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Year : 2011  |  Volume : 54  |  Issue : 1  |  Page : 225-226
Squamous cell carcinoma, syringocystadenoma papilliferum and apocrine adenoma arising in a nevus sebaceus of Jadassohn


Institute of Pathology, Safdarjang Hospital campus, New Delhi, India

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Date of Web Publication7-Mar-2011
 

How to cite this article:
Malhotra P, Arora D, Singh A. Squamous cell carcinoma, syringocystadenoma papilliferum and apocrine adenoma arising in a nevus sebaceus of Jadassohn. Indian J Pathol Microbiol 2011;54:225-6

How to cite this URL:
Malhotra P, Arora D, Singh A. Squamous cell carcinoma, syringocystadenoma papilliferum and apocrine adenoma arising in a nevus sebaceus of Jadassohn. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Nov 23];54:225-6. Available from: http://www.ijpmonline.org/text.asp?2011/54/1/225/77418


Sir,

A 52-year-old male presented with complaints of a plaque-like lesion in the region of right scapula of 20 years duration. There was history of gradual increase in size and sero-sanguinous discharge from the lesion for the past 5 years. On local examination, a partly ulcerated cauliflower like growth was noted which measured 3 × 2 cm. An incisional biopsy reported it as squamous cell carcinoma.Subsequently, wide local excision was performed with 1 cm margin. Intraoperatively, the tumor was superficial and was not invading the underlying muscle. Patient has been under follow-up and no local recurrence has been noticed.

Gross examination revealed an elliptical skin covered tissue measuring 5.5 × 3 × 1 cm, showing a verrucous growth on the surface. Cut surface showed relatively firm gray white areas in the region of the verrucous growth and mucoid to gelatinous nodules in the deeper aspect of the tissue.

Sections from the growth revealed prominent papillomatous hyperplasia of the epidermis with irregular jagged extensions into the deep dermis. The infiltrating epithelium showed features of squamous cell carcinoma [Figure 1]. In continuity with this pathology, sections from the mucoid nodules in the base of the lesion demonstrated pathology in the form of syringocystadenoma papilliferum [Figure 1]. Heterotopic apocrine glands were prominent in the subepithelial region. Some of these were cystically dilated and filled with amorphous eosinophilic secretions. In addition, apocrine adenoma was noted with glands arranged as tubular structures with papillae devoid of stroma projecting into the lumen [Figure 2]. A diagnosis of superficially invasive squamous cell carcinoma with syringocystadenoma papilliferum and apocrine adenoma was made [Figure 3]a-c. The perilesional skin was acanthotic and the dermis showed sparse, abnormally formed pilosebaceous units [Figure 3]d. The rarity of occurrence and coexistence of these lesions on the trunk along with the findings in the perilesional skin led to the consideration of an underlying nevus sebaceus in retrospect.
Figure 1: Squamous cell carcinoma, heterotopic apocrine glands and syringocystadenoma papilliferum (H and E, ×40)

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Figure 2: Apocrine adenoma with heterotopic apocrine glands (H and E, ×40)

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Figure 3: (a) Squamous cell carcinoma - high magnification (H and E, ×400); (b) syringocystadenoma papilliferum (H and E, ×100); (c) apocrine adenoma - high magnification (H and E, ×400); (d) abnormally formed pilosebaceous unit (H and E, ×400)

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Nevus sebaceus of Jadassohn is a complex hamartoma involving pilosebaceous follicle, epidermis and other adnexal structures. A wide variety of benign and malignant tumors have been described in association with nevus sebaceus. [1] The commonest benign tumors are trichoblastoma and syringocystadenoma papilliferum.[2] Amongst malignant tumors, the commonest is basal cell carcinoma with an incidence as high as 10%.

Squamous cell carcinoma has been rarely reported with nevus sebaceus. [3],[4],[5] The development of this complication is associated with regional and distant nodal metastasis.

The majority of these lesions have involved the scalp which is the commonest site of nevus sebaceus. This is the first report of coexisting squamous cell carcinoma and syringocystadenoma papilliferum on the trunk. It has been postulated that the presence of heterotopic apocrine glands at the deep part of nevus sebaceus is responsible for the development of apocrine cysts and syringocystadenoma papilliferum. [2]

This report reiterates the need for close clinical surveillance of nevus sebaceus with prophylactic excision of all new growths. The innocuous looking waxy plaque in unexposed areas may be ignored with grave consequences.

 
   References Top

1.Kaddu S, Schaeppi H, Kerl H, Soyer HP. Basaloid neoplasms in nevus sebaceus. J Cutan Pathol 2000;27:327-37.   Back to cited text no. 1
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2.Cribier B, Scrivener Y, Grosshans E. Tumors arising in nevus sebaceus: A study of 596 cases. J Am Acad Dermatol 2000;42:263-8.  Back to cited text no. 2
    
3.Duncan A, Wilson N, Leonard N. Squamous cell carcinoma developing in a naevus sebaceus of Jadassohn. Am J Dermatopathol 2008;30:269-70.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Ball EA, Hussain M, Moss AL. Squamous cell carcinoma and basal cell carcinoma arising in a naevus sebaceus of Jadassohn: case report and literature review. Clin Exp Dermatol 2005;30:259-60.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Snow JL, Zalla MJ, Roenigk RK, Gibson LE. Sudden nodular growth in a congenital facial lesion. Squamous cell carcinoma arising in a nevus sebaceus Jadassohn (NSJ). Arch Dermatol 1995;131:1069-72.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
Purnima Malhotra
Scientist C, Institute of Pathology, Safdarjang Campus, Post Box 4909, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.77418

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  [Figure 1], [Figure 2], [Figure 3]

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