Cases Of Syringocystadenoma Papilliferum Research Articles

A verrucous tumor of the leg: Atypical case of Syringocystadenoma Papilliferum.

Syringocystadenoma Papilliferum (SCAP) is a benign adnexal tumor. Most of the cases present with a solitary lesion in the head and neck region at birth or in early childhood.In fact, only two cases of SCAP on the lower leg have been reported in the literature. We report an atypical case by its location and its clinical aspect.

Unusual sites with variable presentation of de novo syringocystadenoma papilliferum: A case series.

Syringocystadenoma papilliferum (SCAP) is an uncommon, benign adnexal neoplasm that occurs de novo or in an organoid nevus. It usually presents as a skin-coloured to pink, solitary, smooth, hairless plaque, verruca or nodule frequently on the scalp and forehead. SCAP may be present at unusual sites including the arm, forearm, trunk and chest. Diagnosing SCAP arising on uncommon sites is difficult owing to its varied presentation. Mostly, they are wrongly diagnosed clinically and found to be SCAP only on histopathology. We present this study of cases of SCAP with unusual location and varied presentations, which were clinically misdiagnosed. The five cases included in this study were patients attending the dermatology outpatient department in a tertiary care centre in North India. The clinical presentation and the involved sites were noted by the dermatologist, and a clinical diagnosis was made. Biopsy of the lesions was sent for histopathological examination. There are five patients in the series - four are male and one female, with age ranging from 28 to 48 years. Locations included the forearm, arm, anterior chest wall and lateral abdominal wall. The lesions clinically appeared as warty papule or nodules and one lesion appeared within a plaque, with the average duration being 5.3 years. In all five patients, the lesions were clinically suspected to be either tuberculosis verruca cutis or nodular basal cell carcinoma or dermatofibroma sarcoma protuberans (DFSP) or verruca or fibroma or pyogenic granuloma. A confirmatory diagnosis of SCAP was made for all the patients on histopathology. We are presenting five cases which were misdiagnosed clinically due to the unusual location and varied presentation to emphasise the importance of histopathology in diagnosing SCAP arising de novo, which was clinically misdiagnosed. Also, we present this case series to alert the clinicians about the likelihood of SCAP on unusual locations with varied clinical presentation.

Syringocystadenoma Papilliferum of the Anogenital Area and Buttocks: A Report of 16 Cases, Including Human Papillomavirus Analysis and HRAS and BRAF V600 Mutation Studies.

Syringocystadenoma papilliferum (SCAP) is a benign tumor most commonly located on the head and neck area often associated with nevus sebaceus. In its usual location, the human papillomavirus (HPV) DNA and mutations in the RAS/mitogen-activated protein kinase signaling pathway have been detected in SCAP. We studied 16 cases of SCAP in the anogenital areas and buttock where this neoplasm is rare and attempted to find out whether SCAP in these sites have different histopathological and molecular biological features. It seems that there is no significant difference between the morphology of anogenital SCAP and SCAP in other locations. Several tumors in our cohort demonstrated features resembling those seen in warts, but HPV DNA was not found in these lesions. On the contrary, we identified DNA of HPV high-risk types in some tumors without HPV-related morphology. Our study confirms the role of HRAS and BRAF V600 mutations in the pathogenesis of SCAP, including SCAP in the anogenital areas and buttock.

Contiguous verrucous proliferations in syringocystadenoma papilliferum: A retrospective analysis with additional evaluation via mutation-specific BRAFV600E immunohistochemistry.

Syringocystadenoma papilliferum (SCAP) is an uncommon cutaneous adnexal proliferation. There have been several reports describing collision lesions of SCAP and verruca, although little is known about the frequency of this association. Molecular testing has revealed the BRAFV600E mutation in a large proportion of SCAP cases, although its expression pattern has not been previously evaluated. In this retrospective analysis, we explored the potential histopathological association between verruca and SCAP. We also evaluated mutation-specific BRAFV600E expression in these lesions by immunohistochemistry. Cases of SCAP diagnosed over a 7-year period were closely reviewed for the presence of contiguous verrucous proliferations. Additional sections were cut and stained using the BRAFV600E-specific clone VE1 antibody. Contiguous verrucous proliferations were identified in 9 out of 12 identified cases. Furthermore, expression of the BRAFV600E mutation was identified in 7 out of 12 cases. Interestingly, in SCAP associated with endophytic verrucous proliferations (n = 4), expression of BRAFV600E was found in both the glandular and the contiguous hyperplastic squamous epithelium. Overall, these findings suggest that contiguous verrucous proliferations in SCAP are common. Both components of the neoplasm may express the BRAFV600E mutation, which is suggestive of a common origin.

