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Eccrine Spiradenoma - Submitted on: Tuesday January, 08, 2002
Contributed by:John Bissonette, M.D., Artur Zembowicz, M.D., Ph.D.
Eccrine spiradenoma was first separated from the braod group of benign adnexal neoplasma Kersting in 1956. It is a very characteristic neoplasm that shows a substantial degree of differentiation towards the eccrine unit.

Definition:
Eccrine spiradenoma is a benign eccrine neoplasm consisting of two cell types, peripoheral small dark cells and large pale cells, that form primitive eccrine coils and luminal structures. Together these cells form well-defined lobules in the dermis with no connection to the overlying epidermis.

Clinical Features:
Eccrine Spiradenomas usually form a solitary skin colored or bluish nodule 1-2 cm. in diameter. Sometimes these lesions can reach 5 cm in diameter. They usually occur on the upper body of young adults. Occasionally eccrine spiradenomas form multiple nodules that exhibit a linear or zosteriform pattern. Most lesions are founnd to be tender, and about half of them are painful.

Histology:
Figures
(Click on an image for a larger view)
Figure 1. Low magnification view of eccrine spiradenoma
Figure 2. Medium magnification view of eccrine spiradenoma
Figure 3. High magnification view of eccrine spiradenoma
At lower power several sharply demarcated lobules ("blue balls in the dermis") are seen in the dermis with no connections to the epidermis (Figure 1). Sometimes the neoplasm may consist of only one large lobule, but this is more the exception than the rule. The tumor lobules are smooth and round and delimited by basement membrane material. The high cellular density of these lobules gives them a deeply basophilic appearance.

At high magnification the cells that make up the lobules are arranged in intertwining cords (Figure 2, Figure 3). The cellular cords sometimes enclose small areas of edematous connective tissue. There are two cell types make up these cords. The more peripheral of the two cell types contains small dark nuclei. The cells that make up the center of these cords are larger with pale nuclei. These larger cells often exhibit some degree of luminal differentiation. The center of the luminal structures frequently contains granular eosinophilic PAS positive/diastase resistant material. Occasionally the large polyganal cells form rosettes in lieu of lumina. Electron microscopy shows that the small peripheral dark cells are undifferentiated basal cells while the larger pale cells are intermediate in their differentiation. In some instances the pale cells show numerous microvilli and well developed tonofilament zones resembling ductal cells, whereas in other instances have few thin microvilli and resemble secretory cells.These tumors can show varying degrees of hylinization with hyaline material present in the stroma between the cellular cords or within the cords as droplets. Other features characteristic of this tumor is edema of the stroma around the tumor lobules and peripheral vascularity and lymphocytic infiltrate along the border of these lobules. In addition T-cell lymphocytes are often sprinkled within the tumor lobules reminiscent of thymic architecture.   


Treatment:
Simple excision is the treatment of choice.

Bibliography:
  • Kersting DW, Helwig EB: Eccrine spiradenoma. Arch Dermatol 73:199-227, 1956.
  • Munger BL, Berghorn BM, Helwig EB. A light and electron-microscopic study of a case of multiple eccrine spiradenoma. J Invest Dermatol 1962; 38:289
  • Hashimoto K, Lever WF. Histogenesis of skin appendage tumors. Arch Dermatol 1969; 100:356.
  • Hashimoto K, Gross BG, Nelson RG et al. Eccrine spriadenoma: Histochemical and electron microscopic studies. J Invest Dermatol 1966; 46:347.
  • Shelly WB, Wood MG. A zosteriform network of spiradenoma. J Am Acad Dermatol 1980; 2:59.
  • Tsur H, Lipskier E, Fisher BK. Multiple linear spiradenomas. Plast Reconstr Surg 1981; 68:100.
  • Mambo NC. Eccrine spiradenoma: Clinical and pathological study of 49 tumors. J Cutan Pathol 1983;10:312
  • Cotton DW, Slater DN, Rooney N, et al: Giant vascular eccrine spiradenomas: A report of two cases with histology, immunohistology, and electron microscopy. Histopathology 10:1093-1099, 1986.
  • Kao GF, Laskin WB, Weiss SW: Eccrine spiradenoma occurring in infancy, mimicking a mesenchymal tumor. J Cutan Pathol 17:214-219, 1990.
     

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