Benign Skin Adnexal Tumor Research Articles

Extra-digital glomus tumour of the forehead: a case report of a solitary solid histopathologic subtype

Background: Glomus tumours (GT) are benign neoplasms that develop from neuro-myoarterial structures known as “glomus bodies” involved in temperature and blood pressure control. GT rarely occur in the head and neck region, and the specific location of the glomus tumour on the forehead is even more uncommon. Case presentation: We report the case of a 36-year-old female who presented with painless swelling on the forehead of one year duration with a progressive increase in size. Physical examination showed a small forehead swelling with an initial clinical diagnosis of a sebaceous cyst. The patient had local excision of forehead swelling which was submitted for histopathologic examination. Discussion: The initial histological differential diagnosis included glomus tumour, benign skin adnexal tumour and PEComa. The formalin-fixed-paraffin embedded tissue blocks of the lesion were then subjected to immunohistochemical analysis. The tumour cells were negative for cytokeratin and positive for SMA and S100. Based on the morphology and immunohistochemical staining characteristics of the tumour cells, a diagnosis of glomus tumour was made. Conclusion: Glomus tumour occurring on the forehead is uncommon. Therefore, a high index of suspicion is needed for diagnosis. Immunohistochemistry may be needed to confirm the diagnosis and rule out other close differential diagnoses.

Giant solitary trichoepithelioma: A rare trichogenic tumor

Giant solitary trichoepithelioma (GST) is a rare benign skin adnexal tumor which arises from hair follicle. It represents more mature end of the spectrum of trichoblastoma, and a unique type of trichoepithelioma that is most common in elderly but can be present at any age. Only few cases are reported worldwide and some of which have showed malignant transformation in to basal cell carcinoma. This case is presented due to its scarce presentation over neck region and difficulty encountered in diagnosis of the case.

Cytomorphology of skin adnexal tumors and its correlation with histopathology in a tertiary care center

Objectives: Even though fine-needle aspiration cytology (FNAC) can be successfully used for describing the cytomorphology of skin adnexal tumors and can help in identification of them as benign or malignant, histopathology remains the gold standard in confirmation of diagnosis. Skin adnexal tumors are a large and diverse group and are relatively less commonly encountered in routine practice; hence, knowledge of cytological features of these lesions is crucial for their appropriate management. The present study aims to evaluate the cytomorphological features of skin adnexal tumors on FNAC smears and their correlation with the histopathology. Material and Methods: This is a retrospective study of FNAC of 60 cases of subcutaneous and dermal swellings over a period of 4 years from August 2018 to August 2022 in a tertiary care center. Results: In the 60 cases of skin adnexal tumors evaluated, most cases were within the 2nd to 4th decade with male predominance. The FNA smears were helpful in picking up the nature of skin adnexal tumors, as in our case series, malignant lesions were 8.3% and benign were 91.7%. Majority adnexal lesions were of follicular or sebaceous differentiation. Histological diagnosis was available in 38 cases. Cytological diagnosis in 34 cases was concordant with histopathology. There was discrepancy observed in two cases which were reported as benign skin adnexal tumor but later turned out to be sebaceous carcinoma on histopathology. Conclusion: Even though histopathology being the gold standard for confirmation of diagnosis, in the current era of minimally invasive procedures, FNAC stands out as a valuable modality and can be a promising alternative to diagnose skin adnexal tumors and understand their cytomorphology as the data are limited about it.

Cytomorphological features of syringocystadenoma papilliferum mimicking pilomatricoma at a rare location and in an unusual age group: A cytological diagnostic challenge.

Syringocystadenoma papilliferum (SCAP) is a rare, benign skin adnexal tumor of apocrine or eccrine differentiation usually occurring in the head and neck region of children. It is a difficult entity to diagnose clinically and even cytological diagnosis remains challenging due to overlapping and masquerading cyto-morphological features with other benign cutaneous adnexal tumors. Here we present, one such intriguing case of SCAP with its cytological features mimicking those of pilomatricoma. Moreover, the lesion was located at the right lower abdomen, which in itself is a rare site and its presentation was in an adult male which is an unusual age group. However, fine needle aspiration cytology still remains a very useful investigation for cutaneous tumors as it helps in differentiating benign lesions from malignant and metastatic neoplasms and therefore aids in correct treatment and follow-up of patients.

