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CASE REPORT |
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| Year : 2014 | Volume
: 59
| Issue : 5 | Page : 513-515 |
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| Eccrine Spiradenoma in Knee |
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A Sharma1, P Sengupta2, Anjan Kumar Das3, Manish Kumar Nigam4, S Chattopadhya4
1 Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kamarhati, Kolkata, India
2 Department of Pharmacology, N.R.S. Medical College, Kolkata, India
3 Department of Pathology, Calcutta National Medical College, Kolkata, India
4 Department of Pathology, Burdwan Medical College, Burdwan, India
| Date of Web Publication | 1-Sep-2014 |
Correspondence Address:
A Sharma
95, Dr Abani Dutta Rd, Howrah - 711 101
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-5154.139921
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 Abstract | | |
Eccrine spiradenoma is an uncommon benign adnexal tumor of the eccrine sweat glands. Although it can occur at any age, it is most common in young adults without any sex predilection. Malignant transformation is rare, presenting as rapid increase in size of a long-standing lesion. Here, we report a case of eccrine spiradenoma in a 35-year-old man who presented with swelling over the right knee, with cytological atypia but no recurrence until date.
Keywords: Cytological atypia, benign adenexal tumour, eccrine spiradenoma, eccrine sweat gland
How to cite this article:
Sharma A, Sengupta P, Das AK, Nigam MK, Chattopadhya S. Eccrine Spiradenoma in Knee. Indian J Dermatol 2014;59:513-5 |
What was known?
1. Common site of presentation is upper half of the ventral half of the body
2. Eccrine spiradenoma is an uncommon benign adenexal tumor of eccrine sweat gland (malignant transformation is rare).
| Introduction | |  |
Eccrine spiradenoma, also known as spiradenoma, is an uncommon benign tumor of sweat glands, first described by Kersting and Helwing in 1956. [1] It usually presents as a single skin tumor, showing typical histological features. It mainly occurs in young adults, equally among both sexes. The lesion is mostly solitary and painful and consists of a firm, rounded, bluish, dermal nodule. The nodule usually develops on the head, neck, and back of the trunk. A frequent symptom of this neoplasm is spontaneous pain or tenderness on palpation. Malignant transformation is rare, but has been reported and described in literature previously. We here report a case of eccrine spiradenoma of the right knee in a 35-year-old man with features of cytological atypia.
| Case Report | | |
A 35-year-old man presented with a history of small painful nodule over his right knee for past 2.5 years. Family history and past medical history were insignificant. The lesion began as a small papule, which slowly increased in size over time. The lesion was tender on firm pressure, adherent to superficial dermis, and clinically well demarcated. Routine haematological and biochemical investigations were normal. Mantoux test was negative. The lesion was excised and dispatched for histological examination. Gross examination of the resected specimen showed a 5 × 4-cm, pink-blue nodular lesion with adherent normal looking skin [Figure 1] and [Figure 2]. The specimen was fixed in 10% neutral buffered formaldehyde solution, tissue was processed and stained with hematoxylin and eosin stain. Microscopic examination revealed several sharply delineated, basophilic nodules in the dermis without any connection with the epidermis [Figure 3]. At higher magnifications, the tumor mass was observed to be composed of two distinct cell population the first type being small, dark basaloid cells located at the periphery of the lesion and the second type being large, pale cells having large vesicular nuclei with pale cytoplasm at the center of the lesion. Parts of the tumor also showed some cytological atypia [Figure 4]. Patient was on follow-up, and, until the time of writing this article, no recurrence has been observed. | Figure 1: Gross examination of the resected specimen showing pink-blue nodular lesion with adherent normal looking skin
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 | Figure 3: several sharply delineated, basophilic nodules in the dermis without any connection with the epidermis
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 | Figure 4: H and E stained section of eccrine spiroadernoma showing two cell population small basoloid cell at the periphery and large pale cell at the center, few cell also show atypia, ×400
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| Discussion | | |
Eccrine spiradenoma classically presents in 20-40 years of age. Most presentations of eccrine spiradenoma are solitary, comprising >97% of cases. The incidence of eccrine spiradenoma is somewhat similar in men and women. [2] Malignant transformation is rare, and it usually occurs 20-30 years after the initial lesion detection with a mortality rate of 39% if left untreated. [2]
Eccrine spiradenoma usually appears as a solitary nodule, but multiple lesions may also be present. The epidermis that covers the lesion may be normal in color or pinkish and ulcerated. [3] Eccrine spiradenoma belongs to the group of the painful tumors of the skin. This vast group includes glomus tumor, blue rubber bleb naevus, leiomyoma, eccrine spiradenoma, neuroma, dermatofibroma, angiolipoma, neurilemmoma, endometrioma, glomangioma, and granular cell tumor. [4] Microscopically, the tumor is composed of two types of cells in a well-delineated nodular pattern: Larger, paler cells grouping around the lumina and smaller, darker cells forming the periphery of the tumor. [5] Cystic spaces or small, tubular structures may also be present. [6] Malignant changes usually appear in long-standing tumors and is clinically revealed by a rapidly enlarging tumor mass. [6],[7] Spiradenoma may be associated with other skin adenexal tumors namely trichoepitheliomas and cylindromas (in the form of Brooke-Spiegler syndrome More Details), chondroid syringoma, and apocrine adenoma. Eccrine spiradenoma may present as multiple segmental eccrine spiradenoma, vascular eccrine spiradenoma, carcinosarcomatous ex eccrine spiradenoma, and eccrine spiradenoma with neurofibromatosis. [2],[8],[9],[10],[11],[12]
The method of treatment is surgical excision and because recurrences have been reported, close follow-up of the patient is required.
