Eccrine acrospirome: causes, symptoms, diagnosis, treatment

Eccrine acrospiroma (syn: nodular hydratenoma, light celled hydratenoma, syringoepithelioma, solid cystic hydratenoma, ekrinnaya adenoma of the clear cell type) is usually a solitary intradermal, exophytic or mixed-type node 0.5-2 cm in diameter or larger, hemispherical in shape, of a dense elastic consistency , on a wide base, covered with unchanged skin, sometimes ulcerating. In 15-20% of cases, a clear liquid is isolated from the tumor and soreness is registered approximately in the same percentage. It is localized in any part of the body, but more often on the face, scalp and neck. Duration of the tumor - from several months to 12 years. The average age of patients - women 55 years, men - 51 years.

[1], [2], [3], [4], [5], [6], [7], [8]

Pathomorphology of the eccrine acrospiroma

The ekrinnaya acrospiroma is represented by compact cell clusters in the form of clearly contoured layers or a group of nodules located in the upper layers of the dermis, without connection with or in close connection with the epidermis. Almost half of the cases of clusters of cells are located in cysts or cystic structures with a double-row epithelial lining. Neoplasm in most cases is represented by three types of cells, the ratio of which can vary in different parts 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 the capillaries and are prone to beam grouping. The second type is clearly contoured cells of round or polygonal shape with a light cytoplasm rich in glycogen. Tumors with a predominance of light cells are considered by some authors as an independent nosological form from the group of hydradenomas. The third type is flat epithelial cells, sometimes forming typical foci of dyskeratosis in the form of "twists". Within the lobules among the cellular elements, different sizes of the lumen of the tubular structures are revealed, although the latter may be absent. Often, cystic fissures containing a weakly eosinophilic homogeneous substance are found. The lumens of the tubular structures are lined with cubic cells of the ducts of the eccrine glands or by prismatic secretory cells exhibiting holocrine secretion.

Histochemical studies of ekkrinnoj akrospiromy have shown, that in light cells there is a glycogen, the high concentration of the enzymes characteristic for ekkrinnoj differentiations, especially fosforilazy and respiratory enzymes is noted. In spindle-shaped basaloid-type cells, the activity of alkaline phosphatase was not detected, and in the case of electron microscopy - microfibrils, which excludes their myoepithelial affiliation. These cells, on the contrary, contain tonofilament, resulting in K. Hashimoto et al. (1967) refer them to the cells of the outer layer of the acrosiringum.

Histogenesis of the acrospinal ecrony

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

Differentiate the eccrine acrospirom from tricholemma, since keratinization foci and glycogen content are observed in both cases. However, tumor foci of tricholemma are surrounded around the periphery by cells that have a palisadic orientation.