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CASE REPORT
Year : 2014  |  Volume : 59  |  Issue : 1  |  Page : 88-90
Eccrine poroma on the face: An atypical presentation


Department of Dermatology, S.B.K.S Medical Institute and Research Centre, Piparia, Waghodia, Vadodara, Gujarat, India

Date of Web Publication23-Dec-2013

Correspondence Address:
Rashmi S Mahajan
82 Anushakti Nagar, New Sama Road, Baroda - 390 008
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.123515

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   Abstract 

An eccrine poroma is a solitary tumor arising from the eccrine duct epithelium in the epidermis. The lesions commonly occur on the sole of the foot, the hands, and occasionally on the nose, eyelids, neck, and chest. We report a patient who presented with a slow-growing nodular lesion over her left cheek, prompting a diagnosis of basal cell carcinoma or keratoacanthoma. Biopsy from the nodule revealed a well-defined epidermal tumor with uniform small cuboidal cells with rounded deeply basophilic nuclei, few narrow ductal lumina, and occasional cystic spaces confirming the diagnosis of an eccrine poroma.


Keywords: Eccrine poroma, intercellular bridges, poroid cells


How to cite this article:
Mahajan RS, Parikh AA, Chhajlani NP, Bilimoria FE. Eccrine poroma on the face: An atypical presentation. Indian J Dermatol 2014;59:88-90

How to cite this URL:
Mahajan RS, Parikh AA, Chhajlani NP, Bilimoria FE. Eccrine poroma on the face: An atypical presentation. Indian J Dermatol [serial online] 2014 [cited 2019 Jun 17];59:88-90. Available from: http://www.e-ijd.org/text.asp?2014/59/1/88/123515



   Introduction Top


Eccrine poroma is a benign neoplasm of the acrosyringium. Poromas usually occur on the palms and soles. [1],[2] We report a patient with a slow-growing ulcerated nodule over the face clinically simulating a basal cell carcinoma; however, unexpectedly, the biopsy revealed the growth to be an eccrine poroma. The tumor, often consisting of broad anastomosing bands of uniform appearing cuboidal cells arising within the epidermis and extending downward into the dermis. [2],[3] There is a sharp line of demarcation between the adjacent epidermis and the tumor cells. Occasionally, poromas may be of divergent adnexal differentiation in which case, immunohistochemistry studies may have to be performed. [4]


   Case Report Top


A fifty-year-old woman presented with a slow-growing nodule over the left cheek for one and a half years. The lesion started as a tiny, 2 mm asymptomatic papule on the left cheek and gradually increased to 2 cm in size. There was no history of trauma, pre-existing skin lesion, or topical application at the site of the lesion. There was no family history of similar lesions.

Examination revealed an ulcerated nodule with a peripheral hyperpigmented rim just lateral to the left nasolabial fold [Figure 1]. The lesion was about 1.5 cm in diameter, firm, mobile, non-tender, and did not bleed on touch. The local lymph nodes were not enlarged. Differential diagnoses considered were basal cell carcinoma, squamous cell carcinoma, amelanotic melanoma, and keratoacanthoma.
Figure 1: Ulcerated nodule with peripheral hyperpigmented rim over left cheek

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Excision biopsy was performed, which surprisingly revealed broad anastomosing bands of uniform small cuboidal cells [Figure 2], few ductal lumina, and narrow cystic spaces [Figure 3] within the epidermis. Further, the cuboidal cells showed uneven cytoplasmic clearing [Figure 4]. The histological features clinched the diagnosis of an eccrine poroma. A few occasional mitoses were seen which suggested the requirement of a close follow-up in this patient.
Figure 2: Broad anastomosing bands of uniform small cuboidal cells

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Figure 3: Few ductal lumina and narrow cystic spaces within the epidermis

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Figure 4: Cuboidal cells showing uneven cytoplasmic clearing

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   Discussion Top


Eccrine poroma was first described by Goldman et al. in 1956. [5] The term 'poroma' refers to a group of benign adnexal neoplasms with 'poroid' or terminal ductal differentiation. [2] Clinically, poromas usually present as solitary papules, plaques, or nodules usually over the palms and soles but may appear on any cutaneous surface where they tend to mimic benign and malignant melanocytic and non-melanocytic lesions. About two-third of cases are seen on soles or sides of soles followed by hands and fingers, and rarely over the face. [6],[7] Most of the lesions appear in middle-aged or elderly individuals. [8]

Eccrine poroma may exhibit polymorphic features that can make the diagnosis difficult. Differential diagnosis of eccrine poromas described in previous case reports includes pyogenic granuloma, hemangioma, seborrheic keratosis, verruca, fibroma, melanoma, nevus, cysts, and basal and squamous cell carcinoma. [6],[7]

Eccrine poroma arises within the lower portion of the epidermis and extends downward into the dermis. The tumor cells are uniformly cuboidal with a round basophilic nucleus, and are connected by intercellular bridges. The border between the tumor and the stroma is well defined. The tumor cells contain significant amount of glycogen which is associated with cytoplasmic clearing. Most eccrine poromas show ductal lumina and occasional cystic spaces within the tumor bands which are lined by an eosinophilic, periodic acid-schiff PAS-positive, diastase-resistant cuticle. [1],[2]

