Papillary Syringoadenoma: Causes, Symptoms, Diagnosis, Treatment

Papillary syringoadenoma (syn: papillary ekkrinnaya adenoma, papillary syringocystadenoma, papillary syringocystadenomatous nevus, papillary tubular adenoma is a rare tumor, is localized more often on the skin of the distal parts of the extremities in the form of a clearly delineated nodule of a hemispherical shape, sometimes with a semi-translucent wall, 0.5- 1.5 cm Occasionally, erosion occurs in the central part, the age of patients varies widely, from 9 years to 81. In most cases, patients over the age of 40. The ratio of men to women 1: 5.

[1], [2], [3], [4], [5]

Pathomorphology of papillary syringoadenoma

In the area of the element, papillomatosis is expressed, epidermal outgrowths penetrate the dermis with the formation of cysts. Parenchyma tumors are papillary growths (papillomatosis), covered with two- or multi-row glandular epithelium. Cells facing the lumen, high, prismatic, with oval nuclei and eosinophilic cytoplasm, usually with signs of active holocrine secretion. Cells facing the dermal surface are shallow, cuboidal with rounded dark nuclei and scant cytoplasm. Papillae are rich in stroma with lymphohistiocytic infiltration. In addition to the papillae and cysts, tumors are often found intertwined with tubular structures lined with a two-layered epithelium. In the lumens of tubules, a plentiful granular eosinophilic PAS + content resistant to diastase, and necrotic detritus. Some consider it as necrotizing epithelium, others - as a substance secreted by secretion. The epidermis over the papillae often ulcerates, acanthosis is noted along the edges of the ulceration. Diagnostic sign of papillary syringo adenoma is the presence of a dense, composed of plasmocytes infiltrate in the dermis, especially in the papillae of the stroma of the tumor. Often in the tumor, undeveloped sebaceous glands and hair structures are found.

Histogenesis of papillary syringoadenoma

With respect to the histogenesis of the papillary syringo adenoma, there is still no complete clarity, since not all cases of this tumor have classic secretory signs of the apocrine glands. Thus, electron microscopic examination shows partially ductal, partly eccrine secretion differentiation of tumor elements; In addition, K. Hashimoto et al. (1987) revealed in the epithelial cells of the tumor EKH5 and EKN6 - anti-keratin antibodies, which, in the opinion of the authors, are specific for ekrinnoy differentiation. K. Nizume (1976), on the contrary, revealed differentiation in the direction of the intrafollicular and intradermal divisions of embryonic apocrine glands. Using histochemical methods, Landry and R. Winkelmann (1972) revealed histoenzymatic criteria for apocrine secretion (pronounced endoxyl esterase and acid phosphatase activity), while phosphorylase, an enzyme characteristic of exocrine cells, is not detected in this tumor. Such discrepancies in the evaluation of the histogenesis of the papillary syringo adenoma enable some authors to assert that this nosological form actually represents a collection of neoplasms, partly with eccrine, partly with apocrine differentiation.

Malignant analogs of eccridic hydradenes, according to O.R. Hornstein and F. Weidner (1979), are malignant ecrinic tumors (picarcinoma), malignant clear-celled hydra- nooma, adenocystic or chondroid type of adenocarcinoma, which was included in the WHO classification (1980) under the name "chondroid syringocarcinoma."