Syringofibrocarcinoma Versus Squamous Cell Carcinoma Involving Syringofibroadenoma: Is There a Malignant Counterpart of Mascaró's Syringofibroadenoma?

Abstract

Although a benign syringofibroadenoma has been recognized as an eccrine tumor exhibiting net-like ductal proliferation embedded in fibroma-like stroma, a malignant counterpart has not been described heretofore. An 82-year-old man with severely sun-damaged skin had a 3 cm plaque in the dorsum of his left hand. The clinical diagnosis was squamous cell carcinoma. Histologically, the lesion was a bowenoid squamous cell carcinoma, both in situ (Bowen's disease-like) and bluntly invasive, with a concurrent phase showing unequivocal and widespread ductal differentiation, local expression of carcinoembryonic antigen, and sclerotic stroma. This syringofibrocarcinoma also impinged laterally on a mature and benign syringofibroadenoma and occurred above a minute deep dermal trichoepithelioma. This report presents a probably unrecognized new malignant tumor, clearly distinct yet related to both squamous cell carcinoma and eccrine carcinoma. Because its organoid architecture and the resemblance to and impingement on syringofibroadenoma, the term syringofibrocarcinoma is proposed.

Reactive eccrine syringofibroadenoma arising in peristomal skin: An unusual presentation of a rare lesion

“…54 In the limited reports available, complete excision appears to be the appropriate treatment for ESFA associated with or exhibiting malignant features. [15][16][17][18] In summary, we report a case of ESFA arising in peristomal skin. In this location, given the chronic manipulation and exposure of tissue to gastrointestinal and chemical irritants, ESFA is most likely reactive in nature.…”

“…3,7 Until recently, ESFA was considered to have an entirely benign clinical course. 2,3 However, recent reports have demonstrated an association of ESFA with squamous cell carcinoma or apparent malignant transformation of ESFA, [15][16][17][18] with the proposed term ''eccrine syringofibroadenocarcinoma.'' 17 The histologic features of ESFA are diagnostic and include multiple thin anastomosing cords and strands of benign-appearing, cuboidal epithelial cells that form a lattice that is connected to the undersurface of the epidermis and embedded in a loose fibrovascular stroma.…”

“…15,16,18 In reviewing the reported cases, J AM ACAD DERMATOL VOLUME 58, NUMBER 4 the following unifying features were identified: (1) patients were, on average, in their eighth decade; (2) male patients were affected more than female patients; (3) all cases involved the extremities; and (4) all cases showed worrisome features including inflammation, new growth, ulceration and crusting, and persistent disease despite extensive treatment. Notably, reported cases of peristomal carcinoma presented with similar symptoms.…”

“…2,3 However, recent reports suggest the possibility of an association of ESFA with squamous cell carcinoma or malignant transformation of ESFA. [15][16][17][18] In this study, we report the third case of peristomal ESFA, describe the clinical and histopathologic findings, and emphasize the potential for malignant change in these lesions.…”

Eccrine Syringofibroadenoma Associated With Well-Differentiated Squamous Cell Carcinoma

“…[2][3][4][5][6][7][8][9][10][11][12][13] Carcinoma arising in the background of ESFA is a rare event, with 10 cases reported to date. [14][15][16][17][18][19] Most tumors represented well-differentiated SCC. In this article, we report a case of ESFA associated with SCC, which additionally manifested cytopathic changes suggestive of human papillomavirus (HPV) infection; molecular biologic studies identified HPV DNA in the lesional tissue.…”