Difference between revisions of "Eccrine spiradenoma"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Eccrine_spiradenoma_-_very_low_mag.jpg
| Width      =
| Caption    = Eccrine spiradenoma. [[H&E stain]].
| Synonyms  = spiradenoma
| Micro      = dense nests of cells in the dermis ("dermal blue balls"), mixed cell population (epithelial, myoepithelial, +/-lymphocytes)
| Subtypes  =
| LMDDx      = [[dermal cylindroma]], [[trichoepithelioma]]
| Stains    =
| IHC        = S100 +ve, CK7 +ve, CK18 +ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[skin]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  = pain - see ''[[painful skin lesions]]''
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      = may be related to [[dermal cylindroma]]
| ClinDDx    = [[painful skin lesions]], others
| Tx        = excision
}}
'''Eccrine spiradenoma''', also '''spiradenoma''',<ref>URL: [http://emedicine.medscape.com/article/1062079-overview http://emedicine.medscape.com/article/1062079-overview]. Accessed on: 9 May 2011.</ref> is (usually) a benign, painful skin thingy.  There is case series of malignant ones.<ref name=pmid20851376>{{Cite journal  | last1 = Andreoli | first1 = MT. | last2 = Itani | first2 = KM. | title = Malignant eccrine spiradenoma: a meta-analysis of reported cases. | journal = Am J Surg | volume = 201 | issue = 5 | pages = 688-92 | month = May | year = 2011 | doi = 10.1016/j.amjsurg.2010.04.015 | PMID = 20851376 }}</ref>
'''Eccrine spiradenoma''', also '''spiradenoma''',<ref>URL: [http://emedicine.medscape.com/article/1062079-overview http://emedicine.medscape.com/article/1062079-overview]. Accessed on: 9 May 2011.</ref> is (usually) a benign, painful skin thingy.  There is case series of malignant ones.<ref name=pmid20851376>{{Cite journal  | last1 = Andreoli | first1 = MT. | last2 = Itani | first2 = KM. | title = Malignant eccrine spiradenoma: a meta-analysis of reported cases. | journal = Am J Surg | volume = 201 | issue = 5 | pages = 688-92 | month = May | year = 2011 | doi = 10.1016/j.amjsurg.2010.04.015 | PMID = 20851376 }}</ref>


==General==
==General==
*A painful skin lesion.
*One of the [[ANGEL tumours]]:
**A [[painful skin lesion]].
**Many of these tumours have a prominent vascular component (think of blood vessels throbbing).
*Benign.
*Benign.
*Usually solitary, circumscribed and dermal.
*Most common on the head.
*Multiple lesions, early in life suggest a genetic syndrome.
**Brooke-Spiegler syndrome - spiradenomas, cylindromas and trichoepitheliomas
*Generally considered to be an 'eccrine' tumor but some hypothesize a pilar origin <ref>{{Cite journal  | last1 = Kazakov | first1 = DV. | last2 = Soukup | first2 = R. | last3 = Mukensnabl | first3 = P. | last4 = Boudova | first4 = L. | last5 = Michal | first5 = M. | title = Brooke-Spiegler syndrome: report of a case with combined lesions containing cylindromatous, spiradenomatous, trichoblastomatous, and sebaceous differentiation. | journal = Am J Dermatopathol | volume = 27 | issue = 1 | pages = 27-33 | month = Feb | year = 2005 | doi =  | PMID = 15677973 }}</ref>


==Microscopic==
==Microscopic==
Features:<ref name=dermatlas>URL: [http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=-1193575448 http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=-1193575448]. Accessed on: 29 November 2010.</ref><ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970191-7 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970191-7]. Accessed on: 10 May 2011.</ref>
Features:<ref name=dermatlas>URL: [http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=-1193575448 http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=-1193575448]. Accessed on: 29 November 2010.</ref><ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970191-7 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970191-7]. Accessed on: 10 May 2011.</ref>
*Dense nests of cells in the dermis; "dermal blue balls".
*Dense nests of cells in the dermis; "dermal blue balls".
*Mixed cell population:  
*Biphasic cell population:
**Epithelial.
**outer dark cells with small hyperchromatic nuclei and minimal cytoplasm.
**Myoepithelial.
**inner larger cells with [[vesicular nuclei]] and more cytoplasm.
**In some areas the two cell types mix together with dispersed hyaline droplets.
*Ductal differentiation.
*These cells form lobules that are surrounded by a hyaline or reticulin sheath.
*+/-Lymphocytes.
*+/-Lymphocytes.
*Vascular component - large and small blood vessels.


