Tamoxifen‐induced eccrine squamous syringometaplasia

Abstract

A 74-year-old woman had carcinoma of her right breast for which surgery was performed. Four weeks following the start of tamoxifen therapy, she developed papules and plaques over her face, trunk and limbs. A skin biopsy showed perivascular and periadnexal mixed inflammatory cellular infiltrate with fibroplasia. Notably, the dermis also showed squamous epithelial islands, which in foci were noted to be closely associated with eccrine epithelium. This was confirmed with double peroxidase - alkaline phosphatase immunohistochemistry - the eccrine lumina highlighted with carcinoembryonic antigen (polyclonal) and the squamous metaplasia positive for cytokeratin 5/6. Eccrine squamous syringometaplasia was diagnosed. With close clinicopathological correlation, the cutaneous eruption was attributed to tamoxifen. Following discontinuation of the drug, the eruption resolved. Eccrine squamous syringometaplasia has been reported to occur in association with diverse conditions, including skin ulcers, burns and as a cutaneous adverse drug reaction, most commonly to chemotherapeutic drugs. This is believed to be the first report involving tamoxifen.

Neighboring Look-A-Likes

“…6 Bilateral lesions associated with various medications such as nonsteroidal anti-inflammatory and chemotherapeutic drugs (doxorubicin, tamoxifen) have been reported that exhibit syringoma-like features, occasionally exhibiting squamous metaplasia of eccrine and apocrine sweat ducts and mucinproducing glandular cells. [7][8][9] Similar lesions have been reported in association with chronic radiation dermatitis. Idiopathic cases are rare but have been documented.…”

Eruptive poromatosis in a patient with breast cancer

“…Tamoxifen is known to be associated with a range of dermatological side effects including erythema multiforme, Stevens-Johnson syndrome, urticaria, vasculitis and eccrine squamous syringometaplasia. 13 It is of interest that the eccrine poromas in our patient were ER negative. Whether Tamoxifen has a role in stimulating the development of the eccrine poromas in our patient who continues on this medication and continues to develop widespread lesions is uncertain.…”

“…Apart from its uses in breast cancer, it can be used to treat infertility in women with anovulatory disorders. Tamoxifen is known to be associated with a range of dermatological side effects including erythema multiforme, Stevens‐Johnson syndrome, urticaria, vasculitis and eccrine squamous syringometaplasia . It is of interest that the eccrine poromas in our patient were ER negative.…”

Cutaneous adverse effects of hormonal adjuvant therapy for breast cancer: A case of localised urticarial vasculitis following anastrozole therapy and a review of the literature

“…In total, 21 cases, including the present patient, were identified. Vasculitis was the most common reported adverse cutaneous event for both tamoxifen and aromatase inhibitors, with four cases of vasculitis reported for both drug classes Other reactions to tamoxifen included subacute cutaneous lupus erythematosus (SCLE), radiation recall dermatitis, eccrine squamous syringometaplasia and a maculopapular eruption . Of the five cases involving anastrozole, three cases presented with vasculitis (including our patient) and one case each with SCLE and a micropapular eruption .…”