Clinicopathological Spectrum of Benign Skin Adnexal Tumors in the Pakistani Population: A Single-Center Study.

Background Skin adnexal tumors (SATs) are categorized per the site of origin, for example, hair follicles, sebaceous glands, and sweat glands. In our population, there is limited information related to the clinicopathological characteristics of these tumors. Management and prognosis depend largely upon the morphological type of the tumor. In this study, we assessed the disease spectrum and most prevalent subtypes of benign SATs. Methodology An analysis of 565 cases was conducted in this cross-sectional study between January 2018 and December 2022, using a non-probability consecutive sampling approach. Patient age, gender, site of involvement, and diagnosis were documented according to the fourth edition of the WHO Classification of Skin Tumors published in 2018. Data were entered and analyzed using SPSS Version 26.0 (IBM Corp., Armonk, NY). Results Our study had 565 patients, out of which 271 (47.9%) were males and 294 (52.1%) were females. The mean age was 40.97±19.3 years (range, 2-100 years). Anatomical site variations were as follows, head and neck (n=336, 59.4%), extremities (n=124, 22%), trunk (n=84, 14.9%), and genital areas (n=21, 3.7%). The most common histological subtypes of benign SATs were sweat gland origin (n=350, 62.0%), followed by hair follicle origin (n=161, 28.5 %), and sebaceous gland origin (n=54, 9.5%). Conclusion Sweat gland tumors were the most prevalent class of benign SATs in our study, in which hidradenoma and poroma were the most frequent subtypes. Hair follicle origin was the second most prevalent class of tumors with pilomatricoma being the most frequent. Sebaceous tumors were overall uncommon; nevus sebaceous of Jadasshon was the most common tumor in this class.

A study on clinicopathological spectrum of nodular hidradenoma

<p>Nodular hidradenoma (NH) is an uncommon benign skin adnexal tumor that presents usually as solitary intradermal nodule. This study aims to discuss the various clinicopathological features of NH as it mimics other adnexal tumors, malignancies or metastasis particularly in uncommon sites. Twenty-four cases of histo-pathologically diagnosed NH during study period from 2016 to 2021were taken up for study. Their clinical, gross and microscopic findings were collected from records. Most tumors occurred in head in fifth decade. Cystic change was seen in majority of the cases. Tumor had dual population of cells with predominant clear cell component in five cases. Definitive cytological diagnosis was difficult requiring excision biopsy. Characteristic clinical and histological features help to distinguish NH from other potential mimickers NH need wide excision as they can recur and rarely transform in to malignancy.</p>

Ossifying pilomatricoma: A rare entity

Pilomatricomas are rare benign skin adnexal tumors usually occurring in the head, neck or upper extremities of children and young adults. Ossifying pilomatricoma is a still rarer entity. Here, a case of a 22-year-old lady is reported, who presented with a firm to hard swelling in the right side of the neck. Histopathological examination of the resected specimen showed features of ossifying pilomatricoma with the formation of bone marrow elements. The patient was free of recurrence on 6-month follow-up. The case highlights a rare entity with characteristic histopathological features.