Eccrine poromas may be situated entirely within the epidermis where the tumor cells form discrete aggregates. These intraepidermal poromas are described as 'hidroacanthoma simplex'. When eccrine poromas are located within the dermis, they consist of tumor islands of various shapes with ductal lumina; these are described as 'dermal duct tumors'. [2]

Enzyme histochemical staining shows prevalence of eccrine enzymes such as phosphorylase and succinate dehydrogenase. [1]

Some benign neoplastic proliferations with histopathologic features of "eccrine" poroma could be of apocrine origin. Immunohistochemistry studies reveal that poroid cells are exclusively positive for Cytokeratin (CK) 1/5/10/14, CK5/8, and CK14, which are expressed in the outer cells of normal dermal sweat ducts and stain heterogeneously with anti-CK7, CK8/18, CK10/11, and CK19 antibodies which react in the inner cells of dermal ducts and in the secretory cells of sweat glands. Based on the keratin immunohistochemistry, the neoplastic cells in eccrine and apocrine poromas are considered to be closely related to the cells of dermal sweat ducts and it is difficult to differentiate apocrine poroma from eccrine poroma by keratin expression patterns alone. [4]

Genetic studies reveal p53 protein expression in eccrine poroma. [9]

Poromas, being benign adnexal neoplasms; treatment is optional. Electrosurgical destruction, carbon dioxide laser-assisted removal, or surgical excision may be performed. Topical treatments such as 1% atropine solution have been reported to be beneficial in treatment of superficial lesions. [2],[10]


   Conclusion Top


Forman [3] et al., in their article on eccrine poroma, describe it as a tumor with many faces. The asymptomatic nodule on our patient's face which was masquerading as a cutaneous carcinoma clinically proved to be an eccrine poroma histopathologically.

Even though an eccrine poroma has typical histopathological features, it has a propensity toward varied clinical presentations. Hence, such atypical nodules require a biopsy for confirmation of diagnosis and further management. Enzyme immunohistochemistry and genetic studies help in typifying poromas better. [11]

 
   References Top

1.Ahmed TSS, Priore JD. Seykora JT. Tumours of the Epidermal Appendages. Elder DE, Rosalie E, Johnson BL, editors. Lever's Histopathology of the Skin. 10 th ed. Wolters Kluwer: Lippincott Williams and Wilkins; 2005. p. 885-8.  Back to cited text no. 1
    
2.McCalmont TH. Adnexal neoplasms. Bolognia JL, Jorizzo JL, Rapini RP, et al. editors. Dermatology. 2 nd ed. Mosby: Elsevier; 2008. p. 1704-5.  Back to cited text no. 2
    
3.Forman SB, McMullan FH, Azmi FH. Eccrine poroma: One tumor, many faces. J Cutan Pathol 2005;32:87-8.  Back to cited text no. 3
    
4.Ogawa F, Arai E, Tsuchida T, Kuramochi A, Mitsuhashi T, Ban S, et al. Clinicopathological and immunohistochemical study of eccrine porocarcinoma (malignant eccrine poroma). J Cutan Pathol 2005;32:106.  Back to cited text no. 4
    
5.Goldman P, Pinkus H, Rogin JR. Eccrine poroma; tumors exhibiting features of the epidermal sweat duct unit. AMA Arch Derm 1956;74:511-21.  Back to cited text no. 5
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6.Agrawal S, Kumar B, Sharma N. Nodule on the chest. Indian J Dermatol Venereol Leprol 2009;75:639.  Back to cited text no. 6
    
7.Ferrari A, Buccini P, Silipo V, Simone De P, Mariani G, Marenda S, et al. Eccrine poroma: A clinical-dermoscopic study of seven cases. Acta Derm Venereol 2009;89:160-4.  Back to cited text no. 7
    
8.Altamura D, Piccolo D, Lozzi GP, Peris K. Eccrine poroma in an unusual site: A clinical and dermoscopic simulator of amelanotic melanoma. J Am Acad Dermatol 2005;53:538-40.  Back to cited text no. 8
    
9.Akalin T, Sen S, Yücetürk A, Kandiloglu G. P53 Protein Expression in Eccrine Poroma and Porocarcinoma. Am J Dermatopathol 2001;23:402-6.  Back to cited text no. 9
    
10.Madhukara J, Jayaseelan E, Correa M. Atypical facial eccrine poromatosis-effective treatment with topical atropine. Indian J Dermatol 2006;51:53-4.  Back to cited text no. 10
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11.Robson A, Greene J, Ansari N, Kim B, Seed PT, McKee PH, et al. Eccrine porocarcinoma (malignant eccrine poroma): A clinicopathologic study of 69 cases. Am J Surg Pathol 2001;25:710-20.  Back to cited text no. 11
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
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