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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 33  |  Issue : 2  |  Page : 197-200

Solitary eccrine spiradenoma of caruncle: A rare occurrence


1 Department of Ophthalmology, Speciality Medical Officer, KB Bhabha Hospital, Mumbai, Maharashtra, India
2 Department of Ophthalmology, KB Bhabha Hospital, Mumbai, Maharashtra, India

Date of Submission26-May-2020
Date of Acceptance29-May-2020
Date of Web Publication21-Aug-2021

Correspondence Address:
Dr. Ankita Patil
Department of Ophthalmology, FICO, Speciality Medical Officer, KB Bhabha Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_67_20

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  Abstract 


Eccrine spiradenoma (ES), a sweat gland tumor, is rarely found in the caruncle. Although the occurrence of spiradenoma of carbuncle are rare. On account of the histological composition of the caruncle, which includes, in addition to conjunctiva, hair follicles, sebaceous glands, sweat glands, and accessory lacrimal tissue, the caruncle may develop lesions that may be similar to those found in the skin, conjunctiva, or lacrimal gland. We encountered a 39-year-old female with a nodular growth in her left caruncle, which had developed over the last 10 years. Excision biopsy was carried out under local anesthesia. The histopathology was suggestive for a benign ES. Clinical preoperative diagnosis is very difficult for caruncular lesions and is reached only in about half of the cases. Most lesions of the caruncle are benign, mainly nevi. Reported malignant lesions are very rare, but can be potentially fatal. The possibility of sweat gland tumor should be kept in mind in the diagnosis of caruncle tumors.

Keywords: Caruncle, eccrine spiradenoma, solitary mass


How to cite this article:
Patil A, Kazi S. Solitary eccrine spiradenoma of caruncle: A rare occurrence. Kerala J Ophthalmol 2021;33:197-200

How to cite this URL:
Patil A, Kazi S. Solitary eccrine spiradenoma of caruncle: A rare occurrence. Kerala J Ophthalmol [serial online] 2021 [cited 2021 Nov 30];33:197-200. Available from: http://www.kjophthal.com/text.asp?2021/33/2/197/324200




  Introduction Top


The caruncle (from Latin caro = flesh) is a soft, pink, ovoid body, about 5 mm high and 3 mm broad, situated in the lacus lacrimalis medial to the plica semilunaris. It is more prominent on lateral gaze and is retracted on medial gaze.

The eccrine spiradenoma (ES) is a benign neoplasm of the skin first described by Kersting and Helwig, who considered it to be a derivative of eccrine sweat glands. It usually presents as a solitary, intradermal, and painful nodule, the most common sites being the chest and face.[1]

ESs are benign tumors of the skin found at the site of eccrine sweat glands.[2]

To the best of our knowledge, there has been no report of a primary spiradenoma developing in the palpebral conjunctiva involving caruncle.[3]


  Case Report Top


A 39-year-old female presented in November 2019 with a nodule in the left caruncle for the last 2 years, which had been gradually increasing in size and painless. The swelling measured 3 mm × 2 mm × 1.2 mm and pink in color with no overlying vascularity [Figure 1].
Figure 1: Intraoperative image of caruncle mass

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The growth was firm in consistency and nontender to touch and was negative on translucency test. The surrounding skin and eyelid margin were normal. An ophthalmic examination revealed nothing abnormal, and the patient's vision was 6/6 in both the eyes. A general physical examination also showed nothing abnormal. There was no enlargement of auricular, cervical, or submandibular lymph nodes; the general systemic examination was normal. Clinically, the cystic lesion of the caruncle was suspected, and a full-thickness wide excision of the mass was carried out.

Laboratory data including blood chemistry and serum level of tumor markers were within the normal range. No abnormal findings were seen in the chest X-rays.

Intraoperative findings: Shave excision of the mass was carried out, and the mass was soft to firm in consistency, noncapsulated, and not extending to the surrounding tissue. Bleeding was minimal as the mass was relatively avascular. Care when dissection was taken not to go deep to injure the medial longitudinal ligament and avoided making an opening in the conjunctiva.

Histopathology report

Gross appearance-received soft tissue measuring 2.5mmx2mmx1.5mm.

External surface gray white congested was gray-white, firm, and had a rubbery surface.

As shown in [Figure 2]a Microscopic examination showed keratinized stratified squamous epithelium with underlying dermis showing a tumor mass in the nest and lobules.
Figure 2: (a) H and E stained section showed keratinized stratified squamous epithelium with tumor mass in nest and lobules. (b) H and E.stained section showing tumor cells are basaloid with scanty cytoplasm, mild pleomorphism, present with peripheral palisading

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Tumor cells were basaloid with scanty cytoplasm, And mild pleomorphism, present with peripheral palisading and clefting within the nest of some cells arranged in glandular pattern along with lymphocystic infiltrate [Figure 2]b.

Post-operative day 2 clinical picture of patient [Figure 3]. A spiradenoma is a type of sweat gland tumor, which has a comparatively good clinical course.
Figure 3: Postoperative clinical photo after excision of caruncle mass

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  Discussion Top


ES, first described in 1956, is an uncommon, benign, dermal tumor of apocrine differentiation derived from cutaneous sweat glands.[4] It usually presents as a solitary, intradermal, and painful nodule, the most common sites being the chest and face.