DDx:
DDx:
*[[Dermal cylindroma]].
*[[Dermal cylindroma]].  
**These two tumors are very closely related and overlap.
**Many tumors have areas of both spiradenoma and cylindroma.
**The lobules of cylindroma are small
***more consistently discrete,
***show more a more consistent arrangement of the light and dark cells and are
***often surrounded by prominent hyaline material.
**Individual lobules of cylindroma fit together like pieces of a puzzle.
**Lobules of spiradenoma are larger
***may run together and fuse,
***may not have a prominent hyaline surround and
***may show more disorganization and mixing of the two cell types
*[[Trichoepithelioma]].
*[[Trichoepithelioma]].
**Trichoepithelioma will show
***attempts at hair bulbs,
***areas with more eosinophilic cytoplasm and
***characteristic peritumoral stroma
*[[Glomus tumour]], hemangioma or hemangiopericytoma (vascular spiradenomas).
**The location often speaks against glomus tumour.
*Basal cell carcinoma
**Spiradenoma is deeper, without connection to the epidermis
**Spiradenoma lacks clefting artefact.
**Spiradenoma lacks mitoses and prominent apoptosis.
**BCC lacks ducts
**BCC lobules lack a prominent surrounding hyaline membrane
*Lymphoid aggregate (spiradenoma will be cytokeratin positive)


Images:
===Images===
*[http://commons.wikimedia.org/wiki/File:Eccrine_spiradenoma_-_very_low_mag.jpg Eccrine spiradenoma - very low mag. (WC)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Eccrine_spiradenoma_-_very_high_mag.jpg Eccrine spiradenoma - very high mag. (WC)].
Image:Eccrine_spiradenoma_-_very_low_mag.jpg | Eccrine spiradenoma - very low mag. (WC)
Image:Eccrine_spiradenoma_-_low_mag.jpg | Eccrine spiradenoma - low mag. (WC)
Image:Eccrine_spiradenoma_-_intermed_mag.jpg | Eccrine spiradenoma - intermed. mag. (WC)
Image:Eccrine_spiradenoma_-_high_mag.jpg | Eccrine spiradenoma - high mag. (WC)
Image:Eccrine_spiradenoma_-_very_high_mag.jpg | Eccrine spiradenoma - very high mag. (WC)
Image:Skin Spiradenoma Thrombus LP 13PY174127.jpg|Low power shot of a vascular spiradenoma (SKB)
Image:Skin Spiradenoma Thrombus HP 13PY174127.jpg|Spiradenoma - vascular channels within a basaloid tumor. (SKB)
Image:Skin Spiradenoma Vascular Thrombus 14PY169268.jpg|Thrombosed blood vessel within a spiradenoma.  (SKB)
Image:Skin Spiradenoma MP2 14PYSNP.jpg|Spiradenoma - dispersed hyaline pattern. (SKB)
</gallery>
www:
*[http://dermimages.med.jhmi.edu/images/spiradenoma_2_060109.jpg Eccrine spiradenoma (dermimages.med.jhmi.edu)].<ref name=dermatlas>URL: [http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=-1193575448 http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=-1193575448]. Accessed on: 29 November 2010.</ref>
*[http://dermimages.med.jhmi.edu/images/spiradenoma_2_060109.jpg Eccrine spiradenoma (dermimages.med.jhmi.edu)].<ref name=dermatlas>URL: [http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=-1193575448 http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=-1193575448]. Accessed on: 29 November 2010.</ref>


Line 26: Line 102:
*S100 +ve.
*S100 +ve.
*Keratins 7, 8, and 18 +ve.
*Keratins 7, 8, and 18 +ve.
 
*Ductules are [[EMA]] and [[CEA]] positive.
Notes:
Notes:
*IHC profile essentially identical to dermal cylindroma.<ref name=pmid9129700/>
*IHC profile essentially identical to dermal cylindroma.<ref name=pmid9129700/>
Line 33: Line 109:
*[[Dermatopathology]].
*[[Dermatopathology]].
*[[Non-malignant skin disease]].
*[[Non-malignant skin disease]].
*[[Painful skin lesions]].  
*[[Painful skin lesions]].
*[[Eccrine carcinoma]].


