The diagnosis of sportsman's hernia is difficult. The condition must be distinguished from the more common osteitis pubis and musculotendinous injuries. Early surgical intervention is usually, although not always, successful when conservative management has failed.

A case ofa 60 year old man with malignant eccrine spiradenoma involving the perineum is described. Areas of typical eccrine spiradenoma were admixed with carcinomatous and sarcomatous elements. Immunohistochemical and ultrastructural analysis revealed no evidence of epithelial differentiation in the sarcomatous areas. The tumour qualified for the designation carcinosarcoma arising in eccrine spiradenoma. The clinical course was aggressive with rapid development of nodal and pulmonary metastases. Histology showed an intact epidermis with no evidence of dysplasia. A tumour was present within the dermis and subcutaneous fat. This had a variegated appearance and included areas of typical eccrine spiradenoma ( fig 1A). On high power examination two cell types were identified. Cells with round to ovoid nuclei containing evenly dispersed pale chromatin were admixed with smaller cells that had round hyperchromatic nuclei. Ductular structures were also present. In these areas, there was little nuclear pleomorphism and only an occasional mitotic figure was identified. Adjacent to the typical eccrine spiradenoma, carcinomatous areas were present ( fig 1B). Here, groups and cords of epithelioid cells were surrounded by a fibrovascular stroma. Again two cell types and glandular structures were present. However, tumour cell nuclei were pleomorphic with prominent nucleoli and mitotic figures were easily identified (mitotic count in the region of 10 in 10 high power fields).At the deep aspect of the neoplasm, sarcomatous areas were present (fig 1 C). Tumour cells were spindle shaped with no glandular formation or other discernible arrangement. There was marked nuclear pleomorphism with many multinucleate tumour giant cells. Tumour cells contained moderate to abundant eosinophilic cytoplasm, but cross striations were not identified. Numerous mitotic figures were present (mitotic count in the region of 20 in 10 high power fields), and there were large areas of necrosis. No chondroid areas or areas of osteoid formation were identified.Histology of several of the satellite lesions showed them to be composed of typical eccrine spiradenoma, located in the dermis.Sectioning of the left inguinal lymph node dissection specimen revealed several nodes, one of which was enlarged and necrotic. Histology of this node showed it to be almost totally replaced by metastatic tumour that was extensively necrotic. In areas, the tumour had a carcinomatous appearance, similar to the carcinomatous areas within the skin neoplasm. However, elsewhere the tumour had a sarcomatous appearance, identical to the corresponding areas within the cutaneous neoplasm.The other nodes showed no evidence of metastatic tumour.

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