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LETTER TO EDITOR  
Year : 2014  |  Volume : 57  |  Issue : 2  |  Page : 344-345
Chondroid syringoma with extensive osseous differentiation: A rare finding


1 Department of Pathology, Lady Hardinge Medical College, New Delhi, India
2 Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India

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Date of Web Publication19-Jun-2014
 

How to cite this article:
Nangia A, Sehgal S, Pujani M, Patiri K. Chondroid syringoma with extensive osseous differentiation: A rare finding. Indian J Pathol Microbiol 2014;57:344-5

How to cite this URL:
Nangia A, Sehgal S, Pujani M, Patiri K. Chondroid syringoma with extensive osseous differentiation: A rare finding. Indian J Pathol Microbiol [serial online] 2014 [cited 2020 May 31];57:344-5. Available from: http://www.ijpmonline.org/text.asp?2014/57/2/344/134746


Sir,

Chondroid syringoma is a rare benign adnexal neoplasm of the skin composed of epithelial elements with associated mesenchymal changes. We present a case of chondroid syringoma with ossification and associated marrow spaces, which is a rare finding.

A 24-year-old male presented to the surgery outpatient department with a forehead nodule. It measured 1 cm in diameter, was firm, nontender and not fixed to the underlying bone or surrounding structures. A clinical diagnosis of fibroma was made.

Fine-needle aspiration cytology smears showed cohesive clusters of small cells with scant cytoplasm, round nuclei with regular nuclear membranes and inconspicuous nucleoli. There was a presence of myxoid stromal fragments, many of which were seen in close association of the clusters. A diagnosis of benign appendageal tumor of the skin was given.

Excision of the lesion was subsequently carried out. Gross pathological examination revealed a skin covered grey white globular soft tissue mass measuring 1cm in diameter. Cut surface was grey white, firm to hard. Focally, white gritty areas and myxoid change were noted.

Histopathological section revealed an unencapsulated, well-circumscribed lesion composed of large areas showing bony trabeculae enclosing marrow spaces. [Figure 1] The marrow spaces comprised of fibroadipose tissue without any hematopoiesis. Enchondral ossification was noted in an occasional focus. A small peripherally compressed area showed few nests of cells along with variably sized tubular structures with an outer flattened lining and inner cuboidal cell layer. There were few nests of cells having moderate amount of cytoplasm, round to ovoid nuclei with regular nuclear membrane and vesicular chromatin. Serial sectioning revealed myxoid stroma with occasional focus showing cartilaginous differentiation.
Figure 1: Section showing osseous differentiation (H and E, ×400)

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Immunohistochemistry (IHC) revealed cytokeratin-5 positivity in the nests and tubules of epithelial cells. Epithelial membrane antigen and carcinoembryonic antigen were positive in the inner lining cells of the tubules. S-100 was positive in the outer cuboidal lining cells and in the chondroid area confirming the dual differentiation of the lesion [Figure 2].
Figure 2: Section showing S-100 positivity in epithelial and stromal cells (immunohistochemistry, ×400)

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Ossification is a very rare finding in a chondroid syringoma, and whenever present, it is focal and scant. Extensive ossification in chondroid syringoma has previously been reported by Paul et al. [1] and Eccher et al. [2] Awasthi et al. [3] have reported chondroid syringoma with extensive ossification and marrow differentiation. Benign skin lesions, which show ossification, include pilomatricomas, trichoepitheliomas, hemangiomas, nevi, epidermal cysts, schwannomas, lipomas, and fibromas. Chondroid syringoma is the only biphasic lesion of the skin showing ossification. Presence of enchondral ossification in our case proves that ossification is primary in chondroid syringoma and the cell of origin is pluripotent. All the other skin lesions mentioned undergo metastatic or secondary ossification. Shimizu et al. [4] studied the immunohistochemical panel in a mixed tumor of the skin with marked ossification, whose findings were same as the present case. IHC is useful in confirming the biphasic nature and the cell of origin of chondroid syringoma.

Our case was rare, since it showed extensive bony differentiation along with enchondral ossification and only focal areas showing biphasic differentiation. Such appearances can pose diagnostic difficulty. Further, IHC can be a useful aid to the diagnosis.

 
   References Top

1.Paul K, Sreekar H, Dhanraj P, Lamba S, George SM. Chondroid syringoma with extensive ossification. Ann Maxillofac Surg 2011;1:91-2.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Eccher A, Brunelli M, Gobbo S, Dalfior D, Dvornik G, Barbareschi M, et al. Chondroid syringoma with extensive ossification. Int J Surg Pathol 2007;15:385-7.  Back to cited text no. 2
    
3.Awasthi R, Harmse D, Courtney D, Lyons CB. Benign mixed tumour of the skin with extensive ossification and marrow formation: a case report. J Clin Pathol 2004;57:1329-30.  Back to cited text no. 3
    
4.Shimizu S, Han-Yaku H, Fukushima S, Shimizu H. Immunohistochemical study of mixed tumor of the skin with marked ossification. Dermatology 1996;193:255-7.  Back to cited text no. 4
    

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Correspondence Address:
Shivali Sehgal
Department of Pathology, Lady Hardinge Medical College, New Delhi,
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.134746

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    Figures

  [Figure 1], [Figure 2]

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