Home Ahead of print Instructions Contacts
About us Current issue Submit article Advertise  
Editorial board Archives Subscribe Login   


 
 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 21  |  Issue : 2  |  Page : 157-159

Diagnostic dilemma whether Malignant hidroacanthoma or seborrheic keratosis


Department of ENT and Head and Neck Surgery, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, Tamil Nadu, India

Date of Web Publication20-Apr-2015

Correspondence Address:
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
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-7749.155342

Rights and Permissions
  Abstract 

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 Jul 21];21:157-9. Available from: http://www.indianjotol.org/text.asp?2015/21/2/157/155342


  Introduction Top


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 [1] 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 Top


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. [2] 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.
Figure 1: Preoperative

Click here to view


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.

Management

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.
Figure 2: Intraoperative

Click here to view
Figure 3: Lesion

Click here to view


Follow-up

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.
Figure 4: Postoperative

Click here to view


Differential diagnosis

Clonal seborrheic keratosis, Bowen's disease, Paget's disease and melanoma in situ.


  Discussion Top


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. [3] It arises from intraepidermal portion of the eccrine sweat gland duct epithelium or acrosyringium. [4] 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 [5] 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. [6] 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.

Differential diagnosis

When the tumor is purely intraepidermal or has a predominant intraepithelial component distinction. [7] 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 Top


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.

 
  References Top

1.
Ferri E, Iaderosa GA, Armato E. Metastasizing eccrine porocarcinoma of the nose: Case-report with immunohistochemical study and review of the literature. Internet J Otorhinolaryngol 2008;7:2.  Back to cited text no. 1
    
2.
Ritter AM, Graham RS, Amaker B, Broaddus WC, Young HF. Intracranial extension of an eccrine porocarcinoma. Case report and review of the literature. J Neurosurg 1999;90:138-40.  Back to cited text no. 2
    
3.
Kose R, Coban YK, Ciralik H. Eccrine porocarcinoma arising from preexisting eccrine poroma of the scalp after radiotherapy for cervical cancer. Dermatol Online J 2006;12:18.  Back to cited text no. 3
    
4.
Marone U, Caracò C, Anniciello AM, Di Monta G, Chiofalo MG, Di Cecilia ML, et al. Metastatic eccrine porocarcinoma: Report of a case and review of the literature. World J Surg Oncol 2011;9:32.  Back to cited text no. 4
    
5.
Mulinari-Brenner FA, Mukai MM, Bastos CA, Filho EA, Santamaria JR, Neto JF. Eccrine porocarcinoma: Report of four cases and literature review. An Bras Dermatol 2009;84:519-23.  Back to cited text no. 5
    
6.
Rana RE, Verma SS, Puri VA, Baliarsing AS. Sweat gland tumor (Eccrine porocarcinoma) of scalp: A rare tumor. Indian J Plast Surg 2005;38:51-3.  Back to cited text no. 6
  Medknow Journal  
7.
Plunkett TA, Hanby AM, Miles DW, Rubens RD. Metastatic eccrine porocarcinoma: Response to docetaxel (Taxotere) chemotherapy. Ann Oncol 2001;12:411-4.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed1343    
    Printed11    
    Emailed0    
    PDF Downloaded166    
    Comments [Add]    

Recommend this journal