Indian Journal of Dermatology
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Table of Contents 
CASE REPORT
Year : 2015  |  Volume : 60  |  Issue : 1  |  Page : 85-87
Poroma with sebaceous differentiation: Dermoscopy for the diagnosis of skin tumor with sebaceous differentiation


1 Department of Medicine of Sensory and Motor Organs, Division of Dermatology, Faculty of Medicine, Tottori University, Tottori; Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
2 Department of Medicine of Sensory and Motor Organs, Division of Dermatology, Faculty of Medicine, Tottori University, Tottori, Japan
3 Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Date of Web Publication26-Dec-2014

Correspondence Address:
Takamichi Ito
Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.147807

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   Abstract 

Although divergent adnexal differentiations are occasionally seen in poroma, poroma with sebaceous differentiation is extremely rare. We present here the second case of dermoscopy on poroma with sebaceous differentiation. A 38-year-old Japanese female presented with a 2-year history of a slow-growing nodule on her left forearm. Dermoscopically, fine hairpin-like vessels, beige lobular structures were seen in the nodule. Many small yellow dots were scattered between beige lobular structures, giving orange-beige in color as a whole. On the basis of histopathologic findings, a diagnosis of poroma with sebaceous differentiation was made. Some sebaceous tumors are known to exhibit yellowish structures on dermoscopy. Tumors with sebaceous differentiation, as well as conventional sebaceous tumors, can show yellow structures on dermoscopy.


Keywords: Dermoscopy, poroma, sebaceous differentiation, skin tumor, yellow


How to cite this article:
Ito T, Yoshida Y, Furue M, Yamamoto O. Poroma with sebaceous differentiation: Dermoscopy for the diagnosis of skin tumor with sebaceous differentiation. Indian J Dermatol 2015;60:85-7

How to cite this URL:
Ito T, Yoshida Y, Furue M, Yamamoto O. Poroma with sebaceous differentiation: Dermoscopy for the diagnosis of skin tumor with sebaceous differentiation. Indian J Dermatol [serial online] 2015 [cited 2020 Feb 24];60:85-7. Available from: http://www.e-ijd.org/text.asp?2015/60/1/85/147807

What was known?
Sebaceous tumors can show yellow structures on dermoscopy.



   Introduction Top


Poroma is a benign cutaneous neoplasm that usually occurs in elderly individuals as a solitary reddish-pink nodule. Although divergent adnexal differentiations are occasionally seen in this tumor, poroma with sebaceous differentiation is extremely rare. [1],[2] We present here the second case of dermoscopy on poroma with sebaceous differentiation.


   Case Report Top


A 38-year-old Japanese female presented with a 2-year history of a slow-growing nodule on her left forearm. Physical examination revealed a slightly elevated pink nodule of 4 mm in size [Figure 1]. Dermoscopically, fine hairpin-like vessels, beige lobular structures were seen in the nodule. Of note, many small yellow dots were scattered between beige lobular structures. Some of them were too small to be noted as dots, giving orange-beige in color as a whole [Figure 2]. Histopathologically, the lesion consisted of well-defined nests of monomorphous cuboidal or oval poroid cells with oval nuclei and eosinophilic cytoplasm connected with the overlying epidermis [Figure 3]. Tubular structures formed by cuticular cells and intracytoplasmic canaliculi in those cells were also present [Figure 4]. Poroid or cuticular cells were observed in more than 65% area of the tumor cell nests. Sebaceous lobules of various sizes were noted in the poroid nest [Figure 5]. No atypical mitoses were noted. Based on these findings, a diagnosis of poroma with sebaceous differentiation was made.
Figure 1: Pink nodule on the left forearm

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Figure 2: Dermoscopy. Small yellow dots, fine hairpin-like vessels, and beige lobular structures

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Figure 3: H and E, ×20. Well-defined poroid nest showing sebaceous differentiation

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Figure 4: H and E, ×200. Tubular structures formed by cuticular cells and intracytoplasmic canaliculi

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Figure 5: H and E, ×400. Sebaceous lobules in the poroid nest

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   Discussion Top


Some cutaneous neoplasms can exhibit mixed follicular, sebaceous, and sudoriferous differentiation because of the embryological association of these structures. However, sebaceous differentiation is not generally observed in eccrine poroma because eccrine sweat glands arise from a distinct epithelial unit. Poroma with sebaceous differentiation is thought to develop in association with a folliculosebaceous apocrine unit. Actually, typical poroma without sebaceous differentiation has a predilection to arise on plantar or palmar skin where there are no hair follicles, [1] whereas poroma with sebaceous differentiation usually does not occur in these regions. [2] It is uncertain whether our case is eccrine or apocrine in nature. However, from the concept of folliculosebaceous apocrine unit, we speculate that ours is an apocrine poroma.

