What are eccrine gland tumors?

Updated: Oct 07, 2019
  • Author: Guy J Petruzzelli, MD, PhD, MBA, FACS; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Answer

The nomenclature used to describe and distinguish between apocrine and eccrine tumors is confusing. Fortunately, histologic examination reveals the distinctive feature of sweat duct (eccrine) tumors: the double layer of epithelium. [121] Benign eccrine gland tumors include syringoma and eccrine poroma.

Syringoma

Syringomas occur around the eyes, axilla, or anogenital region. This distribution pattern is similar to apocrine tumors. [124] This tumor is a benign hamartomatous lesion. The presence of succinic dehydrogenases and phosphorylases provides evidence that this lesion is of eccrine origin. Syringomas can occur as solitary or multiple lesions. [125] Removal of these lesions has had variable results. [126] In a case report, Belardi and colleagues used cryotherapy as a successful treatment to remove multiple, painful syringomas. [124] Syringomas are associated with Down syndrome.

Eccrine poroma

Eccrine poroma is a benign tumor that typically occurs on the palms and soles. [127] This lesion is superficial and arises within the epidermis, with sharply demarcated borders. As the lesion develops, the tumor grows into the dermis layer. Upon histologic examination, the lesion contains small, pale cells with oval-shaped, centrally-located nuclei. The pale-staining aspect of these cells distinguishes them from the dark-staining cells of BCC. Other evidence suggests that some of these lesions may actually be derived from the apocrine gland rather than the eccrine gland. [128] The preferred treatment is surgical excision. [129] Although extraordinarily rare, the malignant variant (eccrine porocarcinoma) does occur. The eccrine poroma is sometimes friable and resembles a pyogenic granuloma.

Eccrine carcinomas

Primary eccrine carcinomas are rare malignant tumors with variable histologic forms, including eccrine porocarcinoma, clear cell carcinoma, and mucinous carcinoma. [130] All these tumors have the capacity to metastasize to skin and regional lymph nodes.

Eccrine porocarcinoma is the malignant variant of eccrine poroma. [131] The lesion is characterized histologically by intradermal islands of anaplastic cells bordered by acanthotic epidermis. As the tumor progresses, these anaplastic cells invade the dermal layer. The traditional treatment for eccrine porocarcinoma is wide local excision. Alternatively, Wittenberg and colleagues have demonstrated that Mohs micrographic surgery is effective, with no local recurrence in a limited number of patients. [132] For metastatic lesions, Barzi and colleagues used the combination of isotretinoin and interferon alfa as a chemotherapy regimen, with moderate success. [133]

Clear cell eccrine carcinomas consist of cells with clear cytoplasm and prominent round or oval hyperchromatic nuclei. [134] The abundance of glycogen contributes to the distinctive cytoplasm. Case reports demonstrate difficulties in treating clear cell eccrine carcinomas because of frequent local recurrences. [135] In addition, chemotherapy has been ineffective against metastatic disease.

Mucinous carcinoma typically develops on the eyelids. [136, 137] The tumor contains clusters of small, dark basophilic cells with eosinophilic cytoplasm surrounded by pools of mucin. This lesion often appears as a poorly-differentiated infiltrating tumor with similarities to anaplastic squamous carcinoma. Traditional treatment is excisional biopsy, but definitive treatment is difficult and is complicated by the high rate of local recurrence. [138, 139]


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