A spiradenoma is a tumor of the eccrine sweat glands that arises as a solitary, intradermal, and painful nodule on the chest or face and most frequently in early adulthood. Occasionally, there may be multiple tumors.[1]

It has been well characterized in the dermatological literature, but not in the ophthalmological literature, probably because it is uncommon in the eyelid and caruncle [Table 1].[5],[3]
Table 1: Cases reported

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In our case, the tumor was a solitary lesion at caruncle (site in the palpebral conjunctiva of the eyelid). The majority of spiradenomas have a benign course,[3] and local recurrences have not been reported. Mochizuki et al. reported a lesion of local recurrence because of an inadequate surgical removal, treated the site of the tumor excision with adjunctive cryotherapy to prevent further recurrences.[6]

Malignant changing of spiradenomas is unusual, and the histology of malignant spiradenomas resembles squamous metaplasia or very poorly differentiated pseudosarcomatous spindle cell elements.[4]

In cases of a malignant transformation, the patient might die of systemic metastases several months after the diagnosis.[4]

ESs are benign tumors of the skin found at the site of eccrine sweat glands.[2] It belongs to the group of the painful tumors of the skin, also known as the acronym BLEND AN EGG. This group includes blue rubber bleb nevus, leiomyoma, ES, neuroma, dermatofibroma, angiolipoma, neurilemmoma, endometrioma, glomangioma, and granular cell tumor.[1],[2]

In contrast, the pain arising from an adenoid cystic carcinoma due to infiltrative growth and perineural invasion, however; the pain in ES is related to the presence of small unmyelinated axons in connective tissue around the tumor, or Due to the expansion of the cysts.

ES can cytologically simulate an adenoid cystic carcinoma on fine-needle aspiration cytology because both tumors contain hyaline globules.

Histologically, the tumor is lobular, with two types of cells in the islands. Larger, paler cells are grouped around lumina and smaller, darker cells form the periphery.[7],[8],[9]Of the lobule.

Malignant degeneration of spiradenoma usually appears in long-standing tumors and is clinically revealed by a rapidly enlarging tumor mass.[2],[10] In these cases, the diagnosis of spiradenocarcinoma is made only if a residual benign component is identified.

Clinical differential diagnosis-Caruncle granuloma, caruncular cyst, caruncular hypertrophy.

Histological differential diagnosis

A primary basal cell epithelioma with eccrine differentiation and a lobular, hyalinized syringoma (cylindroma) are conditions which are a prerequisite for the histological differential diagnosis of ES.

A basal cell epithelioma displays a margin of basal cells with a neat, radial configuration.[2] It recapitulates the inferior layer of normal epidermis with vertically articulated basal cells.

A cylindroma is characterized by prominent, hyalinized bands of collagen enveloping and intertwining amidst the tumor lobules and cellular constituents.[2],[10]

ES enunciates compressed tumor lobules of varying dimensions with sharp basophilia. Lightly stained and adjunctive compact, intensely stained, peripheral nuclei are distinctly discernible.[6],[2]


  Conclusion Top


A spiradenoma is a type of sweat gland tumor, which has a comparatively good clinically course, but malignant transformation after repeated recurrences should be speculated.

Surgical excision remains the therapeutic option of choice with minimal incidence of reoccurrences.

Any change in color, size, or vascularization of a caruncular lesion should be excised. Pathological examination should be mandatory.

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.
Kersting DW, Helwig EB. Eccrine spiradenoma. Arch Dermatol 1956;73:199-227.  Back to cited text no. 1
    
2.
Oie S, Sawada A, Mochizuki K, Tsuji K, Hirose Y, Saigo C, et al. Case of recurrence of spiradenoma in palpebral conjunctiva. BMC Ophthalmol 2014;14:85.  Back to cited text no. 2
    
3.
Ahluwalia BK, Khurana AK, Chugh AD, Mehtani VG. Eccrine spiradenoma of eyelid: Case report. Br J Ophthal 1986;70:580-3.  Back to cited text no. 3
    
4.
Englander L, Emer JJ, McClain D, Amin B, Turner RB. A rare case of multiple segmental eccrine spiradenomas. J Clin Aesthet Dermatol 2011;4:38-44.  Back to cited text no. 4
    
5.
Cooper PH, Frierson HF Jr, Morrison AG, Malignant transformation of eccrine spiradenoma, Arc Dermatol, 1985;121:1445-8.  Back to cited text no. 5
    
6.
Levy J, Ilsar M, Deckel Y, Maly A, Pe'er J. Lesions of the caruncle: A description of 42 cases and a review of the literature. Eye (Lond) 2009;23:1004-18.   Back to cited text no. 6
    
7.
Amann J, Spraul CW, Mattfeld T, Lang GK. Eccrine spiradenoma of the eyelid. Klin Monbl Augenheilkd 1999;214:53-4.  Back to cited text no. 7
    
8.
Gupta S, Radotra BD, Kaur I, Handa S, Kumar B, et al. Multiple linear eccrine spiradenomas with eyelid involvement, J Eur Acad Dermatol Venereol, 2001;15:166-6.  Back to cited text no. 8
    
9.
Rodgers IR, Fredrick A, Jakobiec, Eyelid Timors of apocrine, eccrine and pilar origin. In:Albert and Jakobiec's Principles and Practice of Ophthalmology 3rd edition, 2008;3:3343.  Back to cited text no. 9
    
10.
Singh S, Saraf S, Goswami D, Singh S. Case report of solitary eccrine spiradenoma of eyelid. Touch Ophthalmology, online only: DOI:10.17925/EOR.2015.09.01.80.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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