There have been several previous reports in which dermoscopic features of poroma were discussed. [3],[4],[5] These reports demonstrated characteristic vascular patterns, including glomerular vessels, looped or hairpin-like vessels, leaf and flower-like vessels, and branching vessels. These findings corresponded with those in our case.

It is of interest that dermoscopy showed small yellow dots in our case. Since some sebaceous tumors exhibit yellowish structures on dermoscopy, [6],[7] it is most likely that yellow dots reflect sebaceous lobules in the tumor. Thus, when we see yellow structures dermoscopically, we should consider tumors with sebaceous differentiation as a possible differential diagnosis as well as conventional sebaceous tumors. Iwasaki et al. first reported the dermoscopic features of poroma with sebaceous differentiation, [8] but, interestingly, yellowish structures were not evident. We speculate that sebaceous cell aggregations in their case were too small in size and number to be detected by dermoscopy. In contrast, many relatively large sebaceous cell lobules were observed in our case.

Dermoscopic differential diagnosis showing yellowish structures includes sebaceous naevus, sebaceous carcinoma, sebaceous hyperplasia, sebaceoma, sebaceous adenoma, and reticulated acanthoma with sebaceous differentiation. [6] Excluding the yellow dots, dermoscopic features in our case accorded with those in poroma and were different from those in the above diseases. Therefore, it might be possible to form the correct diagnosis through dermoscopy.

Dermoscopy is now widely used to diagnose many pigmented and nonpigmented skin diseases, including general and common diseases. [9],[10] It still harbors significant possibilities to provide additional information for improving diagnostic accuracy in daily clinical practice, such as lesions with sebaceous differentiation.

 
   References Top

1.
Weedon D. Tumor of cutaneous appendages. In: Weedon D, editor. Weedon's Skin Pathology. Philadelphia, U.S.: Churchill Livingstone Elsevier; 2010. p. 798-9.  Back to cited text no. 1
    
2.
Kazakov DV, Kutzner H, Spagnolo DV, Kempf W, Zelger B, Mukensnabl P, et al. Sebaceous differentiation in poroid neoplasms: Report of 11 cases, including a case of metaplastic carcinoma associated with apocrine poroma (sarcomatoid apocrine porocarcinoma). Am J Dermatopathol 2008;30:21-6.  Back to cited text no. 2
    
3.
Shalom A, Schein O, Landi C, Marghoob A, Carlos B, Scope A. Dermoscopic findings in biopsy-proven poromas. Dermatol Surg 2102;38:1091-6.  Back to cited text no. 3
    
4.
Ferrari A, Buccini P, Silipo V, De Dimone 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. 4
    
5.
Aydingoz IE. New dermoscopic vascular patterns in a case of eccrine poroma. J Eur Acad Dermatol Venereol 2009;23:725-6.  Back to cited text no. 5
    
6.
Ito T, Yoshida Y, Furue M, Yamamoto O. Dermoscopic features of reticulated acanthoma (superficial epithelioma) with sebaceous differentiation. Eur J Dermatol 2012;22:704-6.  Back to cited text no. 6
    
7.
Moscarella E, Argenziano G, Longo C, Cota C, Ardigò M, Stigliano V, et al. Clinical, dermoscopic and reflectance donfocal microscopy features of sebaceous neoplasms in Muir-Torre syndrome. J Eur Acad Dermatol Venereol 2012 [In Press].  Back to cited text no. 7
    
8.
Iwasaki J, Yoshida Y, Yamamoto O, Tajima S. Poroma with sebaceous differentiation of the eyelid: A rare site of occurrence. Acta Derm Venereol 2008;88:166-7.  Back to cited text no. 8
    
9.
Yoshida Y, Yamamoto O. Dermoscopic features of ulcerated gouty tophus. Eur J Dermatol 2009;19:646.  Back to cited text no. 9
    
10.
Watanabe T, Yoshida Y, Yamamoto O. Differential diagnosis of pearly penile papules and penile condyloma acuminatum by dermoscopy. Eur J Dermatol 2010;20:414-5.  Back to cited text no. 10
    

What is new?
Tumors with sebaceous differentiation, as well as conventional sebaceous tumors, can show yellow structures on dermoscopy.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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