Twcnty-scvcn patients with malignant eccrine poroma arc presented, and their clinical and pathological features are discussed.Eccrinc ptiroma is a benign tumour of the intra-epidermal component of the eccrine sweat duct (acrosyringium). The first malignant variant reported in the literature has been attributed to Pinkus & Mehregan (1963). Since then there have been few reports of malignant eccrine poroma. We have reviewed the clinical and pathological findings in twenty-seven cases diagnosed at St Thomas's Hospital, London, between 1950 and 1981. MATERIALS AND METHODS These cases were derived from a variety of sources and thus in some instances only representative sections were available for study whilst in other cases large portions of tumour could be examined. All of the material was processed by conventional techniques and 5/1 paraffin sections were cut and stained with haematoxylin and eosin. In some instances further sections were stained by the periodic acid Schiff reaction. Where possible further clinical information was obtained from the patient's hospital notes or from the referring clinician.
RESULTS
Clinical findings (Table i)There were twenty-seven patients of whom twelve were female, fourteen were male and in one case the sex was unknown. The age range was from 19 to 90 years (mean 62). The duration of the lesions varied enormously (range 2 months to 40 years). In six patients the lesion had been present for 20 years or more. Although acral locations were favoured the rumours appeared at various sites. Clinically the tumours presented as verrucous plaques or polypoid growths which
The incidence of tissue eosinophilia in keratoacanthoma and in early and late cases of squamous cell carcinoma of the skin has been studied. Eosinophil infiltration of over 10 cells per high power field was found in 80 cases, and was not related to the size, site or aetiology of the lesions in which it was present. In cases where diagnostic difficulty arises between keratoacanthoma and well differentiated, keratinizing squamous cell carcinoma, if tissue eosinophilia is present the lesion is more likely to be malignant. Though in isolation the finding of an eosinophil infiltrate is not diagnostic it should be added to the list of criteria which help to distinguish these lesions. The pattern of tissue eosinophilia in late cases of squamous cell carcinoma was more extensive and there were two cases which showed massive tumour-associated tissue eosinophilia. This has previously been reported in squamous cell carcinoma at other sites, and may be related to the production of an eosinophilochemotactic factor.
Summary
A case of grossly disfiguring lupus pernio on the nose is described in which surgical excision and split skin grafting produced an excellent result.
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