Squamous Syringometaplasia Research Articles

Clinical and Histopathologic Spectrum of Toxic Erythema of Chemotherapy: A Series of 56 Cases From a Single Institution.

Although many individual cases and small series of toxic erythema of chemotherapy (TEC) have been described, the full spectrum of findings is not well understood. To provide a comprehensive review of the clinical and histopathologic features of TEC with an emphasis on novel histopathologic findings. We searched our electronic medical record for "toxic erythema of chemotherapy" or "neutrophilic eccrine hidradenitis." Fifty-six cases meeting clinical and histopathologic criteria were identified. The electronic medical record and accompanying hematoxylin and eosin-stained slides were retrospectively reviewed. The clinical findings were heterogeneous but included classic presentations such as intertriginous eruptions (34%) and acral erythema (25%). The most common histopathologic features were apoptotic keratinocytes (95%), basal vacuolar change (91%), and epithelial dysmaturation (79%). Eccrine squamous syringometaplasia was seen in over half of the cases (33/56; 59%), whereas neutrophilic eccrine hidradenitis was uncommon (16%). Interestingly, many cases showed prominent interstitial histiocytes (55%). Other novel findings included irregular orthohyperkeratosis (23%), irregular epidermal hyperplasia (14%), and acantholysis (9%). As a retrospective study, it is subject to information bias. This is the largest reported series of TEC. In addition to confirming previously reported features, we identify novel histopathologic findings to add to the spectrum of TEC.

Hand-foot syndrome histopathologically presenting eccrine squamous syringometaplasia due to pembrolizumab after lenvatinib treatment.

Hand-foot syndrome histopathologically presenting eccrine squamous syringometaplasia due to pembrolizumab after lenvatinib treatment.

Radiation-Induced Eccrine Squamous Syringometaplasia With Perineural Invasion.

Eccrine squamous syringometaplasia (ESS) is a benign metaplastic reaction of eccrine ducts that occurs in response to injury and can be a histologic mimic of squamous cell carcinoma (SCC). Reported is an 82-year-old man undergoing Mohs surgery for presumed SCC diagnosed in a field of radiation dermatitis. After 3 Mohs stages, the peculiar squamous proliferation was recognized as ESS and the procedure was aborted. Complicating the interpretation of the Mohs frozen section was the presence of perineural invasion because perineural invasion has not been previously reported to occur with ESS. The histologic features used to distinguish ESS from SCC are discussed.

Extensive Eccrine Squamous Syringometaplasia Mimicking Squamous Cell Carcinoma on Histopathology

Eccrine Squamous Syringometaplasia (ESSM) is a histologically distinctive skin eruption occurring predominantly in acral or intertriginous areas presenting as erythematous macules, papules or patches. It is a response of eccrine ducts and glands to any injury or inflammation. The cuboidal epithelium of eccrine ducts and glands undergoes metaplasia and transforms to keratinised squamous epithelium in ESSM. Other types of metaplastic changes encountered are squamous, mucinous and adenomatous. In squamous syringometaplasia, the metaplastic squamous cells form lobules and florid types can pose a diagnostic dilemma, which if not well understood may lead to an erroneous diagnosis of neoplasia. Literature suggests ESSM as a condition associated with another pathogenic stimuli or therapy; however florid ESSM is very rare. Hereby, the authors present a case report of a 43- year- old male who presented florid ESSM mimicking well-differentiated Squamous Cell Carcinoma (SCC). The present case presented with a non healing elevated lesion on anterior aspect of right leg with itching. Similar lesions were not present in any other part of the body. The patient did not have history of any systemic disease or drug intake. The lesion was excised and sent for histopathology. On gross examination the skin showed irregular thickening and foci of erosion. Microscopy showed acanthotic, hyperkeratotic epidermis and dermal ESSM. There were irregular clusters of metaplastic squamous cell in dermis, resembling invasive islands of SCC. Meticulous examination revealed lobulated architecture of ESSM, lack of individual cell keratinisation/significant atypia or mitosis. The present report highlights the significance of histopathological diagnosis of benign squamous proliferations which can mimic malignancy and cause undue stress to the patient.

Inguinal patch in mpox (monkeypox) virus infection and eccrine syringometaplasia: report of two cases with in situ hybridization and electron microscopy findings.

We report two cases of cutaneous mpox virus infection (formerly known as monkeypox), one of which presented with unusual clinical findings, and demonstrate their histopathological, RNA in situ hybridization (ISH) and ultrastructural characteristics. We observed in two patients with polymerase chain reaction-confirmed mpox virus infection squamous syringometaplasia of the eccrine ducts, a finding that can aid in recognizing this disease and is explained by the demonstration of viral mRNA within eccrine epithelium by ISH.

Eccrine Squamous Syringometaplasia Associated With Lichen Sclerosus et Atrophicus.

