Eccrine Spiradenoma:Three Cases Report And Review Of The Literature

OBJECTIVE:To review the clinical manifestation, diagnosis and treatment of eccrine spiradenoma.METHOD:Report three cases of eccrine spiradenoma followed by a review of the current literature about the clinical manifestations, pathological examination, immunohistochemical, diagnosis, treatment and prognosis.PATIENTS:Case 1. A 47-year-old woman visited our hospital with a subcutaneous nodule on her left shoulder for one year with pain for one month. Physical examination:A subcutaneous nodule about the size of peanuts on the left shoulder, which is soft, activite, no adhesion with the surrounding tissue. Case 2. A 30-year-old woman had a subcutaneous nodule on her left breast for three years. Physical examination:A subcutaneous nodule can be touched on the left breast, which is about a bean size, soft, apparently tenderness, and the axillary lymph nodes were not palpable. Case 3. A 55-year-old woman presented with a painful mass in her right groin which lasted for three months. Physical examination:There is a subcutaneous nodule about the size of mung bean in the right inguinal, which has clear boundary and apparently tenderness. Histopathology:Under low power magnification, spiradenoma appeared as a solid neoplasm composed of a single or few nodules. These aggregations were round with smooth borders and involved the full thickness of the dermis. Under higher magnification, two kinds of cells could be seen. Dark cells were small, basaloid cells with hyperchromatic nuclei located at the periphery, whereas pale cells, which were larger with vesicular nuclei and ample pale cytoplasm, tended to be near the centre of the clusters, Immunohistochemistry:Case 2: CK7, CKP, EMA, CEA were weakly positive. SMA was focally positive. Case 3: CEA was weakly positive, CK7 and CKP were positive.RESULTS:Combined with clinical manifestations, pathological and immunohistochemical examination, three patients were diagnosed as eccrine spiradenoma.CONCLUSION:Eccrine spiradenoma is a relatively uncommon benign skin adnexal tumor. The disease did not show serological and radiological specificity. The diagnosis depends on pathological and immunohistochemical method, however it is sometimes difficult to distinguish with cylindrical tumor histologically. And the lack of specific immune markers proposal makes it more difficult to diagnosis. It’s recommended to use CEA, EMA, CK, Nestin, S-100 and other immune markers to improve the accuracy of diagnosis. Operation is the first choice of treatment for complete resection, postoperative follow-up of this disease should be insisted. A long-term eccrine spiradenoma may rise the possibility of malignant transformation. Malignant eccrine spiradenoma can be treated with radiotherapy and chemotherapy, but the results are not satisfied.