Sweat gland neoplasms

Sweat gland neoplasms

Blue sweat gland tumors differentiate towards the secretory portion of the sweat gland. Red sweat gland tumors differentiate towards the sweat duct. Sweat duct tumors often demonstrate clear cell change. Most sweat gland tumors can show at least focal decapitation secretion, suggesting they are capable of apocrine differentiation.

Cylindroma (turban tumor)

• Islands of blue cells with little cytoplasm

• Dark and pale blue nuclei present

• Jigsaw-puzzle pattern

• Islands outlined by a deeply eosinophilic basement membrane

• Deeply eosinophilic hyaline droplets may be noted in islands

• Often inherited and multiple on the scalp

Fig 5-1 Cylindroma

Spiradenoma

• Larger round islands of blue cells with little cytoplasm

• Dark and pale blue nuclei present

• Islands peppered with black lymphocytes

• Deeply eosinophilic hyaline droplets may be noted in islands

• Usually solitary

Spiradenomas and cylindromas are closely related tumors. Both differentiate towards the secretory portion of the sweat gland. Hybrid tumors occur. Spiradenomas are usually sporadic and solitary, while cylindromas are multiple, inherited, and may occur together with trichoepitheliomas. Spiradenomas are inflamed (lymphocytes) and spontaneously tender.

Fig 5-2 Spiradenoma

Table 5-1

Characteristics of cylindroma versus spiradenoma

Characteristic	Cylindroma	Spiradenoma
Blue cells with little cytoplasm	Yes	Yes
Dark and pale blue nuclei	Yes	Yes
Peppered with black lymphocytes	No	Yes
Hyaline droplets in nests	Yes	Yes
Jigsaw-puzzle pattern	Yes	No
Deeply eosinophilic basement membrane	Yes	No
Inheritance	Autosomal dominant	Sporadic
Tender	No	Yes

Tender tumors: BANGLE

• Blue rubber bleb nevus

• Angiolipoma

• Neuroma, neurilemmoma

• Glomus tumor

• “Eccrine” spiradenoma

These tumors are probably tender because they have:

1. Smooth muscle that can contract to cause pain

2. Compressed nerve

3. Inflammation

Spiradenocarcinoma

• Occurs in long-standing spiradenomas

• Atypia, mitoses, and necrosis

Fig 5-3 Spiradenocarcinoma

Syringocystadenoma papilliferum

• Opens to surface

• Blue papillary fronds extending upward into clear spaces: “fjords and fronds”

• Decapitation secretion

• Plasma cells

Syringocystadenoma papilliform (SPAP) differentiates towards the secretory portion of the sweat gland. SPAP opens to the surface, which looks as though one could slide into it. Plasma cells are typically present in the mesenchymal core of each frond. Clinically, they appear as raised warty plaques on the head or neck. One-third of cases occur within nevus sebaceus.

Fig 5-4 Syringocystadenoma papilliferum

Hidradenoma papilliferum

• Blue dermal nodule with branching cystic spaces

• Papillary fronds

• Decapitation secretion

Hidradenoma papilliferum (HPAP) usually presents clinically as a vulvar dermal nodule, but occasionally presents on a breast, eyelid, or ear. Histologically, HPAP is a maze-like dermal nodule, which looks as though one could hide in it. The arborizing pattern of blue fronds demonstrates decapitation secretion. Like SPAP, it differentiates towards the secretory segment.

Papillary digital carcinoma (aggressive digital papillary adenocarcinoma)

• Blue tumor nodules with cystic change

• Little to no visible cytoplasm

• Papillary fronds

• Atypia, mitoses, and necrosis variable

• Typically involves the hand

• Many patients are young

• Even bland tumors can metastasize

There can be significant histologic similarities to hidradenoma papilliferum. All digital papillary tumors should be considered carcinomas.

Fig 5-5 Hidradenoma papilliferum

Fig 5-6 Papillary digital carcinoma

Mucinous carcinoma

• Islands of blue cells surrounded by mucin (“blue islands floating in a sea of snot”)

• Primary cutaneous mucinous carcinoma and metastatic mucinous carcinoma look identical

Mucinous carcinoma can be primary in the skin, or can be metastatic from a primary cancer of the breast or gastrointestinal tract. Imaging studies may be required.

Fig 5-7 Mucinous carcinoma

Syringoma

• Paisley-tie pattern of tadpole-shaped ducts

• Ample pink cytoplasm

• Dense red sclerotic stroma

• Tumor is small and round

Syrinx refers to a pipe or duct. Syringomas usually appear as small papules on the eyelids. They are especially common in Asian women and in children with Down’s syndrome. Eruptive syringomas typically occur on the chest, back, or penis of a dark-skinned patient. Eruptive syringomas appear as small hyperpigmented papules with no tendency to coalesce.

Fig 5-8 Syringoma

Fig 5-9 Clear cell syringoma

Clear cell syringoma

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Tags: Dermatopathology

Apr 26, 2016 | Posted by admin in Dermatology | Comments Off

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