Spiradenoma Workup

  • Author: Noah S Scheinfeld, MD, JD, FAAD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 2, 2011
 

Laboratory Studies

In the case of malignant spiradenomas, tissue has been tested to determine the presence of hormonal receptors.

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Imaging Studies

MRI, CT, and radiography can be used to assess the presence of metastatic foci in the case of malignant spiradenoma.

Han et al[31] noted malignant spiradenomas distributed in several parts of a patient's body. On MRIs, the spiradenomas manifested as multiple dispersive foci with clear circumferences in the skin and subcutis. The spiradenomas demonstrated low-signal intensity on T1-weighted images and high-signal intensity on short tau inversion recovery images. Although the signal intensities of spiradenomas were not characteristic of other benign tumors, malignant spiradenomas should be in the differential diagnosis of the tumors of the skin and the subcutis.

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Procedures

A skin biopsy helps in establishing the diagnosis of these tumors. The best and really only treatment is surgical excision of these lesions one at a time.

Fine-needle cytology of a spiradenoma of the breast can be performed to aid in diagnosis.[32]

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Histologic Findings

Spiradenomas consist of 1 or more large, sharply delineated, basophilic nodules in the dermis (cannon balls or big blue balls in the dermis). The nodules of spiradenoma are unattached to the epidermis and sometimes extend into the subcutis. The nodules consist of groups of cells in cords, islands, and/or sheets. A trabecular arrangement of cells can be present.

The 2 types of cells in the nodules of spiradenomas are small, dark, basaloid cells with hyperchromatic nuclei and cells with large, pale, vesicular, and ovoid nuclei. Pale cells tend to be at the center of the lesions. Ductlike structures can also be present at the center of the lesions. The lesions are peppered with lymphocytes. Strands of cells are positive for cytokeratin, and the lumina are positive for carcinoembryonic antigen.

Upon electron microscope examination, spiradenomas consist of cellular sheets separated into lobules by strands of amorphous and fibrillar material. Examination reveals translucent polygonal or round cells with mitochondria, small vesicles, and sometimes glycogen granules, which are the dominant population of cells in spiradenomas. Sparse, dark cells are also often noted. Lumina are not always noted, but, when present, they can have microvilli on the lining cells.

Jitsukawa et al[33] performed electron microscopic studies of spiradenomas. Apposite morphologic aspects of the parenchyma were an adenoid cystic organization composed of epithelial, myoepithelial, and nonepithelial cell types; intracytoplasmic lumina were also present in epithelial cells. No evidence indicated that the parenchyma produced any type of secretion. The stroma ramified in and around the parenchyma, occupying extensive areas. The stroma formed tenuous septa of the loose connective tissue that contained embedded blood vessels and nerve fibers. Close examination revealed profiles of cystoid spaces resulting from stromal invagination into the parenchyma.

Meybehm and Fischer[34] noted that spiradenomas and cylindromas express S-100 protein, ascribed to eccrine differentiation within their tubular and large, pale-staining cells.

Tubular cells in both spiradenomas and cylindromas expressed human milk fat globulin and lysozyme, 2 markers associated with apocrine differentiation. In addition, antibodies to alpha–smooth muscle actin tightly mark the small basaloid cells of both spiradenomas and cylindromas.

Both spiradenomas and cylindromas demonstrate identical cytokeratin patterns. As with the sundry aspects of eccrine and apocrine units, the expression of keratins 7, 8, and 18 by spiradenomas and cylindromas demonstrates differentiation in the direction of a parentage from secretory tissue. On the other hand, the expression of keratin 14 in some of the neoplastic cells suggested ductal differentiation.

Ishihara et al[35] have used a novel monoclonal antibody IKH-4, which stains the eccrine secretory coil but not the apocrine secretory segment. They saw positive staining in eccrine hidradenoma, eccrine poroma, spiradenoma, papillary eccrine adenoma, eccrine hidrocystoma, syringoma, eccrine carcinoma, and syringocystadenoma papilliferum (1 case). They noted negative staining in apocrine adenocarcinoma, hidradenoma papilliferum, erosive adenomatosis of the nipple, and primary and metastatic adenocarcinomas. IKH-4 antibody helped researchers differentiate eccrine neoplasms from apocrine neoplasms and eccrine carcinoma from metastatic adenocarcinomas.

Yasui et al[36] noted that DF3 (CA15-3) monoclonal antibody detects the 20–amino acid sequence of epithelial mucin. In normal skin, DF3 antibody reacts strongly and constantly with sebaceous and secretory parts of eccrine and apocrine sweat glands. DF3 stains spiradenomas.