Eccrine squamous syringometaplasia (ESS) has been associated with several conditions including morphea, linear scleroderma, and burns. It is yet to be reported in lichen sclerosus et atrophicus (LSA). We describe a bullous LSA plaque on the forearm of a woman with pre-existing genital LSA and vitiligo. Besides the histopathological findings of bullous LSA, numerous small irregular squamoid structures were present in the mid and upper dermis always above the normal eccrine glands. The histopathology, periodic acid-Schiff stain, and positive immunostains for P63, low molecular weight keratins 8&18, epithelial membrane antigen, and carcinoembryonic antigen supported the diagnosis of ESS. The pathogenesis of ESS in LSA may be related to ischemia, inflammation, and fibrosis.

Painful Plantar Rash with Systemic Symptoms

Painful Plantar Rash with Systemic Symptoms

Bleeding erosions in a man with psoriasis

A man in his 40s presented to us with generalised erosions for past 3 days (figure 1A,B). He was diagnosed with psoriasis and initiated on weekly low-dose (15 mg) oral...

Neutrophilic Eccrine Hidradenitis in a Primary CNS Lymphoma Patient Receiving High-Dose Chemotherap

Neutrophilic Eccrine Hidradenitis (NEH) is a rare inflammatory neutrophilic dermatosis that primarily affects eccrine sweat glands. Although it has been described in various malignancies and with therapeutic agents, it is most frequently associated with cytarabine-based induction chemotherapy for acute myelogenous leukemia. We report a rare case of NEH in a 63-year-old male with a medical history significant for primary CNS lymphoma. The patient was treated with high-dose thiotepa, busulfan, and cyclophosphamide (BuCy) followed by autologous stem cell transplantation, which was complicated by bacteremia and septic shock. Approximately three weeks after chemotherapy, he developed localized bright red, desquamating plaques on his bilateral outer hips, posterior upper thighs, and buttocks. Histological findings revealed neutrophils infiltrating and surrounding the eccrine glands accompanied by squamous syringometaplasia, apoptotic keratinocytes, and basovacuolar changes. This case serves to highlight that NEH should be considered in the differential diagnosis of erosive, erythematous plaques, especially in patients with lymphoproliferative tumors receiving high-dose chemotherapy, in order to provide appropriate clinical management.

Taxanes-induced cutaneous eruption: another histopathologic mimicker of malignancy.

Paclitaxel and docetaxel are antineoplastic drugs that bind the microtubules, producing the arrest of mitoses, which may be seen histopathologically. These histopathologic changes may simulate an intraepidermal keratinocytic malignant neoplasm, and an accurate diagnosis may be only established by clinicopathological correlation. We report six cases of cutaneous eruptions by taxanes in which a striking cytotoxic effect was evident histopathologically. Cutaneous biopsies were obtained in each patient. Atypical starburst-like or ring-like mitoses and dyskeratosis on basal and suprabasal layers of the epidermis. Areas of squamous syringometaplasia were also seen in one case. These findings were interpreted as expression of mitotic arrest due to taxanes. Similar changes have been described in association with other chemotherapeutic drugs such as vincristine, podophyllin and its derivative etoposide; colchicine, busulfan and maytansine, but cases like ours due to taxanes are exceptional or under-reported. Dermatopathologists should be aware of these effects in order to interpret carefully cutaneous biopsy specimens of patients receiving taxanes.

Eccrine squamous syringometaplasia in a patient with plaque‐type morphea

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Coexistence of Eccrine Squamous Syringometaplasia and Graft-Versus-Host Disease in a Patient with Secondary Myelodysplastic Syndrome

Coexistence of Eccrine Squamous Syringometaplasia and Graft-Versus-Host Disease in a Patient with Secondary Myelodysplastic Syndrome

Simulators of Squamous Cell Carcinoma of the Skin: Diagnostic Challenges on Small Biopsies and Clinicopathological Correlation

Squamous cell carcinoma (SCC) is a common and important primary cutaneous malignancy. On skin biopsies, SCC is characterized by significant squamous cell atypia, abnormal keratinization, and invasive features. Diagnostic challenges may occasionally arise, especially in the setting of small punch biopsies or superficial shave biopsies, where only part of the lesion may be assessable by the pathologist. Benign mimics of SCC include pseudoepitheliomatous hyperplasia, eccrine squamous syringometaplasia, inverted follicular keratosis, and keratoacanthoma, while malignant mimics of SCC include basal cell carcinoma, melanoma, and metastatic carcinoma. The careful application of time-honored diagnostic criteria, close clinicopathological correlation and a selective request for a further, deeper, or wider biopsy remain the most useful strategies to clinch the correct diagnosis. This review aims to present the key differential diagnoses of SCC, to discuss common diagnostic pitfalls, and to recommend ways to deal with diagnostically challenging cases.

Eccrine squamous syringometaplasia secondary to cutaneous extravasation of docetaxel: report of three cases

Eccrine squamous syringometaplasia is characterized by the metaplasia of cuboidal epithelial cells of the eccrine sweat ducts into squamous epithelial cells. It has been associated with several conditions including chemotherapy-related bilateral dermatitis, an entity that can take place in body areas rich in eccrine glands, as well as in acral erythema related to chemotherapy. Only a few cases because of cutaneous extravasation of chemotherapy have been previously reported. We report three cases of eccrine squamous syringometaplasia secondary to extravasation of docetaxel.

