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CASE REPORT - SURGICAL PATHOLOGY
Year : 2011  |  Volume : 1  |  Issue : 1  |  Page : 91-92

Chondroid syringoma with extensive ossification


1 Department of Plastic Surgery, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication26-Jul-2011

Correspondence Address:
H Sreekar
Department of Plastic Surgery, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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DOI: 10.4103/2231-0746.83149

PMID: 23483813

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  Abstract 

Chondroid syringoma is a rare appendagel skin tumor. Due to its uncharacteristic presentation, it is rarely diagnosed clinically. Here we present one such case in a 50-year-old lady. She presented with a hard mobile lesion over her nose which was excised. The histologic picture is characterized by a combination of epithelial and myoepithelial structures within a chondromyxoid and fibrous stroma. For these tumors, excision is the treatment of choice.

Keywords: Appendageal tumor, chondroid syringoma, skin tumor


How to cite this article:
Paul K, Sreekar H, Dhanraj P, Lamba S, George SM. Chondroid syringoma with extensive ossification. Ann Maxillofac Surg 2011;1:91-2

How to cite this URL:
Paul K, Sreekar H, Dhanraj P, Lamba S, George SM. Chondroid syringoma with extensive ossification. Ann Maxillofac Surg [serial online] 2011 [cited 2017 Apr 28];1:91-2. Available from: http://www.amsjournal.com/text.asp?2011/1/1/91/83149


  Introduction Top


Chondroid syringoma is a rare primary skin tumor with a reported incidence of <0.098%. It affects usually middle aged and older male patients. The site of predilection is the head and neck region where it typically presents as a slow-growing, painless, firm intracutaneous nodule. [1] Because of its noncharacteristic features, it usually goes undiagnosed. Here we report a case of chondroid syringoma and review the relevant literature. This case to the best of our knowledge is the first to be reported in the Indian subcontinent.


  Case Report Top


A 50-year-old lady presented with an 8-month history of a painless, slow-growing lesion over the tip of nose [Figure 1]. The lesion was hard, nontender, mobile, and measured 2 × 2 × 1 cm. There was no lymphadenopathy. By an elliptical incision, the tumor was excised completely and sent for histopathological examination [Figure 2]. Gross examination showed a well-circumscribed whitish nodular firm mass gritty to cut. A microscopic examination revealed a circumscribed biphasic tumor composed of lobules of epithelial nests lined by two layers of cells, and outer myoepithelial and inner epithelial with foci of squamous differentiation separated by a chondromyxoidstroma. The stroma shows loose chondromyxoid areas with bone formation [Figure 3]. There was no evidence of malignancy or atypia.
Figure 1: Preoperative clinical photograph

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Figure 2: Postexcision photograph

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Figure 3: Microscopy showing extensive ossification in myxoidstroma (H and E, 10x)

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  Discussion Top


Histologically, these tumors contain a combination of epithelial and myoepithelial structures within a chondromyxoid and fibrous stroma. Sometimes these tumors may show differentiation toward skin adnexal structures (like hair follicle, hair matrix, and sebaceous and apocrine glands). [2] Ossification is a rare feature and when present it is focal and scant. [3] Extensive ossification in a benign mixed tumor as in our case at any anatomical site is exceedingly rare, and so far, only few such tumors have been reported in the skin. [3],[4],[5] Akasaka et al. suggested that ossification in the tumors indicates development from pluripotent stem cells. Apart from the rare occurrence of ossification in cutaneous mixed tumours of the skin, secondary (metaplastic) ossification may be seen in a variety of other skin lesions, including nevi, basal cell carcinomas, and pilomatricomas, and less commonly in trichoepitheliomas, hemangiomas, pyogenic granulomas, schwannomas, lipomas, organoidnevi, epidermal and dermoid cysts, dermatofibromas, desmoplastic melanomas, and some cutaneous metastasis. [5] The first-line treatment is the total excision of the tumor while preserving the esthetic and functional structures as in the present case.

Chondroid syringoma (benign mixed tumor of the skin) is an uncommon skin adnexal tumor usually presenting as a slow-growing, painless nodule in the head and neck region. [6],[7],[8] The site of predilection for the tumor is the head and neck region though cases in other areas have been reported. Though various treatment options have been proposed, in view of the chances of malignancy, excision seems the treatment of choice. The chances of malignancy increase with the size of the lesion. Adjuvant chemotherapy and radiotherapy have also been tried. [9] In the evaluation of a cutaneous nose nodule, chondroid syringoma should be considered in the preoperative differential diagnosis which may allow the surgeon to plan for complete excision.

 
  References Top

1.Yavuzer R, Baºterzi Y, Sari A, Bir F, Sezer C. Chondroidsyringoma: A diagnosis more frequent than expected. Dermatol Surg 2003;29:179-81.   Back to cited text no. 1
    
2.Yamamoto O, Yasuda H.An immunohistochemical study of apocrine type of cutaneous mixed tumours with special reference to their follicular and sebaceous differentiation. J Cutan Pathol 1999;26:232-41.  Back to cited text no. 2
    
3.Awasthi R, Harmse D, Courtney D, Lyons CB. Benign mixed tumour of the skin with extensive ossification and marrow formation: A case report. J Clin Pathol 2004;57:1329-30.  Back to cited text no. 3
    
4.Shimizu S, Han-Yaku H,Fukushima S.Immunohistochemical study of mixed tumour of the skin, with marked ossification. Dermatology 1996;193:255-7.  Back to cited text no. 4
    
5.Akasaka T, Onodera H, Matsuta M. Cutaneous mixed tumor containing ossification, hair matrix, and sebaceous ductal differentiation. J Dermatol 1997;24:125-31.  Back to cited text no. 5
    
6.Bekerecioglu M, Tercan M, Karakok M, Atik B. Benign chondroidsyringoma: A confusing clinical diagnosis. Eur J Plast Surg 2002;25:316-8.  Back to cited text no. 6
    
7.Hardisson D, Linares MD, Nistal M. Giant chondroidsyringoma of the axilla. J Cutan Med Surg 1998;3:115-7.  Back to cited text no. 7
    
8.Sliwa-Hähnle K, Obers V, Lakhoo M, Saadia R. Chondroidsyringoma of the abdominal wall. A case report and review of the literature. S Afr J Surg 1996;34:46-8.  Back to cited text no. 8
    
9.Barnett MD, Wallack MK, Zuretti A.Recurrent malignant chondroidsyringoma of the foot: A case report and review of the literature. Am J Clin Oncol 2000;23:227-32.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
1 Chondroid syringoma of the axilla: An unusual tumor diagnosed by fine needle aspiration
Robert Rogers,Fang Zhou,Dianne Grunes,Richard L. Shapiro,Michael Bannan,Aylin Simsir,Allen Leung
Diagnostic Cytopathology. 2016; : n/a
[Pubmed] | [DOI]



 

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