|Year : 2015 | Volume
| Issue : 2 | Page : 157-159
Diagnostic dilemma whether Malignant hidroacanthoma or seborrheic keratosis
P Venu Gopal Reddy, Kiran Kumar, Arvindh Kumar, MK Srinivasan, M Sakthivel, K Muthubabu
Department of ENT and Head and Neck Surgery, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, Tamil Nadu, India
|Date of Web Publication||20-Apr-2015|
Dr. P Venu Gopal Reddy
Department of ENT and Head and Neck Surgery, Meenakshi Medical College Hospital and Research Institute, Kanchipuram - 631 552, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Eccrine porocarcinoma is a rare cutaneous neoplasm that mainly affects elderly people and grows slowly over a long period but often experiences an accelerated growth phase. Malignant eccrine poroma is a rare skin adnexal tumor arising from the eccrine sweat glands. It arises from different sites in the body extremities, palm and trunk. Porocarcinoma is a rare condition, and we are presenting a case of porocarcinoma of pinna.
Keywords: Borst-Jodhansson phenomenon, Porocarcinoma, Seborrheic keratosis
|How to cite this article:|
Reddy P V, Kumar K, Kumar A, Srinivasan M K, Sakthivel M, Muthubabu K. Diagnostic dilemma whether Malignant hidroacanthoma or seborrheic keratosis. Indian J Otol 2015;21:157-9
|How to cite this URL:|
Reddy P V, Kumar K, Kumar A, Srinivasan M K, Sakthivel M, Muthubabu K. Diagnostic dilemma whether Malignant hidroacanthoma or seborrheic keratosis. Indian J Otol [serial online] 2015 [cited 2019 Nov 20];21:157-9. Available from: http://www.indianjotol.org/text.asp?2015/21/2/157/155342
| Introduction|| |
Seborrheic keratosis is common superficial hyperkeratotic tumor with a variety of clinical and histologic patterns.Seborrheic keratosis are such common incidental skin findings that epidemiological studies are lacking. It may present typically as early as thirty's but become more common with advancing age. In general Seborrheic keratosis are more common in Caucasians.
Dermatosis papulosa nigra is felt to be the subset of seborrheic keratosis as they share common histopathlogical features. These are seen in darker skin races such as Hispanics and Asians.
Malignanent hidroacanthoma  is a rare malignancy of eccrine sweat gland1.It mostly affects old people.Clinical diagnosis is difficult and lesions are often mistakenly identified as squamous cell cancer.The tumour has a multitude of synonyms (Hidroacanthoma simplex, sweat gland carcinoma, malignant intraepidermal eccrine poroma, eccrine poroepithlioma, dysplastic poroma, malignant syringoacanthoma, porocarcinoma) .
| Case Report|| |
A 56-year-old lady presented with dark pigmented nodule in the right pinna since 3 months. It was gradually increasing in size, no itching or pain or spontaneous bleeding or sudden increase in growth or ulceration. No history of neck swelling. Patient was treated by excision of lesion by electrocautery. Excision biopsy histopathological examination showed features showed suggestive of seborrheic keratosis.  After excision lesion recurred which showed definite increase in both the extent of lesion and pigmentation. And histopathological examination of biopsy showed malignant hidroacanthoma.
On examination solitary hyperpigmented lesion 2 cm × 2 cm in size polypoidal exfoliative growth with irregular surface, irregular margins extending toward the external auditory meatus but not involving external auditory canals [Figure 1]. Nontender, firm in consistency, does not bleed to touch.
Biopsy of recurred lesion
Histopathology examination (HPE) showed asymmetrical, solid, nodular growth pattern with infiltrating borders. The neoplastic cells have basaloid features resembling those of poroma, but shows sign of atypia, pleomorphic, hyperchromatic nuclei and prominent nucleoli. There is an eccrine differentiation.
Patient underwent wide local excision of the lesion followed by split thickness skin grafting. The graft was harvested from the left postaural region. These are the intraoperative photographs [Figure 2] and [Figure 3]. HPE report of lesion showed sharply demarcated nests of tumor cells within the epidermis (Borst-Jodhansson phenomenon). It shows asymmetrical, solid, nodular growth pattern with infiltrating borders. The neoplastic cells have basaloid features resembling those of poroma, but shows sign of atypia, pleomorphic, hyperchromatic nuclei and prominent nucleoli. There is an eccrine differentiation.
This case was followed-up postoperatively at 1 st week [Figure 4], 1 st month, 2 nd month and 6 th month and lesion did not recur to appear.
Clonal seborrheic keratosis, Bowen's disease, Paget's disease and melanoma in situ.
| Discussion|| |
Malignant hidroacanthoma is a rare skin adnexal tumor usually found in the lower extremities. It was first described by Pinkus and Mehregan in 1963, and arises from intraepidermal and dermal eccrine sweat glands.  It arises from intraepidermal portion of the eccrine sweat gland duct epithelium or acrosyringium.  Incidence is 0.005-0.01%. They can also occur in trunk, vulva, breast, nail bed and upper extremity. Case presented with verrucous plaque with polypoidal growth, ulcerative lesion. Signs of malignant transformation in an eccrine poroma include itching, pain, spontaneous bleeding, ulceration. HPE - It shows sharply demarcated nests of tumor cells within the epidermis (Borst-Jadhasson phenomenon). It shows asymmetrical, solid, nodular growth pattern with infiltrating borders. The distinction between malignant and benign hidroacanthoma simplex is based on the identification of cytologically malignant cells within tumor nests. When an in situ component coexists with an invasive encapsulated papillary carcinoma (EPC), it clearly indicates a primary neoplasm. The neoplastic cells have basaloid  features resembling those of poroma, but shows sign of atypia, pleomorphic, hyperchromatic nuclei and prominent nucleoli. Malignant cells contain glycogen-rich and often contain several nuclei.  Carcinoembryonic antigen-positive ductal structures are present in most cases, confirming the eccrine differentiation of the tumor. Stroma surrounding EPC may be highly myxoid, mucinous, hyalinized or fibrotic.
When the tumor is purely intraepidermal or has a predominant intraepithelial component distinction.  Presence of an adjacent benign poroid component is a helpful feature in establishing the diagnosis. Clonal seborrheic keratosis, Bowen's disease, Paget's disease and melanoma in situ.
| Conclusion|| |
Although seborrheic keratosis is a more common condition, it is always essential that while treating this condition a wide excision be done since there is a possibility of malignant conditions like hidroacanthoma being masked by a misleadingly benign presentation which has poorer prognosis.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]