Indian Journal of Dermatology
CASE REPORT
Year
: 2006  |  Volume : 51  |  Issue : 4  |  Page : 294--296

Chondroid syringoma of the eyebrow and elbow


Rashmi Kumari, Devinder Mohan Thappa 
 Department of Dermatology and STD, JIPMER, Pondicherry - 605 006, India

Correspondence Address:
Devinder Mohan Thappa
Department of Dermatology and STD, JIPMER, Pondicherry - 605 006
India




How to cite this article:
Kumari R, Thappa DM. Chondroid syringoma of the eyebrow and elbow.Indian J Dermatol 2006;51:294-296


How to cite this URL:
Kumari R, Thappa DM. Chondroid syringoma of the eyebrow and elbow. Indian J Dermatol [serial online] 2006 [cited 2022 May 16 ];51:294-296
Available from: https://www.e-ijd.org/text.asp?2006/51/4/294/30302


Full Text

A 45-year-old man visited our outpatient department with a nodule on his right eyebrow and right elbow. The elbow lesion was first noticed by him 5 years back and the eyebrow lesion was present for the past three years. Both the lesions were otherwise asymptomatic and slowly increasing in size. Physical examination showed a firm, painless, mobile, 5 cm nodule on the right elbow and a similar 1.5 cm nodule on the right eyebrow [Figure 1]. Overlying skin was normal with no loss of hair. Regional lymph nodes were not palpable. The nodules were excised and sent for histopathology.

Gross pathological examination showed a well-circumscribed, whitish firm mass. Histological examination revealed abundant chondroid stroma with nests and strands of epithelial cells arranged in tubular and cystic branching cords which were lined by two layers of epithelial cells [Figure 2]. A luminal layer of cuboidal cells and a peripheral layer of flattened cells were present. Furthermore, there were large and small aggregates of epithelial cells without lumina as well as single epithelial cells widely scattered throughout the stroma. No cytological atypia was seen. On the basis of histopathology a diagnosis of chondroid syringoma was made. Following complete excision, no recurrence was seen after two years of follow-up.

Chondroid syringoma (CS) is a rare, benign, skin appendagal tumor, first described by Billorth in 1859 for a group of tumors of the salivary gland that contained varying amounts of mucoid and cartilaginous material.[1] Virchow and Minssen referred to them as mixed tumors with both epithelial and mesenchymal origin.[2]

This uncommon sweat gland tumor presented as a solitary, 0.5-3 cm, slow-growing, painless, nonulcerated subcutaneous or intracutaneous nodule.[1],[2] The sites of predilection for CS are on the head and neck region, particularly cheek, nose or skin above the lip of middle-aged or older males.[1],[2] Rarer sites include the scalp, eyelid orbit, hand, foot, forehead, axillary region, abdomen, penis, vulva and scrotum.[1] Here we report an unusual case with two benign CS located on the right elbow and right eyebrow.

Histologically, CS consists of mixed epithelial and mesenchymal elements, with epithelial cells arranged in cords and forming tubules with a myoepithelial layer, set in a myxoid or chondroid stroma.[3] Osteoid stroma or mature adipocytes can be present in rare cases. Headington, in a review of seven patients with CH, proposed two histologic groups and differentiated between an apocrine and eccrine type on the basis of the pattern of the lumina observed.[4] The apocrine type is characterized by tubular and cystic branching lumina lined by two layers of epithelial cells. The eccrine type is characterized by small tubular lumina lined by a single layer of cuboidal epithelial cells. In our patient, histological examination revealed an abundant chondroid stroma intermingled with epithelial structures arranged in branching tubular and cystic ducts lined with two layers of cells, consistent with apocrine type of chondroid syringoma.

The differential diagnosis of CS includes other benign tumors of epidermal or mesenchymatous appendages such as dermoid or sebaceous cyst, neurofibroma, dermatofibroma, basal cell carcinoma, pilomatricoma, histiocytoma and seborrheic keratosis.[1],[2]

The usual first-line treatment is total excision of tumor as recurrence occurs if incompletely excised. In our case, the tumor was completely excised without recurrence and there was no evidence of malignancy on histopathology. However, rare cases of malignant CS have been reported.[5] These patient should be followed up carefully for both local recurrence and metastasis.

There are only five cases of benign chondroid syringoma measuring over 4 cm reported in the literature.[1] Our case is unusual with respect to its location(over the extremity), multiple number and large size for a benign chondroid syringoma (5 cm).

References

1Sungur N, Uysal A, Gümüs M, Kocer U. An unusual chondroid syringoma. Dermatol Surg 2003;29:977-9.
2Yavuzer R, Basterzi Y, Sari A, Bir F, Sezer C. Chondroid syringoma: A diagnosis more frequent than expected. Dermatol Surg 2003;29:179-81.
3Lever WF, Schaumburg-Lever G. Histopathology of the Skin, 6th ed. JB Lippincott: Philadelphia; 1983. p. 560-2.
4Headington JT. Mixed tumors of skin: Eccrine and apocrine types. Arch Dermatol 1961;84:989-96.
5Metzler G, Schaumburg-Lever G, Hornstein O, Rassner G. Malignant Chondroid Syringoma: Immunohistopathology. Am J Dermatopathol 1996;18:83-9.