Opciones de eem
Malignant eccrine spiradenoma MES is a rare malignancy of the eccrine sweat glands. It usually presents as a opciones de eem, firm, reddish painful and small solitary nodule. Head and neck are rare locations. Etiology is unknown although previous trauma is believed to be an implicated factor. MES arises over a prior benign spiradenoma.
Clinical behavior is aggressive with a high rate opciones de eem recurrences and distant metastases. Diagnosis is based on histological findings and treatment must be aggressive from the beginning to achieve the best results. Since Kersting and Helwig first described the case inand Beekley et al. Based on these particular features we report a case of a year-old man diagnosed on a MES that arises in a very unusual location, with a peculiar histopathology and behavior.
El EEM se origina sobre un espiradenoma benigno previo. Desde que, enKersting y Helwig describieran el primer caso, y, enBeekley y cols.
Eccrine spiradenoma is an uncommon and slow growth tumor of the eccrine sweat glands. Since Beekley et al. Diagnosis is based on histopathological findings. Opciones de eem local excision associated with cervical neck dissection is opciones de eem elective treatment. A year-old man was referred to our Oral and Maxillofacial Surgery Department with a lesion in the nasolabial fold Fig.
Primary lesion in the nasolabial fold. According to the diagnosis, a MRI and a radionuclide bone scan were performed. Facial MRI showing the lesion white arrow. The tumor was diagnosed as a malignant eccrine spiradenoma stage IV so that palliative treatment with chemotherapy was performed. Partial bone opciones de eem was obtained since radiological point of opciones de eem but primary tumor kept on growing.
Although tumoral stage was advanced, we decided, according to the patient, performing a radical surgery treatment. Then, a FNAC of the primary lesion confirmed the diagnosis and a wide surgical excision of the tumor with neck dissection and reconstruction with a cervicopectoral flap was planned.
Histopathological examination revealed an encapsulated tumor composed by two cell types disposed in solid groups and areas with glandular, squamous and even sarcomatoid differentiation.
Mitosis rate was so high and wide necrotic areas were frequently seen. The capsule had tumoral invasion foci Fig. No one of the twelve cervical lymph nodes isolated was infiltrated by the tumor. Eight months later, the patient presented a recurrence on the cervicopectoral scar, near the lips. According to this, a new resection was performed again obtaining histological free margins Fig.
Surgical bed with adequate safety margins. Nowadays, three years after last surgery there have been no signs of local recurrences and metastatic opciones de eem have been controlled by chemotherapy Fig.
Postoperative aspect of the patient from lateral and frontal view. Notice the good aesthetic result. Opciones de eem report tries to make a special emphasis concerning a proper management of eccrine spiradenoma, frequently benign, but, as in our case and due to an incorrect initial management, sometimes malignant.
Since Kersting and Helwig first described the case in9 and Beekley et al. Eccrine spiradenoma is usually benign and may occur in infancy but opciones de eem commonly arises in young people 2nd to 4th decades as a small, firm and reddish painful solitary nodule 0.
Malignant form of eccrine spiradenoma MES is extremely infrequent and only 50 cases have been reported in the literature. It may develop de novo or most frequently, arises in pre-existing benign eccrine spiradenoma as a sudden growth or pain in people over 50 years old after a variable latent period may be as long as 75 yearswith no gender differences. Multiple cases have been described associated with other neoplasms as cylindromas, hidradenomas or trichoepitheliomas into the Brooke—Spiegler syndrome.
In these cases, lesions combine features of both cylindromas and spiradenomas. Such findings include proliferation of atypical cells with hyperchromatic nuclei, increased mitoses, nuclear pleomorphism and loss of periodic acid-Schiff-positive basement membrane and loss of the typical dual cell population disposed in cords.
Another microscopic features may be present as areas of necrosis, focal squamous differentiation, invasion of the surrounding tissues and increased vascularization of the tumor. The last condition can lead to diagnostic confusion with a vascular neoplasm.
