Evaluation of Syringomas by In Vivo Reflectance Confocal Microscopy: A Report of Two Cases

Abstract

Syringomas are benign adnexal tumors that are characterized histologically by the presence of small solid and cystic epithelial structures in the upper half of the reticular dermis. Reflectance confocal microscopy is a noninvasive diagnostic method that enables in vivo visualization of tissues with a resolution that approximates that of conventional histopathology. The use of this method in skin imaging over the past several years has improved dermatological diagnoses, creating the potential for its wide application in such diagnoses, especially for benign and malignant skin tumors. We describe its use in the diagnosis of syringoma in 2 patients and correlate the resulting clinical, histopathological, and digital reflectance confocal microscopy images.

The differential diagnosis of syringoma and milia based on the imaging of reflectance confocal microscopy

“…For milia lesions, the RCM images showed the relatively high refractive, but not monomorphous, global keratin in superficial dermis, which correlated to the subepidermal keratin-filled cysts lined with stratified epithelium in histology. Our findings about the RCM features of syringoma were similar with Jiménez MR's report, 6 who observed solid and ductal epithelial structures, and dark round spaces (luminar) present in dermis, which was the most significant change in the syringomas by RCM.…”

“…A detailed description of the technique and the device used has been published previously. [4][5][6][7] After imaging with RCM, the same lesions were biopsied and analyzed histologically to investigate the accuracy of RCM imaging. Then, the exact lesions imaged were suggested to be biopsied and analyzed histologically.…”

Imaging of Vulva Syringoma With Reflectance Confocal Microscopy

“…A recent case report of syringoma considered the dark areas surrounded by rims of epithelia as the characteristic of syringoma based on RCM findings (19). They interpreted the encircling hollow dark areas as lumina.…”

Microscopia confocal a laser na avaliação in vivo de tumores cutâneos de anexo

“…Pode haver mitose, mas formas anormais não são frequentes. Paliçada periférica ausente ou presente focalmente, ausência de fenda peritumoral 1,21 .…”

“…Hiperplasias sebáceas estão excluídas desta síndrome. Tem sido descrito um subtipo da síndrome, sendo o mesmo classificado com SMT tipo II, no qual existe inativação de um gene reparador de remoção de base que leva a um padrão de herança autossômica recessiva20,21 .Ocorre mais frequentemente no sexo masculino 3:2. A idade média de surgimento de neoplasias sebáceas é 53 anos, variando de 21 anos a 88 anos.…”