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 Table of Contents  
LETTER TO EDITOR
Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 141-142

An unusual presentation of chondroid syringoma over nose


1 Department of Dermatology, HBT Medical College and Cooper Hospital, Mumbai, Maharashtra, India
2 Department of Dermatology, KEM and Seth GS Medical College, Mumbai, Maharashtra, India

Date of Web Publication19-Dec-2018

Correspondence Address:
Dr. Ankita Agrawal
Department of Dermatology, HBT Medical College and Cooper Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdpdd.ijdpdd_20_18

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How to cite this article:
Agrawal A, Gupta A, Makhecha M, Rambhia K. An unusual presentation of chondroid syringoma over nose. Indian J Dermatopathol Diagn Dermatol 2018;5:141-2

How to cite this URL:
Agrawal A, Gupta A, Makhecha M, Rambhia K. An unusual presentation of chondroid syringoma over nose. Indian J Dermatopathol Diagn Dermatol [serial online] 2018 [cited 2019 Mar 24];5:141-2. Available from: http://www.ijdpdd.com/text.asp?2018/5/2/141/247864



Sir,

Chondroid syringoma is a rare, benign tumor of sweat glands, composed of epithelial and mesenchymal elements with abundant chondromyxoid matrix. It is difficult to diagnose chondroid syringoma clinically and dermoscopically; histopathology is an invaluable tool in the diagnosis.[1] We are reporting a rare case of chondroid syringoma over the nose. A 62- year-old- female presented with painless progressively enlarging swelling over the nose for 9 years. Examination showed skin colored 1.5 cm × 1.5 cm rounded, firm, mobile, nontender, nonfluctuant, adherent nodule to the skin above, with overlying central whitish 2- mm papule over the right lateral dorsum of the nose [Figure 1]. On dermoscopy [Figure 2], brownish globule with central white dot was seen, with foci of telangiectasia. A differential diagnosis of dermoid cyst, pilomatricoma, sebaceous cyst, osteoid osteoma, and calcified mucoid cyst was considered. Excision biopsy of nodule was done and sent for histopathology. Histopathological examination revealed, well-circumscribed mass centered in deep dermis consisting of multiple branching tubulo-alveolar glandular structures. These tubules were lined by two layers of epithelial cells, a luminal layer of cuboidal cells and a peripheral layer of flattened cells [Figure 3] embedded in an abundant stroma with cystic dilatation at few places. Multiple ducts lined by a single layer of epithelium and nests of polygonal cells were also present. The stroma in many areas had mucoid and faintly basophilic cartilaginous metaplasia [Figure 4]. The final diagnosis of chondroid syringoma of eccrine type was made. No recurrence was noted after 8 months of follow up.
Figure 1: Skin colored nodule with overlying white papule

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Figure 2: Dermoscopic image showing brown globule with white dot and telangiectasia

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Figure 3: Tubuloalveolar glandular structures lined by two layers of epithelial cells with mucoid and chondroid stroma (H and E, ×10)

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Figure 4: Abundant basophilic cartilaginous metaplasia (H and E, ×40)

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The term ‘chondroid syringoma’ was introduced in 1961 by Hirsch and Helwig. It is also known as mixed tumor of skin, because the tumor consists of epithelial structures associated with mesenchymal change.[2],[3] Chondroid syringoma is firm intradermal or subcutaneous nodules usually found on the head and neck, followed by trunk and extremities. Their usual size is between 0.5 to 3.0 cm. The incidence is twice as high in males as compared to females.[4] Histopathology should be done as it has peculiar features to diagnose the disease and also differentiate benign case from malignant ones.

Histologically, two types of chondroid syringoma have been recognized: one with large tubular cystic, partially branching lumina, and the other with small, tubular lumina. Chondroid syringoma with large branching type is most commonly seen which has found in our case. The gland involved could be eccrine or apocrine in nature. Histopathology of chondroid syringoma, shows the following: A) tubulo-alveolar structures lined by a double epithelium along with cystic dilation and branching, B) mucoid and chondroid matrix, C) ductal structures lined by single layer of epithelium, D) nests of polygonal cells, and E) the presence of keratinous cysts. In most instances, the tubular lumina contain small amounts of amorphous, eosinophilic material that is periodic acid-Schiff positive and diastase resistant. The mucoid stroma stains with alcian blue and mucicarmine. Lack of symmetry and an infiltrative pattern of growth are important features in distinguishing between benign mixed tumors and malignant variant.[5] Most mixed tumors do not recur after surgical excision, but seeding and regrowth of stromal and epithelial elements may occur, especially after an incomplete curettage. In our case, complete excision was done and there was no recurrence after 8 months of follow-up.

This case is presented for the rarity of the diagnosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yavuzer R, Basterzi Y, Sari A, Bir F, Sezer C. Chondroidsyringoma: a diagnosis more frequent than expected. DermatolSurg 2003;29(2):179-81.  Back to cited text no. 1
    
2.
Kumar B. Chondroid syringoma diagnosed by fine needle aspiration cytology. Diagn Cytopathol 2010;38:38-40.  Back to cited text no. 2
    
3.
Sungur N, Uysal A, Gümüs M, Koçer U. An unusual chondroid syringoma. Dermatol Surg 2003;29:977-9.  Back to cited text no. 3
    
4.
diVisconteSchiano M, Picciano P. Chondroidsyringoma. A case report. Chirurgiaitaliana. 2002;54(2):241-4.  Back to cited text no. 4
    
5.
Barnett MD, Wallack MK, Zuretti A, Mesia L, Emery RS, Berson AM. Recurrent malignant chondroid syringoma of the foot: A case report and review of the literature. Am J Clin Oncol. 2000;23:227-32.  Back to cited text no. 5
    


    Figures

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



 

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