Saboorian et al[37] noted an interesting case of malignant spiradenomas of the breast. Microscopically, the malignant spiradenoma demonstrated the typical features of a spiradenoma, with areas of adenocarcinoma, squamous cell carcinoma, and sarcoma. The sarcomatous component consisted of rhabdomyosarcoma and osteosarcoma. Immunoperoxidase staining demonstrated p53 protein only in carcinomatous and sarcomatous cells.

Kurokawa et al[38] found spiradenomas co-expression of cytokeratin and smooth muscle actin, suggesting differentiation toward myoepithelial cells.

Ko et al[39] noted a giant vascular spiradenoma that occurred in a 56-year-old Korean woman. They noted that the clinical differential diagnosis included an angiomatous lesion, a determination based on its florid vascularity and hemorrhagic manifestations.

Immunohistochemical stainings demonstrated 3 types of cells, specifically (1) pale epithelial cells, (2) small basal cells, and (3) myoepithelial cells.

Ohtsuki et al[40] performed a detailed immunohistochemical analysis on spiradenoma tissue from a 40-year-old woman. Immunohistochemically, antibodies to cytokeratins (AE1/AE3, CAM5.2) and CK 5/6 stained diffusely positive in all tumor cells. The intermingled Langerhans cells did not stain diffusely positive. These Langerhans cells harbored interdigitated nuclei, and their cytoplasm was positive for S-100 protein and CD1a; additionally, their nuclei were occasionally positive for S-100 protein.

In these Langerhans cells, antibody-to-epithelial membrane antigen positively stained for the surface of both intracytoplasmic and true glandular lumina. With fine structural examination, Langerhans cells were noted among the tumor cells, extending fine irregular processes among the tumor cells. Birbeck granules manifested clearly within the cytoplasm of the Langerhans cells. Intracytoplasmic lumina with microvilli on their surfaces occurred in some tumor cells. In these examinations of spiradenoma, 15 Langerhans cells were seen per low-power field.

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Contributor Information and Disclosures
Author

Noah S Scheinfeld, MD, JD, FAAD  Assistant Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, and New York Eye and Ear Infirmary; Private Practice

Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Optigenex Consulting fee Independent contractor

Specialty Editor Board

Evan R Farmer, MD  Clinical Professor of Pathology and Dermatology, Department of Pathology, Virginia Commonwealth University School of Medicine

Evan R Farmer, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, and International Society of Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Consulting fee Consulting; Celgene Honoraria Safety Monitoring Committee; GSK - Glaxo Smith Kline Consulting fee Consulting; TenXBioPharma Consulting fee Safety Monitoring Committee

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

References

  1. Kerstein DW, Helwig EB. Eccrine spiradenoma. AMA Arch Derm. Mar 1956;73(3):199-227. [Medline].

  2. Ekmekci TR, Koslu A, Sakiz D. Congenital blaschkoid eccrine spiradenoma on the face. Eur J Dermatol. Mar-Apr 2005;15(2):73-4. [Medline].

  3. Scheinfeld NS, Tarlow MM, Burgin S. Blaschkoid eccrine spiradenomas. Cutis. Jul 2002;70(1):73-5. [Medline].

  4. Dabska M. Malignant transformation of eccrine spiradenoma. Pol Med J. 1972;11(2):388-96. [Medline].

  5. Bumgardner AC, Hsu S, Nunez-Gussman JK, Schwartz MR. Trichoepitheliomas and eccrine spiradenomas with spiradenoma/cylindroma overlap. Int J Dermatol. May 2005;44(5):415-7. [Medline].

  6. Clarke J, Ioffreda M, Helm KF. Multiple familial trichoepitheliomas: a folliculosebaceous-apocrine genodermatosis. Am J Dermatopathol. Oct 2002;24(5):402-5. [Medline].

  7. Kazakov DV, Schaller J, Vanecek T, Kacerovska D, Michal M. Brooke-Spiegler syndrome: report of a case with a novel mutation in the CYLD gene and different types of somatic mutations in benign and malignant tumors. J Cutan Pathol. Aug 2010;37(8):886-90. [Medline].

  8. Dijkhuizen T, van den Berg E, Nikkels PG, Hoekstra HJ, de Jong B. Cytogenetics of a case of eccrine spiradenoma. Hum Pathol. Sep 1992;23(9):1085-7. [Medline].

  9. Mambo NC. Eccrine spiradenoma: clinical and pathologic study of 49 tumors. J Cutan Pathol. Oct 1983;10(5):312-20. [Medline].

  10. Yildirim S, Akoz T, Akan M, Ege GA. De novo malignant eccrine spiradenoma with an interesting and unusual location. Dermatol Surg. Apr 2001;27(4):417-20. [Medline].