Biphasic Sarcomatoid Sweat Gland Carcinoma With Ductal Epithelial And Spindled Myoepithelial Cell Components (Malignant Mixed Tumor Of Skin)

Abstract Introduction/Objective Sweat gland carcinomas are a group of malignant skin adnexal tumors that are difficult to diagnose due to their rarity, wide morphologic variation, and limited literature on diagnosis and classification. These tumors may appear bland and morphologically resemble benign skin adnexal tumors, or may appear poorly differentiated and mimic metastatic carcinoma especially from a breast primary. Biphasic sweat gland carcinomas are an even rarer entity, with only few cases reported in literature, and have been described to consist of a well- differentiated ductal epithelial component and a poorly differentiated, sarcomatoid, spindle cell component. Methods/Case Report Our case report describes a 53 year old female referred to our institution for diagnosis of an excised skin lesion of the right upper arm, which had been slowly growing for 8 years. The histology revealed a biphasic malignant neoplasm involving the dermis and subcutis. The tumor consisted of an epithelial cell component with glandular and squamoid morphology and positive for CK5/6, CK7, and CAM5.2, and a spindled myoepithelial cell component with sarcomatoid morphology and positive for S100, vimentin, and p63. Stains for CK20, ER, PR, PAX8, CEA, and TTF1 were negative. The histological and clinical findings favored a primary skin adnexal tumor, rather than a metastatic lesion. The patient underwent wide local excision of the lesion given that margins of the original excision were indeterminate. The histology of this re-excision demonstrated the same biphasic tumor with ductal epithelial and sarcomatoid myoepithelial cell components positive for the same stains. Although margins were negative in this re-excision, 3-4 months later, the patient developed dyspnea with multiple new pulmonary and hilar masses discovered on imaging, and new-onset headache with a frontal lobe mass discovered on brain imaging. These masses were biopsied/resected, and revealed to be metastases of the original cutaneous tumor positive for the same markers. Results (if a Case Study enter NA) NA Conclusion This case report describes a rare, diagnostically challenging case of a biphasic sweat gland carcinoma with ductal epithelial and sarcomatoid myoepithelial cell components, which demonstrated aggressive behavior with distant metastasis. These tumors are a clinicopathological quandary given their rarity and the paucity of literature on their characterization.

Cytological Evaluation of Palpebral Lesions: An Insight into its Limitations Aided with Histopathological Corroboration.

Context:Eyelids by virtue of its unique histomorphology give rise to multitudes of different pathological conditions. Appropriate preoperative cytological diagnoses of these cases are necessary to determine their optimal therapy.Aims:The aims of this study were to evaluate the utility of various cytological techniques in diagnosing the definite pathology for palpebral lesions and thereby to highlight the drawbacks associated with cytology in this context.Materials and Methods:Fine-needle cytology with or without applying the aspiration was the preferable method. Ulcerated lesions were sampled through scrapings.Results:Totally 62 cases were examined. Cytologically, 22 lesions were diagnosed as nonneoplastic, 38 lesions were neoplastic, and nondiagnostic material was obtained twice. Malignant tumors predominated among the neoplastic cases. Basal cell carcinoma (BCC) was the most common malignancy observed. On histopathological corroboration, benign skin adnexal tumor was found to be the most frequently misinterpreted entity. Two (out of four cases) of those tumors were confirmed as melanocytic nevus and BCC. A single case of squamous cell carcinoma was also cytodiagnostically erred into sebaceous carcinoma.Conclusions:Cytologically palpebral pathologies, including the neoplastic ones, are at times vulnerable to misinterpretation. To avert such dilemma, it is better to readily excise any recurrent lesion, basaloid neoplasm, or any necrohemorrhagic lesion presumptive of overshadowing the neoplastic pathology underneath.

CHONDROID SYRINGOMA OF MEDIAL CANTHUS – A RARE CASE REPORT

Chondroid syringoma of the skin is a rare, benign skin adnexal tumor, usually exhibited as a slowly growing intradermal or subcutaneous nodule, typically located in the head-and-neck region. Chondroid syringoma usually appears on the face; medial canthus being a rare site of predilection. The diagnosis is usually made retrospectively based on histological features of the surgically excised mass which is usually asymptomatic. We present a rare case of a 35-year-old man who presented with a painless, subcutaneous nodule in the medial canthus of the right eye. The diagnosis of chondroid syringoma was rendered. To the best of our knowledge, only one case of chondroid syringoma of the medial canthus has been documented in the literature. Histopathological examination is mandatory for arriving at the diagnosis. It should be considered in the differential diagnosis of all the slowly growing nodular lesions in the face.

