Indian Journal of Dermatology
CASE REPORT
Year
: 2007  |  Volume : 52  |  Issue : 2  |  Page : 99--101

Late onset eccrine angiomatous hamartoma treated with intralesional sclerosant: A case report and brief review of literature


Feroze Kaliyadan1, V Sundeep2, KR Hiran3, Ziad Fouzia3,  
1 Department of Dermatology, Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India
2 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India
3 Department of Pathology, Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India

Correspondence Address:
Feroze Kaliyadan
Department of Dermatology, Amrita Institute of Medical Sciences and Research Center, Elamakkara, Kochi - 26, Kerala
India

Abstract

A 29-year-old male patient presented to us with multiple swellings on his left leg associated with localized sweating and occasional throbbing pain. Based on the clinical features and histopathology, a diagnosis of Eccrine angiomatous hamartoma was made. The patient showed good response with regression of lesions after four intralesional injections of ethoxysclerol (polidocanol). We present this as a case of late onset eccrine angiomatous hamartoma with multiple lesions, responding to treatment with intralesional ethoxysclerol.



How to cite this article:
Kaliyadan F, Sundeep V, Hiran K R, Fouzia Z. Late onset eccrine angiomatous hamartoma treated with intralesional sclerosant: A case report and brief review of literature.Indian J Dermatol 2007;52:99-101


How to cite this URL:
Kaliyadan F, Sundeep V, Hiran K R, Fouzia Z. Late onset eccrine angiomatous hamartoma treated with intralesional sclerosant: A case report and brief review of literature. Indian J Dermatol [serial online] 2007 [cited 2020 Nov 24 ];52:99-101
Available from: https://www.e-ijd.org/text.asp?2007/52/2/99/33288


Full Text

 Introduction



Eccrine angiomatous hamartoma (EAH) (also known as sudoriparous angioma) is a rare cutaneous lesion. Though EAH is a benign lesion, treatment in the form of excision or sclerosants may be required in some symptomatic cases. [1] We report a case of EAH treated with intralesional sclerosant injections.

A 29-year-old male patient, working in an offshore oil rig in Angola (Africa), presented to us with complaints of multiple swellings on the left leg, gradually increasing in size over the last 15 years. The patient had sought medical advise primarily because he noticed occasional throbbing pain in the lesions over the last few months. The pain according to the patient was worsened by prolonged standing and cold exposure. On examination multiple firm nodules were seen mainly over the posterior aspect of the lower leg. The nodules varied in size from 2 cm (centimeters) to 5 cm. Lesions had a bluish hue and were nontender on palpation [Figure 1]. On firmly stroking the surface beaded drops of perspiration were visible over the lesion [Figure 2]. Based on the history and clinical features a possibility of Eccrine angiomatous hamartoma was considered. This was confirmed by histopathological studies, which revealed circumscribed foci composed of a mixture of mature eccrine glands, capillary-sized blood vessels and lipomatous tissue [Figure 3],[Figure 4],[Figure 5],[Figure 6]. A Doppler study was done to assess the depth of the lesion. Doppler study revealed a diffuse subcutaneous predominantly hypoechoic lesion (greater than 1 cm thickness) seen in the subcutaneous plane of calf.

The case was discussed with the plastic surgeon to consider excision and grafting. However considering the diffuse nature and the depth of the lesion excision was deferred. Instead a trial with sclerosing agents was tried. The patient was given five sittings of intralesional sclerosant with 2 ml of 3% ethoxysclerol (polidocanol), with an interval of two weeks between the sittings. By the end of the fifth sitting, the lesion had regressed considerably [Figure 7],[Figure 8]. When the patient was reviewed a month after the last sitting the lesions had further regressed and the patient reported that his symptoms had significantly improved with the patient being free of pain even after prolonged standing or strenuous physical activity.

 Discussion



EAH is a rare cutaneous tumor, characterized histologically by proliferation of eccrine secretory coils and ducts, surrounding capillary angiomatous channels and occasionally other minor elements. [2] Typically EAH presents as a solitary flesh-colored or violaceous, papule or plaque appearing at birth or during childhood usually showing an acral prediliction. It may or may not be associated with hyperhidrosis and pain. [3],[4] EAH is considered to be a variant of the eccrine nevus. Though it classically presents in childhood, there have been reports of adult onset cases some presenting as late as 65 years. [5],[6]

Histopathology EAH typically demonstrates the presence of a mixture eccrine structures and vascular channels. [7] EAH has been seen to be associated with a number of other histological elements including adipose tissue, mucin and neural elements. [7],[8],[9] Immunohistochemical studies on EAH have been done demonstrating the presence of antigens commonly found in eccrine glands like carcinoembryonic antigen (CEA) and S-100 protein. [2] Other antigens demonstrated include CD34, CD44, human nerve growth factor receptor and Ulex europaeus antigens. [2]

Medical intervention is generally indicated either for the pain or for cosmetic reasons. The treatment of choice is surgical excision, [4] however in cases in which surgical removal may pose practical difficulties, other options like intralesional sclerosants and lasers have been tried. [5],[10]

Aethoxysclerol (also called aethoxysklerol, polidocanol) is a common sclerosant used in the treatment of varicose veins. It acts by provoking damage to the endothelium by attacking the lipids of the membrane, thereby causing cell damage and inflammation. Aethoxysclerol is also a local anesthetic and is therefore the injection process is relatively painless. [11] The use of sclerosants is generally safe though complications like necrosis and scarring can be rarely seen. An isolated case of cardiac arrest attributed to polidocanol sclerotherapy has been reported. [12]

In our case medical intervention was planned mainly because of the associated pain. Our case had certain uncommon features like the presence of multiple lesions, the presence of lipomatous tissue in histology and the relatively older age of onset. Because of the more diffuse and extensive distribution of the lesion, surgical excision posed practical difficulties. Hence,we opted for intralesional sclerosants which we found worked quite effectively in causing the lesion to regress.

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