  11. Granter SR, Seeger K, Calonje E, Busam K, McKee PH. Malignant eccrine spiradenoma (spiradenocarcinoma): a clinicopathologic study of 12 cases. Am J Dermatopathol. Apr 2000;22(2):97-103. [Medline].

  12. Chou SC, Lin SL, Tseng HH. Malignant eccrine spiradenoma: a case report with pulmonary metastasis. Pathol Int. Mar 2004;54(3):208-12. [Medline].

  13. Kao GF, Laskin WB, Weiss SW. Eccrine spiradenoma occurring in infancy mimicking mesenchymal tumor. J Cutan Pathol. Aug 1990;17(4):214-9. [Medline].

  14. Kazakov DV, Soukup R, Mukensnabl P, Boudova L, Michal M. Brooke-Spiegler syndrome: report of a case with combined lesions containing cylindromatous, spiradenomatous, trichoblastomatous, and sebaceous differentiation. Am J Dermatopathol. Feb 2005;27(1):27-33. [Medline].

  15. Amoroso C, Grandi E, Carinci F. Eccrine spiradenoma of the ear: case report. Int J Oral Maxillofac Surg. Dec 2003;32(6):662-3. [Medline].

  16. Nadig SK, Alderdice JM, Adair RA, Rao TJ. Eccrine spiradenoma: an unusual presentation with otalgia. Otolaryngol Head Neck Surg. Feb 2004;130(2):277-8. [Medline].

  17. Meyer TK, Rhee JS, Smith MM, Cruz MJ, Osipov VO, Wackym PA. External auditory canal eccrine spiradenocarcinoma: a case report and review of literature. Head Neck. Jun 2003;25(6):505-10. [Medline].

  18. Leach BC, Graham BS. Papular lesion of the proximal nail fold. Eccrine spiradenoma. Arch Dermatol. Aug 2004;140(8):1003-8. [Medline].

  19. Chen G, Cheuk W, Cheung JS, Chan JK. Carcinosarcoma ex eccrine spiradenoma of the vulva: report of the first case. Int J Gynecol Pathol. May 2011;30(3):301-5. [Medline].

  20. Amann J, Spraul CW, Mattfeld T, Lang GK. [Eccrine spiradenoma of the eyelid]. Klin Monbl Augenheilkd. Jan 1999;214(1):53-4. [Medline].

  21. Gupta S, Radotra BD, Kaur I, Handa S, Kumar B. Multiple linear eccrine spiradenomas with eyelid involvement. J Eur Acad Dermatol Venereol. Mar 2001;15(2):163-6. [Medline].

  22. Beekley AC, Brown TA, Porter C. Malignant eccrine spiradenoma: a previously unreported presentation and review of the literature. Am Surg. Mar 1999;65(3):236-40. [Medline].

  23. Jamshidi M, Nowak MA, Chiu YT, Perry EA, Fatteh SM. Giant malignant eccrine spiradenoma of the scalp. Dermatol Surg. Jan 1999;25(1):45-8. [Medline].

  24. Arslan E, Unal S, Cinel L, Demirkan F, Cin I. Malignant eccrine spiradenoma occurring on a traumatized area. Plast Reconstr Surg. Jul 2002;110(1):365-7. [Medline].

  25. Chase DM, Basu T, Saffari B, Ries S, Berman ML. Malignant eccrine spiradenoma of the vulva: a case report and review of the literature. Int J Gynecol Cancer. May-Jun 2006;16(3):1465-9. [Medline].

  26. Jariwala A, Evans A, McLeod G. Not all stubbed toes are innocuous--A case report of rare malignant eccrine spiradenoma (spiradenocarcinoma) of the toe. Foot Ankle Surg. Jun 2010;16(2):e32-3. [Medline].

  27. Siegel HJ, Said-Al-Naief N, Long J, Lopez-Ben RR, Klein M. Giant eccrine spiradenoma of the hand. Am J Orthop (Belle Mead NJ). Aug 2008;37(8):E141-3. [Medline].

  28. Turhan-Haktanir N, Demir Y, Tokyol C. A case of eccrine spiradenoma arising in nevus sebaceous in an adolescent girl. Am J Dermatopathol. Apr 2008;30(2):196-7. [Medline].

  29. Rodriguez-Martin M, Sanchez Gonzalez R, Saez-Rodríguez M, Garcia-Bustínduy M, Martín-Herrera A, Noda-Cabrera A. An unusual case of congenital linear eccrine spiradenoma. Pediatr Dermatol. Mar-Apr 2009;26(2):180-3. [Medline].