Eccrine squamous syringometaplasia associated with vemurafenib therapy

for genetic aberrations of the immune system that may play a role in predisposing individuals to developing MF. However, data on possible etiologic factors involved in the multistep carcinogenic mechanism are equivocal. In general, it is thought that MF represents a disease potentiated by chronic antigen stimulation resulting in clonally activated T cells with malignant potential. Infectious pathogens, both viral and bacterial, and chemical exposures have been implicated as possible inciting agents in MF; yet, evidence for causation was lacking. Skin-limited disease appears to be a result of clonal skin resident effector memory cells. Although the pathogenesis of MF remains unclear, associations between chronic dermatoses and MF have been described. Although our patient was not formally patch tested, it is plausible that an initial contact allergy from the sex hormones or chemical components of the contraceptive patch could have resulted in a robust, chronic dermatitis that enabled malignant transformation of a subset of CD4 cells. However, subsequent observations are necessary to validate this potential association between chronic dermatoses and MF.

Olanzapine-Induced Eccrine Squamous Syringometaplasia

Eccrine squamous syringometaplasia is a histopathologic pattern that has mainly been described in patients receiving chemotherapy. Its association to nonchemotherapeutic agents is rare, with very few cases reported in the literature. We present the case of a 55-year-old patient with schizophrenia, who developed a skin eruption 5 weeks after initiating treatment with olanzapine. The histopathologic study revealed squamous syringometaplasia of the dermal eccrine ducts.

Tamoxifen‐induced eccrine squamous syringometaplasia

A 74-year-old woman had carcinoma of her right breast for which surgery was performed. Four weeks following the start of tamoxifen therapy, she developed papules and plaques over her face, trunk and limbs. A skin biopsy showed perivascular and periadnexal mixed inflammatory cellular infiltrate with fibroplasia. Notably, the dermis also showed squamous epithelial islands, which in foci were noted to be closely associated with eccrine epithelium. This was confirmed with double peroxidase - alkaline phosphatase immunohistochemistry - the eccrine lumina highlighted with carcinoembryonic antigen (polyclonal) and the squamous metaplasia positive for cytokeratin 5/6. Eccrine squamous syringometaplasia was diagnosed. With close clinicopathological correlation, the cutaneous eruption was attributed to tamoxifen. Following discontinuation of the drug, the eruption resolved. Eccrine squamous syringometaplasia has been reported to occur in association with diverse conditions, including skin ulcers, burns and as a cutaneous adverse drug reaction, most commonly to chemotherapeutic drugs. This is believed to be the first report involving tamoxifen.

Chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia: Reappraisal of epidemiological, clinical, and pathological features

Chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia: Reappraisal of epidemiological, clinical, and pathological features

Chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia: Reappraisal of epidemiological, clinical, and pathological features

A characteristic cutaneous eruption related to the use of cytostatic chemotherapeutic drugs has been described in the literature. This condition appears to be characterized by an erythematous eruption, primarily affecting the intertriginous areas bilaterally, together with eccrine squamous syringometaplasia as the main histologic feature. We sought to establish the epidemiologic, clinical, and histologic characteristics of this poorly defined chemotherapy drug-related eruption. Retrospective data were collected from 21 consecutive patients with this clinical and histopathologic pattern who attended an oncology center between January 1999 and September 2009. Two skin biopsy specimens were obtained from all patients, with the first being taken within 24 hours of onset, and the second 72 to 96 hours after onset. The patients analyzed were predominantly female (72%), with a mean age of 52 years (range 10-69 years). The lesions presented clinically as bilateral erythematous plaques affecting both axillae (95%), groin (88%), and side aspects of the neck (48%). The main histologic feature in all cases was eccrine squamous syringometaplasia, characterized by the transformation of the eccrine cuboidal epithelium into two or more layers of squamous cells with intercellular bridges. The onset of the eruption appeared within 30 days (range 2-30 days) after the initiation of the cytostatic agent infusion. The lesions resolved with desquamation and postinflammatory hyperpigmentation. The same cutaneous pattern recurred in up to 50% of patients in whom the oncologist reintroduced the cytostatic treatment. Small sample size was a limitation. We suggest the term "chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia" to describe this distinctive entity, which is primarily associated with pegylated liposomal doxorubicin infusions and chemotherapeutic regimens used in autologous bone-marrow transplantation.

Chemotherapy-drug related symmetrical intertriginous dermatitis with underlying eccrine squamous syringometaplasia: Clinicopathologic study of 20 cases of a new drug reaction pattern

Chemotherapy-drug related symmetrical intertriginous dermatitis with underlying eccrine squamous syringometaplasia: Clinicopathologic study of 20 cases of a new drug reaction pattern