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Year : 2018  |  Volume : 61  |  Issue : 1  |  Page : 143-144
Chondroid syringoma with extensive cystic change and focal syringometaplasia: A rare histomorphological finding


Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

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Date of Web Publication22-Mar-2018
 

How to cite this article:
Jain A, Arava S. Chondroid syringoma with extensive cystic change and focal syringometaplasia: A rare histomorphological finding. Indian J Pathol Microbiol 2018;61:143-4

How to cite this URL:
Jain A, Arava S. Chondroid syringoma with extensive cystic change and focal syringometaplasia: A rare histomorphological finding. Indian J Pathol Microbiol [serial online] 2018 [cited 2019 Dec 13];61:143-4. Available from: http://www.ijpmonline.org/text.asp?2018/61/1/143/228176




Chondroid syringoma (CS) of the skin is a rare benign tumor of the sweat gland origin that histomorphologically resembles pleomorphic adenoma (mixed tumor) of the salivary gland. It usually affects middle-aged individual with male predominance.[1] Histologically, two variants of CS are described apocrine and eccrine. The apocrine type demonstrates irregular branching tubules and focal cysts (tubulocystic pattern), and the eccrine type is composed of uniform, small, round tubules.[2] CS with extensive cystic change is a rare phenomenon that can lead to an erroneous diagnosis of other common tumors with cystic change. Furthermore, mucinous syringometaplasia is a rare type of metaplasia described in the eccrine glands that develops in response to trauma and chronic inflammation, where eccrine duct epithelium contains mucin-laden goblet cells.[3] A 70-year-old female presented with solitary 0.5 cm × 0.5 cm nodular, nontender swelling in the left lower eyelid. Clinically, a diagnosis of sebaceous cyst was presumed. Excision biopsy revealed variably sized dilated cystic glands, [Figure 1]a surrounded by a tiny area showing biphasic growth pattern, where epithelial component was formed of bilayered tubules and mesenchymal component comprised of dense fibrous stroma with focal chondromyxoid change. A focus of syringometaplasia [Figure 1]b is also observed concluding a diagnosis of CS with extensive cystic change and focal syringometaplasia.
Figure 1: Chondroid syringoma showing (a) extensive cystic change (H and E, ×20) with (b) a tiny focus of characteristic chondroid syringoma morphology; few glands show focal mucinous (goblet cell) syringometaplasia (arrow, H and E, ×40)

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CS is a rare tumor of the skin with an overall incidence of about <0.098% of all skin tumors. It usually presents in the head and neck region as solitary, painless nodular swelling, generally 0.5–3 cm in diameter; however, rarely, other sites can be affected. Clinically, the differential diagnosis includes sebaceous cysts, adnexal tumors, neurofibroma, dermatofibroma, pilomatricoma, histiocytoma, basal cell carcinoma, and seborrheic keratosis.[1] It comprises both epithelial and mesenchymal components (biphasic) with a wide spectrum of patterns histologically analogous to mixed tumors of the salivary gland. Apocrine variant is lined by double-layered epithelium (inner cuboidal cells show cytokeratin and epithelial membrane antigen positivity and outer flattened cells show S-100 and vimentin positivity), and eccrine variant contains ducts with small lumina lined by only a single-layered epithelium.[2] However, mesenchymal components mainly composed of chondromyxoid stroma, focal lipomatous, squamous, sebaceous, apocrine, and osseous metaplasias are described with this entity. CS with atypical features, i.e., extensive ossification, extensive cystic changes, predominantly chondromyxoid stroma with scant epithelial component, giant size, and atypical location, can pose diagnostic challenges.[1],[2],[4] Furthermore, incidental finding of mucinous metaplasia may add to diagnostic dilemma. Our case showed extensive cystic changes; however, a tiny area of characteristic CS morphology contributed in diagnosis, thus highlighting the importance of extensive sampling. Differential diagnosis of CS with extensive cystic change may include eccrine hidrocystoma and syringocystadenoma papilliferum.[4] Complete surgical resection is the treatment of choice. To conclude, CS is a rare benign tumor, extensive cystic change can pose diagnostic dilemma, and awareness of this entity can prevent erroneous diagnosis.

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There are no conflicts of interest.



 
   References Top

1.
Cýralýk H, Bülbüloǧlu E, Arýcan O, Saşmaz S. A 72-year-old man with a mass in his right axilla. Acta Dermatovenerol Alp Pannonica Adriat 2007;16:177-9.  Back to cited text no. 1
    
2.
Bhasin TS, Mannan R, Bhatia PK, Sharma M, Bhalla A. Fine needle aspiration cytology diagnosis of the eccrine variant of chondroid syringoma – Case report of a rare entity with review of literature. J Clin Diagn Res 2010;4:2641-4.  Back to cited text no. 2
    
3.
Abbas O, Bhawan J. Syringometaplasia: Variants and underlying mechanisms. Int J Dermatol 2016;55:142-8.  Back to cited text no. 3
    
4.
Khan K. Chondroid syringoma: A case with unusual cytological findings. Indian J Dermatol 2013;58:157.  Back to cited text no. 4
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Correspondence Address:
Sudheer Arava
Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_539_16

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