Author(s) : Junko GOSHIMA, Hiroyuki HARA, Tomoyoshi OKADA, Hiroyuki SUZUKI , Department of Dermatology, Nihon University School of Medicine, 30‐1 Oyaguchi‐kamimachi, Itabashi‐ku, Tokyo 173‐8610, Japan . |
ARTICLE
Auteur(s) : Junko GOSHIMA, Hiroyuki HARA, Tomoyoshi
OKADA, Hiroyuki SUZUKI
Department of Dermatology, Nihon University School of Medicine,
30‐1 Oyaguchi‐kamimachi, Itabashi‐ku, Tokyo 173‐8610,
Japan
Reprints: J. Goshima
A 33‐year‐old Japanese man was referred to our Clinic because of
the papilloma‐like lesion on the scrotum for 3 years. Physical
examination disclosed a reddish‐yellowish papillary appearing tumor
measuring 5 × 7 mm with an attached 4‐mm stalk on
the scrotum (Fig.
1a). A clinical diagnosis of verruciform xanthoma was made.
An excisional biopsy was performed.. Histopathologic examination of
the specimen revealed varying degrees of surface features ranging
from papillomatosis to a cup‐like depression of small papillations.
Several cystic invaginations extended downward from the epidermis
(Fig. 1b). The
glandular epithelium consisted of two to several layers of cells.
The luminal row of cells consisted of high columnar oval nuclei and
light eosinophilic cytoplasm. Some of these cells showed
decapitation secretion. The outer row of cells consisted of small
cuboidal cells with round nuclei and comparatively meager
cytoplasm. A marked inflammatory infiltrate containing many plasma
cells was present around the cystic invaginations. These findings
were compatible with those of syringocystadenoma papilliferum
(SCAP). Immunohistochemistry was performed. With the antibodies
against epithelial CKs such as 4.1.18, 170.2.14 and CAM 5.2,
luminal cells revealed a positive staining. Neither D6 (gross
cystic disease fluid protein‐15) nor 1.10.F3 (human milk fat
globulin‐1: HMFG‐1) were expressed in any tumor cells. A case of
SCAP arising on the scrotum without an association with nevus
sebaceous was reported. The occurrence of SCAP on the scrotum is
distinctly uncommon. There have been only two cases previously
reported in the literature [1, 2]. 40% cases arising on the head
and neck are associated with nevus sebaceus, other cases may occur
de novo [3]. SCAP is usually thought to imply an apocrine
origin [4]. However, it seems strange that the occurrence of SCAP
is quite rare in the axilla, breast or scrotum, where apocrine
glands are frequently observed. Almost all cases of SCAP are
observed in anatomic sites normally devoid of apocrine glands [1].
Recent studies show that HMFG‐1 is expressed in the luminal
cells of the excretory duct and of the secretory coil of apocrine
sweat glands and sebaceous glands in normal skin [5]. Therefore,
HMFG‐1 is thought to be a tissue marker of apocrine epithelium
[5]. In the present study, HMFG‐1 was not expressed in the
tumor cells, although cytokeratins revealed similar
immuno‐reactivities to apocrine differentiation. Future studies
will provide us with information on the pathogenesis of SCAP.
References
1 . Helwig EB, Hackney VC. Syringocystadenoma papilliferum:
lesions with and without naevus sebaceous and basal cell carcinoma.
Arch Dermatol Syphilol 1955; 71: 361‐72.
2 . Coyne JD, Fitzgibbon JF. Mixed syringocystadenoma
papilliferum and papillary eccrine adenoma occurring in a scrotal
condyloma. J Cutan Pathol 2000; 27: 199‐201.
3 . Mammino JJ, Vidmar DA. Syringocystadenoma papilliferum.
Int J Dermatol 1991; 30: 763‐6.
4 . Mazoujian G, Margolis R. Immunohistochemistry of gross
cystic disease fluid protein (GCDFP‐15) in 65 benign sweat
gland tumors of the skin. Am J Dermatopathol 1988; 10:
28‐35. de Viragh PA, Szeimles RM, Eckert F. Apocrine cystadenoma,
apocrine hidrocystoma, and eccrine hidrocystoma: three distinct
tumors defined by expression of keratins and human milk fat
globulin 1. J Cutan Pathol 1997; 24: 249‐55.
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