Four years retrospective study of skin adnexal tumors: Histomorphology and special stain study

Background: Skin adnexal tumors (SATs) are uncommon and may cause diagnostic problems. Objective: The aim of this study is to determine the frequency of SATs with respect to their clinicopathological features over a period of 4 years. Materials and Methods: It was a retrospective, descriptive study. Formalin-fixed, paraffin-embedded sections were stained with hematoxylin and eosin for histopathological analysis and with special stains as Alcian blue/periodic acid–Schiff stain for confirmation. Results: A total number of cases that were diagnosed as SATs were 18; benign tumors were 17 (94.4%) and one malignant tumor (5.6%). Most tumors were of sweat gland origin (61.1%) followed by hair follicle origin (33.3%) then by sebaceous gland origin (5.6%). The age ranged from 3 to 51 years and male: female ratio was 1.57:1. The head-and-neck region was the most common location (44.4%). Hidradenoma (35.3%) was the most common benign tumor followed by pilomatrixoma (23.5%) and spiradenoma (17.6%) while sebaceous carcinoma was the only malignant tumor detected. Conclusion: The overall incidence of SATs was found to be very low. Benign SATs were more as compared with the malignant tumors. A careful histopathological assessment is essential for accurate diagnosis.

Clinical and histopathological profile of benign appendageal tumours of skin: a descriptive study from Andhra Pradesh

<p class="abstract"><strong>Background:</strong> Skin adnexal tumors are those neoplasms that arise from pilosebaceous units, eccrine sweat glands or apocrine sweat glands. Vast majority of appendageal tumors are benign and most of the benign skin adnexal tumors are asymptomatic papules or nodules and often difficult to diagnose clinically. The objective of the study was to study the clinical and histological features suggestive of benign skin appendageal tumors.</p><p class="abstract"><strong>Methods:</strong> This is a descriptive observational study conducted among 50 patients presenting with clinical features suggestive of benign skin appendageal tumors attending at outpatient department of DVL, Kurnool medical college/ GGH, Kurnool between January 2016 to June 2017.<strong></strong></p><p class="abstract"><strong>Results:</strong> The highest age incidence was in the age group of 21-30 years- 24 cases (48%). The commonest tumors in this study were eccrine gland tumors i.e 43 cases (86%). Syringomas were the commonest tumors (38 cases, 76%). Commonest presenting lesion was papule (82%). Commonest site is face (94%).</p><p class="abstract"><strong>Conclusions:</strong> The commonest tumors recorded were eccrine gland tumors (86%). Syringomas constitute the largest group (76%) followed by trichoepitheliomas (6%). The highest age incidences was in 3<sup>rd</sup> decade (48%), followed by 4<sup>th</sup> decade (42%).</p>

Cytomorphological diagnosis of pilomatricoma in an unusual location

Pilomatricomaisa benign skin adnexal tumor that is derived from hair matrix. Pilomatricomas usually present in children and adolescents but can occur at any age. Pilomatricomas are generally asymptomatic and found mainly in the head and neck area. Upper extremities not a common site for this lesion. It israrely identified on the chest, trunk, or lower extremities. They areeasily diagnosed on histology due to their typical histological features but diagnosis in cytology is generally difficult as the features may mimic other skin lesions and leads to misdiagnosis. Here we describe a case of pilomatricoma of left arm in a 25 year old male, which was diagnosed on cytology. The cytological smears were cellular and consist of aggregates of anucleate squames, basaloid cells and shadow cells. Subsequent histopathologyof the excised lesion confirmed the diagnosis of Pilomatricoma. Through thisreport we highlight the cytomorphological features that helps us in arriving the correct diagnosis of Pilomatricomaon Fine needle aspiration cytology (FNAC) smears.

