Dermatology Online Journal
Eccrine porocarcinoma arising from preexisting eccrine poroma of the scalp after radiotherapy for cervical cancer
- Author(s): Kose, Rustu
- Coban, Y Kenan
- Ciralik, Harun
- et al.
Eccrine porocarcinoma arising from preexisting eccrine poroma of the scalp after radiotherapy for cervical cancerSutcuimam University School of Medicine, Plastic Surgery Department, Kahramanmaras,Turkey
Rustu Kose, Y Kenan Coban, Harun Ciralik
Dermatology Online Journal 12 (6): 18
Eccrine porocarcinoma may arise from eccrine poroma or it may occur de novo. We present a rapidly growing occipital malignant eccrine poroma on the scalp following to a radiotherapy for cervical carcinoma. A wide excision with skin grafting resulted no recurrence during a 1-year followup. Although malignant transformation is well known for other skin cancers this was not reported for eccrine poroma.
Eccrine porocarcinoma is a rare malignant sweat gland tumor [1, 2, 3]. Clinical presentation can vary from an indurated plaque, a nodular erythematous lesion, to a polypoid ulcerated and bleeding lesion. Diagnosis of eccrine porocarcinoma on clinical observation only is unlikely. Differential diagnosis of a porocarcinoma includes poroma, verruca vulgaris, pyogenic granuloma, squamous cell carcinoma, basal cell carcinoma and malignant melanoma. Treatment of porocarcinoma is primary excision and sentinel lymph node biopsy . Because it has metastatic potential, chemotherapy has been tried, but consistent results are not reported [5, 6]. It may arise in continuity with a benign preexistent poroma . We report an example of malignant eccrine poroma arising in a preexisting poroma after the administration of radiotherapy for cervical squamous cell carcinoma.
|Figure 1||Figure 2|
|Figure 1. Tumor on the scalp|
|Figure 2. Histopathology of the tumor revealing uniformly small, cuboidal cells with cytological atypia and connection by intercellular bridges. (Hematoxylin-eosin stain; original magnification × 20.)|
A 52-year-old female presented with an 8-cm solid tumor on the occipital scalp region (Fig. 1). For 3 years she had been undergoing radiotherapy treatment for inoperable cervical carcinoma. The patient indicated that a smaller lesion was present on the scalp for 20 years. Coincident with her radiotherapy the lesion underwent rapid enlargement. The most prominent clinical symptoms were itching, bleeding, and disfigurement. Physical examination showed no palpable lymph nodes. Magnetic resonance imaging revealed no distant organ metastases. The lesion was excised with 2-cm margins under general anesthesia. The defect was repaired with a split-thickness skin graft from the thigh. Histologic examination of the lesion revealed a tumor arising from the epidermis comprised of solid masses of monomorphic basaloid cells with round, deeply basophilic nuclei, connected by intercellular bridges and varying numbers of cystic or ductal structures, in a richly vascularized stroma. High-power sections showed that the characteristic ductal structures were positive with periodic acid-Schiff stain. Cytologic atypia was found in the sections (Fig. 2). Fungal and bacteriologic studies and direct immunofluorescence microscopy produced negative findings. The pathology diagnosis was malignant eccrine poroma. No recurrence was observed during a 1-year followup.
Malignant eccrine poroma may arise from a sebaceous nevus, poroma, actinic lesions, and from normal skin. It may develop de novo. It is usually seen in the elderly. The lower extremity is the most prominent involvement site . Scalp and neck involvement is reported also . The malignant transformation of eccrine poroma is a well known entity . Benign eccrine poroma arises from the intraepidermal portion of the eccrine gland duct. The development of this tumor during pregnancy is reported but the relationship between eccrine sweat apparatus tumors and gestation is not well understood . The pathogenesis of this lesion has not been elucidated, but the occurrence of eccrine poromas after trauma or radiation exposure has been documented in the literature [12, 13]. Although the development of porocarcinoma in a traumatized area is reported, the occurrence of the malignant eccrine poroma after radiotherapy has not been described , but other forms of radiation-induced skin cancer is well known . Radiation-induced skin cancer may be associated with radiotherapy or occupational exposure. Several factors seem to influence the risk of radiation-induced cancer, such as total dose, young age at the time of irradiation, nature of irradiated tissue, and associated disease . This case suggests that malignant transformation of preexisting eccrine poroma may occur following to radiotherapy.
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