Syringoma Workup

  • Author: Christopher R Shea, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 17, 2010
 

Histologic Findings

Syringoma is a tumor that is located mostly in the superficial dermis. Syringomas are composed of numerous small ducts embedded in a sclerotic stroma (see image below).

Histologic section of syringoma demonstrates numerHistologic section of syringoma demonstrates numerous small ducts in a sclerotic stroma. Note the tadpole-shaped ducts.

The walls of the ducts are usually lined by 2 rows of cuboidal-to-flattened epithelial cells and contain a lumen filled with periodic acid-Schiff–positive, eosinophilic, amorphous debris. Some of the ducts have elongated tails of epithelial cells that produce the characteristic comma-shaped or tadpole appearance. Keratinous cysts can be found on the surface. Rarely, tumor cells may appear clear as a result of glycogen accumulation (see image below).

Histologic section of clear-cell syringoma. Histologic section of clear-cell syringoma.

In a research context, enzyme immunohistochemical tests demonstrate the presence of eccrine enzymes such as leucine aminopeptidase, succinic dehydrogenase, and phosphorylase in syringomas. The immunohistochemical pattern of cytokeratin expression indicates differentiation toward both the uppermost part of the dermal duct and the lower intraepidermal duct (ie, sweat duct ridge).[15] Distinguishing between eccrine and apocrine ducts may be difficult.

The histologic differential diagnosis includes sclerosing (morphealike) basal cell carcinoma and desmoplastic trichoepithelioma. Importantly, syringoma should be distinguished from microcystic adnexal carcinoma, which has similar histologic features but tends to infiltrate the deep dermis and subcutaneous tissue. Therefore, partial superficial biopsies may be problematic in this situation.

Chondroid syringoma is a different benign adnexal tumor with a characteristic myxoid cartilaginous matrix that is analogous to the benign mixed tumor (pleomorphic adenoma) of the salivary glands.

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Contributor Information and Disclosures
Author

Christopher R Shea, MD  Professor and Chief, Section of Dermatology, Department of Medicine, University of Chicago

Christopher R Shea, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society of Dermatopathology, Arthur Purdy Stout Society, Association of Professors of Dermatology, Chicago Dermatological Society, Dermatology Foundation, Illinois Dermatological Society, International Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Ibiayi Dagogo-Jack  University of Chicago Pritzker School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Guitart J, Rosenbaum MM, Requena L. 'Eruptive syringoma': a misnomer for a reactive eccrine gland ductal proliferation?. J Cutan Pathol. Mar 2003;30(3):202-5. [Medline].

  2. Marzano AV, Fiorani R, Girgenti V, Crosti C, Alessi E. Familial syringoma: report of two cases with a published work review and the unique association with steatocystoma multiplex. J Dermatol. Mar 2009;36(3):154-8. [Medline].

  3. Uede K, Yamamoto Y, Furukawa F. Brooke-Spiegler syndrome associated with cylindroma, trichoepithelioma, spiradenoma, and syringoma. J Dermatol. Jan 2004;31(1):32-8. [Medline].

  4. Schepis C, Siragusa M, Palazzo R, Ragusa RM, Massi G, Fabrizi G. Palpebral syringomas and Down's syndrome. Dermatology. 1994;189(3):248-50. [Medline].

  5. Urban CD, Cannon JR, Cole RD. Eruptive syringomas in Down's syndrome. Arch Dermatol. Jun 1981;117(6):374-5. [Medline].

  6. Ong GC, Lim KS, Chian LY. Eruptive syringoma in a patient with trisomy 21. Singapore Med J. Feb 2010;51(2):e46-7. [Medline].

  7. Koh MJ. Multiple acral syringomas involving the hands. Clin Exp Dermatol. Oct 2009;34(7):e438. [Medline].

  8. Petersson F, Mjornberg PA, Kazakov DV, Bisceglia M. Eruptive syringoma of the penis. A report of 2 cases and a review of the literature. Am J Dermatopathol. Jul 2009;31(5):436-8. [Medline].

  9. Yung CW, Soltani K, Bernstein JE, Lorincz AL. Unilateral linear nevoidal syringoma. J Am Acad Dermatol. Apr 1981;4(4):412-6. [Medline].

  10. Shelley WB, Wood MG. Occult syringomas of scalp associated with progressive hair loss. Arch Dermatol. Jul 1980;116(7):843-4. [Medline].

  11. Dupre A, Carrere S, Bonafe JL, Christol B, Lassere J, Touron P. [Eruptive generalized syringomas, milium and atrophoderma vermiculata. Nicolau and Balus' syndrome (author's transl)]. Dermatologica. 1981;162(4):281-6. [Medline].

  12. Hamsch C, Hartschuh W. Microcystic adnexal carcinoma - aggressive infiltrative tumor often with innocent clinical appearance. J Dtsch Dermatol Ges. Sep 25 2009;[Medline].

  13. Kao PH, Hsu CK, Lee JY. Clinicopathological study of Fox-Fordyce disease. J Dermatol. Sep 2009;36(9):485-90. [Medline].

  14. Jeon EK, Cho AY, Lee Y, Seo YJ, Park JK, Lee JH. Multiple yellow-brown papules on the neck and anterior trunk of a patient with diabetes mellitus. Clin Exp Dermatol. Jul 2009;34(5):643-4. [Medline].

  15. Eckert F, Nilles M, Schmid U, Altmannsberger M. Distribution of cytokeratin polypeptides in syringomas. An immunohistochemical study on paraffin-embedded material. Am J Dermatopathol. Apr 1992;14(2):115-21. [Medline].

  16. Jamalipour M, Heidarpour M, Rajabi P. Generalized eruptive syringomas. Indian J Dermatol. 2009;54(1):65-7. [Medline]. [Full Text].

  17. Al Aradi IK. Periorbital syringoma: a pilot study of the efficacy of low-voltage electrocoagulation. Dermatol Surg. Oct 2006;32(10):1244-50. [Medline].

  18. Park HJ, Lee DY, Lee JH, Yang JM, Lee ES, Kim WS. The treatment of syringomas by CO2 laser using a multiple-drilling method. Dermatol Surg. Mar 2007;33(3):310-3. [Medline].

  19. Wang JI, Roenigk HH Jr. Treatment of multiple facial syringomas with the carbon dioxide (CO2) laser. Dermatol Surg. Feb 1999;25(2):136-9. [Medline].

  20. Cho SB, Lee SH, Lee SJ, Lee JE, Kim DH. Syringoma treated with pinhole method. J Eur Acad Dermatol Venereol. Jul 2009;23(7):852-3. [Medline].

 
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The multiple, small, yellow papules in the lower lid and upper part of the cheek correspond to syringomas. The blue cyst in the inner canthus is an eccrine hidrocystoma. Courtesy of Mark S. Brown, MD, University of South Alabama Medical Center.
Eruptive syringomas.
Histologic section of syringoma demonstrates numerous small ducts in a sclerotic stroma. Note the tadpole-shaped ducts.
Histologic section of clear-cell syringoma.
 
 
 
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