Cytokeratin 15 expression in apocrine mixed tumors of the skin and other benign neoplasms with apocrine differentiation

To clarify the features of apocrine mixed tumors (AMT) of the skin among benign neoplasms with apocrine differentiation in their relationship to follicular stem cells, we investigated the immunohistochemical expression of CK15 (LHK15 and C8/144B), which is a relatively specific marker of hair follicle stem cells in the bulge, in 35 cases of eight different benign neoplasms with presumed apocrine differentiation. All eight cases of AMT of the skin showed CK15 immunostaining of the neoplastic cells, and all four cases of syringocystadenoma papilliferum, all five cases of spiradenoma, and both cases of cylindroma also showed a focally positive reaction to CK15. None of the other benign neoplasms with presumed apocrine differentiation showed CK15 expression. In AMT of the skin, the proportion of CK15-positive cells in the follicular or sebaceous differentiation group (78.8%, average of four cases) was significantly higher than the group without this differentiation (8.8%, average of four cases). AMT of the skin are unique among benign neoplasms with apocrine differentiation in their substantial and constant CK15 expression, suggesting that they derive from multipotent epithelial stem cells in the bulge. AMT of the skin with follicular or sebaceous differentiation are considered to show an immature stage of apocrine differentiation still rich in stem cells or to originate from stem cells with an incompletely established apocrine fate. The partially positive reaction for CK15 in syringocystadenomas papilliferum and spiradenoma/cylindroma may depend on the ability to express CK15 in stem cells with an apocrine fate or result from the follicular and apocrine nature of this neoplasm.

Immunohistochemical Study of Lysozyme in Various Benign Sweat Apparatus Tumors

We investigated the existence of lysozyme in various sweat apparatus tumors by adopting the avidin-biotin-peroxidase complex method. Positive reactions for lysozyme were found in four cases of apocrine cystadenoma, hidradenoma papilliferum, and an apocrine sweat apparatus benign tumor resembling "apocrine spiradenoma", all of which derive from apocrine sweat apparatus. On the other hand, in ten cases of syringoma, eccrine hidrocystoma, clear cell hidradenoma, eccrine spiradenoma, and eccrine poroma, which derive from eccrine sweat apparatus, no positive stainings for lysozyme were obtained. In four out of five cases of mixed tumor of the skin, the apocrine type exhibited positive results. Two cases of syringocystadenoma papilliferum were negative for lysozyme. The investigation of lysozyme in various sweat apparatus tumors is useful in determining the direction of differentiation in these tumors.

Immunohistochemistry of Gross Cystic Disease Fluid Protein (GCDFP-15) in 65 Benign Sweat Gland Tumors of the Skin

Sixty-five cases of benign sweat gland tumors of the skin were studied for the expression and localization of gross cystic disease fluid protein-15 (GCDFP-15) by immunoperoxidase methods. There was positive staining of tumors of probable apocrine differentiation in 10 of 11 cases of apocrine hidrocystoma and five of five cases of hidradenoma papilliferum. There was no immunoreactivity for GCDFP-15 for tumors of probable eccrine differentiation, including five cases of eccrine hidrocystoma, five cases of eccrine poroma, five cases of eccrine spiradenoma, 10 cases of clear cell hidradenoma, and nine cases of syringoma. There was variable positive staining of tumors of more uncertain histogenesis, including eight of eight cases of syringocystadenoma papilliferum, one of four cases of cylindroma, and two of two cases of chondroid syringoma (mixed tumor). The above data support a functional differentiation of the expression of GCDFP-15 by eccrine compared to apocrine glandular epithelium with benign tumor development.

Syringocystadenoma papilliferum. A plasmacytotropic tumor.

Seven cases of syringocystadenoma papilliferum were studied by immunohistochemical methods for the presence of IgG, IgA, IgM, and secretory component in tumor epithelial cells and IgG, IgA, and IgM in plasma cells underlying the tumor epithelium. Six of seven cases showed IgA positivity within epithelial cells, one case showed faint intraepithelial IgG staining, and none stained for IgM. Four of five cases were positive for secretory component. The plasma cells were predominantly of the IgG and IgA class. These findings suggest that the association of plasma cells with this tumor is a consequence of epithelial attraction via a mechanism similar to that utilized by glands of the normal secretory immune system.