| Conclusion | | |
We thus conclude that such tumor needs to be treated early to prevent malignant changes and recurrence probably in long-standing cases. In the case presented here, some cytological atypia that could have later progressed to malignancy was observed. To avoid repeat surgery (if malignancy is found histologically), wider resection of the lesion was performed at the first opportunity. Fortunately, in this case, until date, there has been no recurrence.
| References | | |
| 1. | Kersting DW, Helwig EB. Eccrine spiradenoma. AMA Arch Derm 1956;73:199-227. 
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| 2. | Englander L, Emer JJ, McClain D, Amin B, Turner RB. A rare case of multiple segmental eccrine spiradenomas. J Clin Aesthet Dermatol 2011;4:38-44.
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| 3. | Kaleeswaran AV, Janaki VR, Sentamilselvi G, Kiruba MC. Eccrine spiradenoma. Indian J Dermatol Venereol Leprol 2002;68:236-7.
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| 4. | Naversen DN, Trask DM, Watson FH, Burket JM. Painful tumors of the skin: "LEND AN EGG." J Am Acad Dermatol 1993;28:298-300.
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| 5. | Hashimoto K, Lever WF. Histogenesis of skin appendage tumors. Arch Dermatol1969;100:356-69.
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| 6. | Van den Oord JJ, De Wolf-Peeters C. Perivascular spaces in eccrine spiradenoma. A clue to its histological diagnosis. Am J Dermatopathol 1995;17:266-70.
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| 7. | Cooper PH, Frierson HF Jr, Morrison AG. Malignant transformation of eccrine spiradenoma. Arch Dermatol 1985;121:1445-8.
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| 8. | Berçin S, Kutluhan A, Metin A, Süren D. Malignant eccrine spiradenoma on the lateral margin of nose as an infrequent localization. Indian J Dermatol 2009;54:173-5.
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| 9. | Amiya KN, Rashmi K, Devinder MT. Eccrine spiradenoma with chondroid syringoma in Blaschkoid distribution. Indian J Dermatol 2009;75:600-2.
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| 10. | Michal M. Spiradenoma associated with apocrine adenoma component. Pathol Res Prac 1996;192:1135-9.
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| 11. | Kim MH, Cho E, Lee JD, Cho SH. Giant vascular eccrine spiradenoma. Ann Dermatol 2011;23(Suppl 2):S197-200.
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| 12. | Chen G, Cheuk W, Cheung JS, Chan JK. Carcinosarcoma ex eccrine spiradenoma of the vulva: Report of the first case. Int J Gynecol Pathol 2011;30:301-5.
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What is new?
1. Uncommon site of presentation of eccrine spiradenoma (i.e., knee)
2. Atypia (which may progress to frank malignancy) has been observed in
this case.
[Figure 1], [Figure 2], [Figure 3], [Figure 4] |
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| This article has been cited by | | 1 |
Eccrine Spiradenoma of the Forehead: A Case Report |
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| Xin-Xin Yang, Qian Zhang, Li-Ming Huang, Wei Zhang, Xin-Feng Wu | | International Journal of Dermatology and Venereology. 2020; 3(2): 121 | | [Pubmed] | [DOI] | |
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