Nodular Cystic Basal Cell Carcinoma of the Trunk: a Diagnostic Dilemma in an Unsuspecting Youth

Basal cell carcinoma (BCC) commonly affects the elderly and is mostly confined to the head and neck region. Only 10% of all cases occur on the trunk. We presented a case of bullous lesion on the abdomen in a young male, initially diagnosed by clinicians as a vascular nevus. Histopathological examination and immunohistochemistry (IHC) revealed it to be Nodular cystic variant of BCC. This rare variant of BCC morphologically resembles benign skin adnexal tumor of Eccrine syringofibroadenoma. Ber Ep4 positivity on IHC established the correct diagnosis. This case highlights that nodular cystic variant of BCC can be a diagnostic dilemma for clinicians and pathologists.

Histopathological study of 26 rare skin adnexal tumours over 5 years - a diagnostic dilemma!

Background: Skin adnexal tumors (SATs) are rare in Indian subcontinent and hence pose difficulty in diagnosis as they may histopathologically look like more common skin malignancies in this region. Several studies on SATs have been carried out in Western countries but very few in this region. Objective: To correlate SATs with age, sex, and location and determining its incidence in the Department of Pathology at Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha and to address dilemmas in diagnosing them. Materials and Methods: A total of 26 cases were included in this study from January 2010 to June 2015 with respect to incidence of adnexal tumors, age, and sex distribution. All slides were stained with hematoxylin and eosin and then findings were corroborated with special stains such as PAS and reticulin wherever required. Result: Of all, 92.31% (24/26) were benign and 7.69% (2/26) were malignant adnexal tumors. The sebaceous gland tumors constituted the largest group (42.31% 11/26) cases followed by the sweat gland tumor (34.62%, 9/26) cases and hair follicle tumor (23.10%, 6/26) cases. Overall male:female ratio was 1.16:1. The most common age group was 40–49 years and the commonly affected body part was head and neck region (61.53%, 16/26) followed by trunk (15.38%, 4/26). Eccrine poroma, sebaceous hyperplasia, and pilomatricoma were the most common benign tumors and two sebaceous carcinoma were the only two malignant tumors seen. Conclusion: The incidence of benign skin adnexal tumors was more as compared to the malignant tumors. Malignant tumors were seen in older age.

Syringocystadenoma papilliferum: A case series and review of the literature in Indian context

Syringocystadenoma papilliferum (SCAP) is a rare benign skin adnexal tumour commonly (50%) found in infants and children and less commonly (15–30 %) found at puberty and in adolescents. It usually presents as irregular papule or smooth hairless plaque on the scalp and forehead, however, nodular or verrucous transformation is reported at puberty. Microscopically it is characterized by ducts connecting to the surface, containing papillary processes and lined with two epithelial layers. Head and neck is the commonest (75%) and lower extremity is the rarest reported location. Here we report a case series of SCAP at five different locations throughout the body. The clinical and histological features and the differential diagnoses are also discussed.

Clinical significance of CYLD downregulation in breast cancer

Cylindromatosis (CYLD) is a tumor suppressor gene that is mutated in familial cylindromatosis, a rare autosomal dominant disorder associated with numerous benign skin adnexal tumors. CYLD is now known to regulate various signaling pathways, including transforming growth factor-β signaling, Wnt/β-catenin signaling, and NF-κB signaling by deubiquitinating upstream regulatory factors. Downregulation of CYLD has been reported in several malignancies; however, the clinical significance of CYLD expression in many malignancies, including breast cancer, remains to be elucidated. This study investigated the clinical significance of CYLD in breast cancer and its roles in tumor progression. We evaluated CYLD expression in matched normal breast tissue samples and tumor breast tissue samples from 26 patients with breast cancer and in a series of breast cancer cell lines. In addition, by means of immunohistochemistry, we investigated CYLD protein expression and its clinical significance in 244 breast cancer cases. We also analyzed the effects of CYLD repression or overexpression on breast cancer cell viability, cell migration, and NF-κB activity with or without receptor activator of NF-κB ligand (RANKL) stimulation. Breast cancer tissues demonstrated significantly reduced CYLD mRNA expression compared with normal breast tissues. Downregulation of CYLD promoted cell survival and migratory activities through NF-κB activation, whereas CYLD overexpression inhibited those activities in MDA-MB-231 cells. As an important finding, CYLD overexpression also inhibited RANKL-induced NF-κB activation. Our immunohistochemical analysis revealed that reduced CYLD protein expression was significantly correlated with estrogen receptor negativity, high Ki-67 index, high nuclear grade, decreased disease-free survival, and reduced breast cancer-specific survival in primary breast cancer. Moreover, reduced CYLD expression was an independent factor for poor prognosis in breast cancer. CYLD downregulation may promote breast cancer metastasis via NF-κB activation, including RANKL signaling.