==References==
==References==

Latest revision as of 05:40, 2 January 2016

Eccrine spiradenoma
Diagnosis in short

Eccrine spiradenoma. H&E stain.
Synonyms spiradenoma
LM dense nests of cells in the dermis ("dermal blue balls"), mixed cell population (epithelial, myoepithelial, +/-lymphocytes)
LM DDx dermal cylindroma, trichoepithelioma
IHC S100 +ve, CK7 +ve, CK18 +ve
Site skin
Symptoms pain - see painful skin lesions
Prevalence uncommon
Prognosis benign
Other may be related to dermal cylindroma
Clin. DDx painful skin lesions, others
Treatment excision

Eccrine spiradenoma, also spiradenoma,[1] is (usually) a benign, painful skin thingy. There is case series of malignant ones.[2]

General

  • One of the ANGEL tumours:
    • A painful skin lesion.
    • Many of these tumours have a prominent vascular component (think of blood vessels throbbing).
  • Benign.
  • Usually solitary, circumscribed and dermal.
  • Most common on the head.
  • Multiple lesions, early in life suggest a genetic syndrome.
    • Brooke-Spiegler syndrome - spiradenomas, cylindromas and trichoepitheliomas
  • Generally considered to be an 'eccrine' tumor but some hypothesize a pilar origin [3]

Microscopic

Features:[4][5]

  • Dense nests of cells in the dermis; "dermal blue balls".
  • Biphasic cell population:
    • outer dark cells with small hyperchromatic nuclei and minimal cytoplasm.
    • inner larger cells with vesicular nuclei and more cytoplasm.
    • In some areas the two cell types mix together with dispersed hyaline droplets.
  • Ductal differentiation.
  • These cells form lobules that are surrounded by a hyaline or reticulin sheath.
  • +/-Lymphocytes.
  • Vascular component - large and small blood vessels.

DDx:

  • Dermal cylindroma.
    • These two tumors are very closely related and overlap.
    • Many tumors have areas of both spiradenoma and cylindroma.
    • The lobules of cylindroma are small
      • more consistently discrete,
      • show more a more consistent arrangement of the light and dark cells and are
      • often surrounded by prominent hyaline material.
    • Individual lobules of cylindroma fit together like pieces of a puzzle.
    • Lobules of spiradenoma are larger
      • may run together and fuse,
      • may not have a prominent hyaline surround and
      • may show more disorganization and mixing of the two cell types
  • Trichoepithelioma.
    • Trichoepithelioma will show
      • attempts at hair bulbs,
      • areas with more eosinophilic cytoplasm and
      • characteristic peritumoral stroma
  • Glomus tumour, hemangioma or hemangiopericytoma (vascular spiradenomas).
    • The location often speaks against glomus tumour.
  • Basal cell carcinoma
    • Spiradenoma is deeper, without connection to the epidermis
    • Spiradenoma lacks clefting artefact.
    • Spiradenoma lacks mitoses and prominent apoptosis.
    • BCC lacks ducts
    • BCC lobules lack a prominent surrounding hyaline membrane
  • Lymphoid aggregate (spiradenoma will be cytokeratin positive)

Images

  • Eccrine spiradenoma - very low mag. (WC)

  • Eccrine spiradenoma - low mag. (WC)

  • Eccrine spiradenoma - intermed. mag. (WC)

  • Eccrine spiradenoma - high mag. (WC)

  • Eccrine spiradenoma - very high mag. (WC)

  • Low power shot of a vascular spiradenoma (SKB)

  • Spiradenoma - vascular channels within a basaloid tumor. (SKB)

  • Thrombosed blood vessel within a spiradenoma. (SKB)

  • Spiradenoma - dispersed hyaline pattern. (SKB)

www:

IHC

Features:[6]

  • S100 +ve.
  • Keratins 7, 8, and 18 +ve.
  • Ductules are EMA and CEA positive.

Notes:

  • IHC profile essentially identical to dermal cylindroma.[6]

See also

References

  1. ↑ URL: http://emedicine.medscape.com/article/1062079-overview. Accessed on: 9 May 2011.
  2. ↑ Andreoli, MT.; Itani, KM. (May 2011). "Malignant eccrine spiradenoma: a meta-analysis of reported cases.". Am J Surg 201 (5): 688-92. doi:10.1016/j.amjsurg.2010.04.015. PMID 20851376.
  3. ↑ Kazakov, DV.; Soukup, R.; Mukensnabl, P.; Boudova, L.; Michal, M. (Feb 2005). "Brooke-Spiegler syndrome: report of a case with combined lesions containing cylindromatous, spiradenomatous, trichoblastomatous, and sebaceous differentiation.". Am J Dermatopathol 27 (1): 27-33. PMID 15677973.
  4. ↑ 4.0 4.1 URL: http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=-1193575448. Accessed on: 29 November 2010.
  5. ↑ URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970191-7. Accessed on: 10 May 2011.
  6. ↑ 6.0 6.1 Meybehm, M.; Fischer, HP. (Apr 1997). "Spiradenoma and dermal cylindroma: comparative immunohistochemical analysis and histogenetic considerations.". Am J Dermatopathol 19 (2): 154-61. PMID 9129700.
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