  30. Englander L, Emer JJ, McClain D, Amin B, Turner RB. A rare case of multiple segmental eccrine spiradenomas. J Clin Aesthet Dermatol. Apr 2011;4(4):38-44. [Medline]. [Full Text].

  31. Han YD, Huan Y, Deng JL, Zhang YG, Zhang CH. MRI appearance of multiple eccrine spiradenoma. Br J Radiol. Jan 2007;80(949):e27-9. [Medline].

  32. Bosch MM, Boon ME. Fine-needle cytology of an eccrine spiradenoma of the breast: diagnosis made by a holistic approach. Diagn Cytopathol. 1992;8(4):366-8. [Medline].

  33. Jitsukawa K, Sueki H, Sato S, Anzai T. Eccrine spiradenoma. An electron microscopic study. Am J Dermatopathol. Apr 1987;9(2):99-108. [Medline].

  34. Meybehm M, Fischer HP. Spiradenoma and dermal cylindroma: comparative immunohistochemical analysis and histogenetic considerations. Am J Dermatopathol. Apr 1997;19(2):154-61. [Medline].

  35. Ishihara M, Mehregan DR, Hashimoto K, et al. Staining of eccrine and apocrine neoplasms and metastatic adenocarcinoma with IKH-4, a monoclonal antibody specific for the eccrine gland. J Cutan Pathol. Feb 1998;25(2):100-5. [Medline].

  36. Yasui S, Ando I, Kukita A, Hino H, Ohara K. DF3 (CA15-3) antibody as a marker of cutaneous adnexal tumors. Acta Derm Venereol. Mar 1994;74(2):98-100. [Medline].

  37. Saboorian MH, Kenny M, Ashfaq R, Albores-Saavedra J. Carcinosarcoma arising in eccrine spiradenoma of the breast. Report of a case and review of the literature. Arch Pathol Lab Med. May 1996;120(5):501-4. [Medline].

  38. Kurokawa I, Nishimura K, Tarumi C, et al. Eccrine spiradenoma: co-expression of cytokeratin and smooth muscle actin suggesting differentiation toward myoepithelial cells. J Eur Acad Dermatol Venereol. Jan 2007;21(1):121-3. [Medline].

  39. Ko JY, Lee CW, Moon SH, Song KW, Park CK. Giant vascular eccrine spiradenoma: report of a case with immunohistochemical study. J Korean Med Sci. Feb 2006;21(1):172-6. [Medline].

  40. Ohtsuki Y, Ohtsuka H, Kurabayashi A, et al. Immunohistochemical and electron microscopic studies of Langerhans cells in a case of multiple eccrine spiradenomas. Med Mol Morphol. Dec 2007;40(4):221-5. [Medline].

  41. Sridhar KS, Benedetto P, Otrakji CL, Charyulu KK. Response of eccrine adenocarcinoma to tamoxifen. Cancer. Jul 15 1989;64(2):366-70. [Medline].

  42. Mirza I, Kloss R, Sieber SC. Malignant eccrine spiradenoma. Arch Pathol Lab Med. May 2002;126(5):591-4. [Medline].

  43. Martins C, Bartolo E. Brooke-Spiegler syndrome: treatment of cylindromas with CO2 laser. Dermatol Surg. Sep 2000;26(9):877-80; discussion 881. [Medline].

  44. Hantash BM, Chan JL, Egbert BM, Gladstone HB. De novo malignant eccrine spiradenoma: a case report and review of the literature. Dermatol Surg. Sep 2006;32(9):1189-98. [Medline].

  45. Lara JF, Nadeem MA, Asaadi M. Malignant mixed tumor ex eccrine spiradenoma: an unusual pattern of malignant dedifferentiation. Ann Diagn Pathol. Jun 2001;5(3):155-61. [Medline].

  46. Liapakis IE, Korkolis DP, Koutsoumbi A, Fida A, Kokkalis G, Vassilopoulos PP. Malignant hidradenoma: a report of two cases and review of the literature. Anticancer Res. May-Jun 2006;26(3B):2217-20. [Medline].

  47. Michal M, Lamovec J, Mukensnabl P, Pizinger K. Spiradenocylindromas of the skin: tumors with morphological features of spiradenoma and cylindroma in the same lesion: report of 12 cases. Pathol Int. May 1999;49(5):419-25. [Medline].

  48. Rajan N, Burn J, Langtry J, Sieber-Blum M, Lord CJ, Ashworth A. Transition from cylindroma to spiradenoma in CYLD-defective tumours is associatedwith reduced DKK2 expression. J Pathol. Jul 2011;3:309-21. [Medline].

 
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