Immunohistochemically, MES exhibit variable expression of cytokeratins, carcinoembryonic antigen, epithelial opciones de eem antigen and S protein. Overexpression of p53 protein in benign spiradenomas has been associated with malignant transformation, usually into a carcinoma; however, carcinosarcomatous transformation has also been reported. Areas of spiradenoma near or in transition with a malignant tumor such as rhabdomyosarcoma, osteosarcoma, leiomyosarcoma, and chondrosarcoma may be present although less frequently.
All these variable and inconstant histological features can lead to a mistaken diagnosis with other skin malignances 6,13 such as carcinoma, basal cell carcinoma, clear cell hidradenoma or malignant condroid syringoma.
The mainstay of therapy is surgical excision, which may be curative opciones de eem some cases. Cervical lymph nodes should be dissected if tumor metastases are suspected clinically to complete the treatment if cervical disease is present and to prevent lympathic spread if the neck is staged as N opciones de eem.
The usefulness of other therapeutic alternatives such as hormonal therapy with tamoxifen, chemotherapy and radiotherapy remains to be determined 2,4—6,8,9,11 and they have been used unsuccessfully opciones de eem the treatment of these patients. We do not agree with these thoughts, based on our clinical case. This finding should represent a new chemotherapy schedule useful in selected cases.
MES usually metastasizes to regional lymph nodes and opciones de eem frequently to lung, brain and liver. While distant metastases are uncommon, they generally portend an ominous prognosis.
Opciones de eem overall prognosis is so poor that Meyer et al. Other authors as Herzberg et al. It is noticeable that our patient, three years after the last surgery, keeps still alive with a good quality of life. Nevertheless, postoperative long-term follow-up is necessary in all the patients to prevent any local or metastatic recurrence.
We are face to face with a rare tumor of the eccrine sweat glands. Malignant forms are extremely uncommon although described. Diagnosis is complicated and is based on histological findings. Recurrences after treatment are frequent and often occur after incomplete tumor excisions so that aggressive surgical treatment must be performed although the tumor is benign.
The authors state that there are no conflicts of interest in writing this article. This journal is available in English. Rev Esp Cir Oral Maxilofac ; Malignant eccrine spiradenoma of the nasolabial fold. Espiradenoma ecrino maligno en el surco nasolabial.
Recibido 08 mayoAceptado 19 julio opciones de eem Diagnosis is based on histological findings and treatment must be aggressive from the beginning to achieve the best results. Based on these particular features we report a case of a year-old man diagnosed on a MES that arises in a very unusual opciones de eem, with a peculiar histopathology and behavior.
Eccrine spiradenoma, Skin tumor, Wide surgical resection, Follow-up. Introduction Eccrine spiradenoma opciones de eem an uncommon and slow growth tumor of the eccrine sweat glands. Case report A year-old man was referred to our Oral and Maxillofacial Surgery Department with a lesion in the nasolabial fold Fig. Primary lesion in the nasolabial fold.
Facial MRI showing the lesion white arrow. Surgical bed with adequate safety margins. Notice the good aesthetic result. Eccrine spiradenoma of the ear: Int J Oral Maxillofac Surg, 32pp. Opciones de eem eccrine spiradenoma of the neck: Otolaryngol Head Neck Surg,pp. Otolarygol Head Neck Surg,pp. J Am Acad Dermatol, 44pp. Papular lesion opciones de eem the proximal nail fold. Arch Dermatol,pp. Pathol Int, 54pp.
Cutis, 69pp. External auditory canal eccrine spiradenocarcinoma: Head Neck, 25pp. Malignant eccrine spiradenoma occurring on a traumatized area. Plastic Reconstruct Surg,pp.
Malignant eccrine spiradenoma opciones de eem Am J Dermatopathol, 22pp. An unusual case of early malignant transformation in a spiradenoma. Dermatol Surg, 21pp. Arch Pathol Lab Opciones de eem,pp. Arch Dermatol, 73pp. Am Surg, 65pp. Otros websites Elsevier Elsevier Portugal Dfarmacia.
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