Indian Journal of Dermatology
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CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 3  |  Page : 300-301
Chondroid syringoma with extensive cartilaginous differentiation


1 Clinical Department of Pathology and Cytology “Ljudevit Jurak”, University Clinical Hospital Center Sestre Milosrdnice, Vinogradska Cesta 29, Zagreb, Croatia
2 Clinical Department of Pathology, University Clinical Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia

Date of Web Publication22-Sep-2022

Correspondence Address:
Mašić Silvija
Clinical Department of Pathology and Cytology “Ljudevit Jurak”, University Clinical Hospital Center Sestre Milosrdnice, Vinogradska Cesta 29, Zagreb
Croatia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_204_18

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How to cite this article:
Silvija M, Irena VD, Davor T. Chondroid syringoma with extensive cartilaginous differentiation. Indian J Dermatol 2022;67:300-1

How to cite this URL:
Silvija M, Irena VD, Davor T. Chondroid syringoma with extensive cartilaginous differentiation. Indian J Dermatol [serial online] 2022 [cited 2022 Oct 6];67:300-1. Available from: https://www.e-ijd.org/text.asp?2022/67/3/300/356727




Sir,

Chondroid syringoma is rare, benign skin appendegeal tumor representing 0.01%–0.098% of primary skin tumors.[1],[2] Common locations are head and neck, yet extremities, chest, abdomen, and genital area have been reported.[1],[2],[3],[4] Usually affects middle-aged men presenting as firm, painless, well-demarcated tumor.[1],[2] Characteristic appearance of both components (epithelial, mesenchymal) within chondromyxoid stroma can be accompanied by skin adnexal structures (hair follicles, sebaceous glands, and apocrine glands), osseous tissue, and cartilage.[1] To the best of our knowledge, few cases demonstrating large amount of cartilage have so far been reported.[4],[5] This feature recognition is important to avoid possible diagnostic pitfalls and provide adequate treatment and follow-up.

A 45-year-old male, whose patient consent form has been obtained, was complaining of a nodular, painless scalp tumor. Tumor excision and pathohistological analysis followed. Grossly, subcutaneous tumor, rounded, harder in consistency and 2 cm in largest diameter was observed. It contained epithelial polygonal cells and tubuloalveolar structures made of two-layered epithelia surrounded by chondromyxoid matrix [Figure 1]a and [Figure 1]b. Also, cystic areas with erythrocytes, keratinous cysts, and extensive cartilage areas were found, suggesting the diagnosis of chondroid syringoma. No cellular atypia, necrosis, or tumor invasion was seen. Tumor was excised completely and inked margins were free of tumor. Regular follow-up was advised due to its possible malignant potential. There was no recurrence of the tumor during 3-year follow-up.
Figure 1: (a) Extensive area of cartilage formation in chondroid syringoma, H and E, ×100; (b). Epithelial polygonal cells and tubuloalveolar structures with areas of chondromyxoid matrix, H and E, ×200

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This tumor is characterized by both epithelial elements demonstrating apocrine or eccrine differentiation and mesenchymal component comprised of myxoid or collagenous matrix.[1] Dermoscopic pattern is nonspecific, undefined, and insufficient for the diagnosis;[3] thus, the diagnosis is obtained through pathohistological analysis according to the presence of one or combination of cuboidal or polygonal cells nests, tubuloalveolar structures, keratinous cysts, matrix (myxoid, chondroid, adipocytic, fibrous), and ductal structures with one or two rows of cuboidal cells.[1],[2],[5] Initially, fine needle aspiration (FNA) cytology can be performed revealing chondromyxoid matrix containing uniform plasmacytoid and epithelial cells.[1] In doubtful cases, immunochemistry is valuable[1] with epithelial layer being positive for epithelial membrane antigen (EMA), cytokeratins (CK), carcinoembryonic antigen (CEA), yet myoepithelial cells for S- 100, glial fibrillary acidic protein (GFAP), vimentin, and neuron- specific enolase (NSE).[4]

Most similar to chondroid syringoma is pleomorphic adenoma; however, differential diagnosis of chondroid syringoma includes pleomorphic adenoma, other adnexal tumors (cylindroma, hidradenoma, and spiradenoma), as well as pilomatrixoma and basal cell carcinoma[3],[4] [Table 1].
Table 1: Differential diagnosis of chondroid syringoma

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Rarely, chondroid syringoma undergoes malignant transformation characterized by a different location (usually extremities), larger size (>3 cm), infiltrative and rapid growth, deeper tissue involvement, necrosis, cytologic atypia, atypical mitoses, and satellite nodules.[1],[2],[3] It requires a more radical approach combining surgery, radiotherapy, and chemotherapy.[1]

Chondroid syringoma treatment includes wide surgical excision with negative margins.[2],[5] Also, follow-up for recurrence and metastasis is necessary due to possible malignant potential.[4]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Sharma S, Sharma SC. Benign chondroid syringoma of foot: A clinical dilemma. J Cancer Prev Curr Res 2020;11:27-30.  Back to cited text no. 1
    
2.
Paik YS, Liess BD. Chondroid syringoma of the scalp: Case report and discussion of clinical features, histopathology and treatment. Ear Nose Throat J 2011;90:190-1.  Back to cited text no. 2
    
3.
Linares Gonzales L, Aguayo Carreras P, Rueda Villafranca B, Navarro-Trivino FJ. Chondroid syringoma mimicking basal cell carcinoma. Case Res Lett 2020;111:341-3.  Back to cited text no. 3
    
4.
Pal S, Sengupta S, Jana S, Bose K. Fine-needle aspiration cytology of chondroid syringoma of fore arm: Report of a rare case. J Cytol 2014;31:171-3.  Back to cited text no. 4
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5.
Sulochana S, Madavan Manoharan A. Chondroid syringoma – an unusual presentation. J Clin Diagn Res 2014;8:13-4.  Back to cited text no. 5
    


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