Eccrine acrospiroma: causes, symptoms, diagnosis, treatment

Eccrine acrospiroma (syn.: nodular hidradenoma, clear cell hidradenoma, syringoepithelioma, solid-cystic hidradenoma, clear cell eccrine adenoma) is usually a solitary intradermal, exophytic or mixed node with a diameter of 0.5-2 cm or more, hemispherical, densely elastic consistency, on a wide base, covered with unchanged skin, sometimes ulcerating. In 15-20% of cases, a clear fluid is released from the tumor and pain is recorded in about the same percentage. It is localized in any part of the body, but most often on the face, scalp and neck. The duration of the tumor is from several months to 12 years. The average age of patients - women - 55 years, men - 51 years.

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Pathomorphology of eccrine acrospiroma

Eccrine acrospiroma is represented by compact cellular clusters in the form of clearly contoured layers or groups of nodules located in the upper layers of the dermis, without connection with the epidermis or in close connection with it. In almost half of the cases, cell clusters are located in cysts or cyst-like structures with a two-row epithelial lining. The neoplasm in most cases is represented by three types of cells, the ratio of which can vary in different areas of the same tumor. The main cellular element of acrospiroma is polygonal or oval cells with intensely stained cytoplasm and moderately hyperchromic monomorphic nuclei. These cells are closely adjacent to each other, often located around capillaries and tend to be bundled. The second type is clearly contoured cells of a round or polygonal shape with light cytoplasm rich in glycogen. Tumors with a predominance of light cells are considered by some authors as an independent nosological form from the hidradenoma group. The third type is flat epithelial cells, sometimes forming typical foci of dyskeratosis in the form of "swirls". Inside the lobules, among the cellular elements, lumens of tubular structures of various sizes are revealed, although the latter may be absent. Cystic clefts containing a weakly eosinophilic homogeneous substance are often found. The lumens of tubular structures are lined with cubic cells of the ducts of eccrine glands or prismatic secretory cells exhibiting holocrine secretion.

Histochemical studies of eccrine acrospiroma have shown that the light cells contain glycogen, and a high concentration of enzymes characteristic of eccrine differentiation, especially phosphorylase and respiratory enzymes, is noted. In the spindle-shaped basaloid cells, no alkaline phosphatase activity was detected, and electron microscopy showed no microfibrils, which excludes their myoepithelial origin. These cells, on the contrary, contain tonofilaments, as a result of which K. Hashimoto et al. (1967) attribute them to the cells of the outer layer of the acrosyringium.

Histogenesis of eccrine acrospiroma

Histoenzymatic and electron microscopic data indicate a tendency of the tumor toward bipolar differentiation, which, on the one hand, indicates a connection with the pore of the sweat gland, and on the other, differentiation in the direction of the cells of the intradermal part of the sweat gland ducts, as well as the epithelium of the secretory sections.

Eccrine acrospiroma is differentiated from trichilemmomas, since foci of keratinization and glycogen content are observed in both cases. However, the tumor foci of trichilemmomas are surrounded on the periphery by cells that have a palisade-like orientation.