Chondroid syringoma of the medial canthus.

Chondroid syringoma, or pleomorphic adenoma of the skin, is a rare, benign skin adnexal tumor. It is usually exhibited as a slowly growing intradermal or subcutaneous nodule, typically located in the head and neck region. Because of the unremarkable clinical symptomatology of this rare tumor, the diagnosis is exclusively made retrospectively based on histological confirmation of the surgically excised tumor. We present a rare case of a chondroid syringoma located in the left medial canthus of a 58-year-old man. The patient had no symptoms and decided to excise it for cosmetic reasons only. Local excision with a macroscopic wide cuff of normal tissue was done, without destroying the aesthetic and functional structures, since the defect was restored by a finger flap. One year postoperatively, the patient has remained disease-free. Chondroid syringoma usually appears in the face but the location in the medial canthus is not mentioned in the literature for the last twenty years.

Histopathological Study of Skin Adnexal Tumours—Institutional Study in South India

Objective. The aim of this study was correlation of skin adnexal tumors with age, sex, and location and determining its incidence in the Department of Pathology at Dr. D. Y. Patil Medical College and Hospital, Kolhapur, Maharashtra. Material and Methods. 56 cases were included in this study from Jan 2004 to June 2010 with respect to incidence of adnexal tumors, age, and sex distribution. All slides were stained with haematoxylin and eosin and then findings were corroborated with special stains like PAS and reticulin wherever required. Results. 80.36% (45/56) were benign and 19.64% (11/56) were malignant adnexal tumors. The sweat gland tumors constituted the largest group (42.86% 24/56) cases followed by the hair follicle tumors (35.71%, 20/56) of cases and sebaceous gland tumors (21.43%, 12/56) cases. Overall male : female ratio was 1.07 : 1. The commonest age group was 51–60 years and the commonest affected body part was head and neck region (64.28%, 36/56) followed by trunk (14.28%, 8/56). Clear cell hidradenoma and pilomatricoma were commonest benign tumors and sebaceous carcinoma was the only malignant tumor seen. Conclusion. The incidence of benign skin adnexal tumors was more as compared to the malignant tumors. Malignant tumors were seen in older age group, usually over 50 years of age.

PP179: Chondroid syringoma of the medial canthal: Case report

Chondroid syringoma, or Pleomorphic adenoma of the skin, is a rare, benign skin adnexal tumour. It is usually exhibited as a slowly growing intradermal or subcutaneous nodule, typically located in the head and neck region. Because of the unremarkable clinical symptomatology of this rare tumour, the diagnosis is exclusively made retrospectively based on histological confirmation of the surgically excised tumour. We present a rare case of a Chondroid Syringoma located in the left medial canthal of a 58-year-old man. The patient had no symptoms and decided to excise it for cosmetic reasons only. Local excision with a macroscopic wide cuff of normal tissue was done, without destroying the aesthetic and functional structures, since the defect was restored by a finger flap. One year postoperatively, the patient has remained disease-free. Chondroid syringoma usually appears in the face but the location in the medial canthal is not mentioned in the literature the last twenty years.