patient because of the rare occurrence of this presentation.

Multiple eccrine spiradenomas in zosteriform distribution in a child.

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Multiple eccrine spiradenomas in zosteriform distribution in a child.