Chemotherapy-Induced Eccrine Squamous Syringometaplasia

Valks, Ruud

doi:10.1001/archderm.1997.03890430089012

Cited by 61 publications

(38 citation statements)

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“…Based on these findings, a herpetic infection was discounted. There was also a clear relationship between the beginning of chemotherapy and the development of the lesions, as in the previously reported chemotherapy‐induced cases 5 …”

Section: Discussionsupporting

confidence: 79%

Eccrine squamous syringometaplasia mimicking a herpetic infection

et al. 2004

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A 69‐year‐old woman with a history of hypertension and essential tremor was diagnosed with a Burkitt‐like diffuse large‐cell lymphoma. She received chemotherapy with cyclophosphamide, vincristine and adriamycin (HyperCVAD). Ten days after starting the second cycle of chemotherapy (HyperCVAD), she presented with well‐defined, intense, erythematous macules which coalesced to form a symmetric diffuse erythema located on the upper back. Later, the lesions progressed and affected the lower back and perineal areas, extending to the groin. In a few days, a gradual diminution of the erythema was seen, with subsequent development of postinflammatory gray‐brownish hyperpigmentation. On the lower back, there were also superficial erosions. Some asymptomatic, closely grouped, gray papules, vesicles, and blisters were found in the groin, resembling the typical lesions of herpetic infection (Fig. 1). Two biopsies of the groin and one of the upper back were performed, and were processed for histopathologic and microbiologic study. 1 Closely grouped gray papules, vesicles, and blisters on the groin mimicking a herpetic infection The histopathologic study showed epidermal hyperplasia with acanthosis and papillomatosis. In both biopsies, eccrine ducts covered by mature squamous epithelium were found in the reticular dermis (Fig. 2a−c). In the sample from the groin, an intracorneal bulla was found. Numerous normal isolated cornified cells were seen within the lumen of the bulla (Fig. 2d). An inflammatory mononuclear infiltrate was also present in a periductal and perivascular distribution. No multinucleation, ground‐glass nuclei, or peripheral margination of chromatin were found. Therefore, no morphologic evidence of herpes virus infection was present. 2 Low (a), medium (b), and high (c) magnification showing epidermal hyperplasia and squamous syringometaplasia involving dermal eccrine ducts. (d) Medium power magnification of the intracorneal bulla (hematoxylin and eosin staining; a, ×40; b, ×100; c, ×400; d, ×100) Cultures and serologic analyses for herpes simplex virus (HSV) 1 and 2, varicella zoster virus (VZV), and cytomegalovirus (CMV) were negative. The lesions were treated with topical corticosteroids, with a good response in a few days.

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Section: Discussionsupporting

confidence: 79%

Eccrine squamous syringometaplasia mimicking a herpetic infection

et al. 2004

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“…Ecrine syringosquamous mataplasia (ESSM) is a unique reaction of the sweat duct epithelium that usually follows the administration of cytotoxic drugs 1 . It is characterized clinically by the development of localized or generalized maculopapular, vesicular or pustular eruption, but rarely erosive plaques, and microscopically by squamous metaplasia of the sweat ducts 2,3 that, in some cases, may show striking similarity to squamous cell carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…ESSM is an extremely rare condition which occurs as erythematous macules, papules, plaques, or vesicles that may be localized or generalized. It develops 2–39 days after starting chemotherapy and usually clears spontaneously within 4 weeks 3,4 …”

Section: Discussionmentioning

confidence: 99%

Eccrine syringosquamous metaplasia

et al. 2001

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A 7 year‐old male child presented with erythematous erosive plaques affecting the upper and lower eyelids of the left eye and extending to the cheek. Crustations over the right nostril were also evident. His general health status was normal. His medical history revealed that he was suffering from chronic myeloid leukemia for which he was receiving cyclic pulse therapy of cytarabine, doxorubicin and prednisone. It was noticed that the skin eruption was activated after each cycle and faded in 2–3 weeks to reappear after the next cycle but it never really cleared completely. The clinical differential diagnosis included herpes simplex, contact dermatitis, neutrophilic eccrine hidradenitis (NEH) and atypical fungal infection. The investigations included a complete blood count which showed a picture of improving leukemia with a total leucocytic count of 60 000/cc, RBCs count 3.7 × 106/cc, and platelet count of 110 000/cc. His hemoglobin was 9% The differential leucocytic count was as follows: basophils 0; eosinophils 4; blast cells 0; promyelocytes 0; myelocytes 10; juvenile cells 7; staff cells 14; segmented 45; lymphocytes 18 and monocytes 2. Cultures for fungi were negative, and serological examination for HIV, herpes simplex (IgG and IgM) cytomegalovirus and Epstein‐Barr virus antibodies were within normal ranges. Examination of a skin biopsy taken from the periorbital lesions revealed the presence of numerous islands of squamous cells extending from the epidermis into the upper‐ and mid‐dermis. Some of the islands were typically present around sweat ducts. On higher magnification, the cells forming the islands and lining the ducts were found to have abundant eosinophilic cytoplasm and large pale nuclei with prominent nucleoli. Some of the cells were dyskeratotic and there were occasional mitotic figures. Sparse lymphoid cell infiltrate was found surrounding some of the squamous cell islands. Based on the findings of squamous metaplasia of the cells lining the sweat ducts as well as the resemblance of some islands to squamous cell carcinoma, the diagnosis of eccrine syringosquamous metaplasia was made. Apart from the use of topical antibiotic creams, the patient received no therapy for his condition. Spontaneous improvement occured within 18 days after initial presentation but it recurred after the next cycle of chemotherapy.

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“…It has been described in association with chronic cutaneous ulcers and scars (3,4), keratoacanthoma (4), squamous cell carcinoma (4), lobular panniculitis (5), pyoderma gangrenosum (5), benoxaprofen ingestion (6) and in patients undergoing chemotherapy (7). However, only 3 HIV positive patients have been reported to have ESS in association with herpetic infection (1).…”

Section: Discussionmentioning

confidence: 99%

Herpetic Infection on the Vulva Associated with Eccrine Squamous Syringometaplasia in Malignant Lymphoma

Choi¹

1999

Acta Dermato-Venereologica

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Chemotherapy-Induced Eccrine Squamous Syringometaplasia

Cited by 61 publications

References 1 publication

Eccrine squamous syringometaplasia mimicking a herpetic infection

Eccrine squamous syringometaplasia mimicking a herpetic infection

Eccrine syringosquamous metaplasia

Herpetic Infection on the Vulva Associated with Eccrine Squamous Syringometaplasia in Malignant Lymphoma

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