The Journal of Dermatology Vol. 6: 329-331. 1979
PLAQUE TYPE SYRINGOMA ICHIRO KIKUCHI, MASAHIRO IDEMORI AND MICHIHARU OKAZAKI ABSTRACT
Special types of syringoma include eruptive syringoma (1) and syringoma on the vulva and on the upper extremities (2). We present a large one, 1x5 em in size. found on the right side of the neck. and preoperatively diagnosed as nevus sebaceus.
Fig. 1. Close-up view of plaque type syringoma showing a lichenified surface. There is a nevus pigmentosus to the right of the syringoma ..
Case. A 29·year-old. otherwise healthy Japanese housewife visited the Department of Dermatology. Miyazaki Medical College, in October 1978 because of a brown asymptomatic plaque on the right side of her neck which had been present since the age of 20. At age 22, a biopsy was performed at another Received May 8. 1979; accepted for publication June 25. 1979. Department of Dermatology, Miyazaki Medical College, Kiyotake, Miyazaki, 889-16,Japan.
Fig. 2. Reflection ultraviolet photOgfll"y (4)';eveals plaque type syringoma on the right neck and minute syrinogoma lesions around it. Her cheek. heavily painted with cosmetics. shows many depressions and papules. Minute skin surface changes can be well visualized by this technique.
hospital. without a definite conclusion. At around age 26. several skin-colored papules appeared inferior to the plaque. She visited us because of its tendency toward enlargement and cosmetic concerns. Examination revealed a brown, slightly elevated, lichenified plaque, about 1 em by 5 em in size, running parallel to the mandible (Figs. 1 and 2).
330
KIKUCHI ET AL
Fig. 3.
Tadpole or comma-shaped strands of cells are seen, enclosed in a fibrous stroma. This is characteristic of syringoma. H & E. Original magnification xIOO.
Fig. 4.
High magnification of Fig. 3. Original magnification x200.
331
SYRINGOMA
Several small papules of the same nature were present on the eyelids and solitary papules were present on both breasts. The genitals were not involved. The plaque was removed under local anesthesia. Histological examination revealed an acanthotic epidermis with increased melanin granules in the basal layer and "islands" of fibroepithelial tumors typical of normal syringoma. There were many strands of cells and cysts lined with cells similar to those lining normal eccrine ducts. Some of the cysts included PAS positive substances which were digestable by diastase. There were tadpole or comma-shaped strands of cells characteristic of syringoma (Figs. 4 and 5). COMMENT
Syringoma is usually described as showing small papules, multiple in number, but it does not usually appear as a plaque. Among 149 cases of syringoma, Kawashima and his associates (3) found only one solitary case, but they did not find a plaque type syringoma (personal communication). Under the diagnosis of eruptive hidradenoma or eruptive
syringoma, Hashimoto and his associates (1) described two cases of syringoma with disseminated distribution. One of the lesions measured 15 mm in diameter. Our case differs from theirs because there were no disseminated lesions of syringoma. Therefore, we named our case plaque type syringoma. Microscopically, it showed "islands" of syringoma lesions. ACKNOWLEDGEMENT Mr. Hideo Uchimura took the ultraviolet photograph. REFERENCES 1) Hashimoto, K., DiBella, R.J., Borsuk, G.M. and Lever. W.F.: Eruptive hidradenoma and syringoma, Arch. Dermatol., 96: 500-519, 1967. 2) Ariyoshi, M. and Toshitani, S.: Syringoma restricted to both upper arms, Nishinihon J. Dermatol., 34: 426-427,1972. (in Japanese) 3) Kawashima, Y., Yakata, T., Mouri, N., Okada, Y. and Fukushiro, R.: Sweat organ tumors at the Department of Dermatology, Kanazawa University, Rinsho Dermatol., 20: 977-983,1978. (in Japanese) 4) Kikuchi, 1., Idemori, M., Uchimura, H. and Inoue, S.: Reflection ultraviolet photography in dermatology, J. Dermatol., 6: 81-85, 87-93, 1979.
PLAQUE TYPE SYRINGOMA ICHIRO KIKUCHI, MASAHIRO IDEMORI AND MICHIHARU OKAZAKI ABSTRACT
Special types of syringoma include eruptive syringoma (1) and syringoma on the vulva and on the upper extremities (2). We present a large one, 1x5 em in size. found on the right side of the neck. and preoperatively diagnosed as nevus sebaceus.
Fig. 1. Close-up view of plaque type syringoma showing a lichenified surface. There is a nevus pigmentosus to the right of the syringoma ..
Case. A 29·year-old. otherwise healthy Japanese housewife visited the Department of Dermatology. Miyazaki Medical College, in October 1978 because of a brown asymptomatic plaque on the right side of her neck which had been present since the age of 20. At age 22, a biopsy was performed at another Received May 8. 1979; accepted for publication June 25. 1979. Department of Dermatology, Miyazaki Medical College, Kiyotake, Miyazaki, 889-16,Japan.
Fig. 2. Reflection ultraviolet photOgfll"y (4)';eveals plaque type syringoma on the right neck and minute syrinogoma lesions around it. Her cheek. heavily painted with cosmetics. shows many depressions and papules. Minute skin surface changes can be well visualized by this technique.
hospital. without a definite conclusion. At around age 26. several skin-colored papules appeared inferior to the plaque. She visited us because of its tendency toward enlargement and cosmetic concerns. Examination revealed a brown, slightly elevated, lichenified plaque, about 1 em by 5 em in size, running parallel to the mandible (Figs. 1 and 2).
330
KIKUCHI ET AL
Fig. 3.
Tadpole or comma-shaped strands of cells are seen, enclosed in a fibrous stroma. This is characteristic of syringoma. H & E. Original magnification xIOO.
Fig. 4.
High magnification of Fig. 3. Original magnification x200.
331
SYRINGOMA
Several small papules of the same nature were present on the eyelids and solitary papules were present on both breasts. The genitals were not involved. The plaque was removed under local anesthesia. Histological examination revealed an acanthotic epidermis with increased melanin granules in the basal layer and "islands" of fibroepithelial tumors typical of normal syringoma. There were many strands of cells and cysts lined with cells similar to those lining normal eccrine ducts. Some of the cysts included PAS positive substances which were digestable by diastase. There were tadpole or comma-shaped strands of cells characteristic of syringoma (Figs. 4 and 5). COMMENT
Syringoma is usually described as showing small papules, multiple in number, but it does not usually appear as a plaque. Among 149 cases of syringoma, Kawashima and his associates (3) found only one solitary case, but they did not find a plaque type syringoma (personal communication). Under the diagnosis of eruptive hidradenoma or eruptive
syringoma, Hashimoto and his associates (1) described two cases of syringoma with disseminated distribution. One of the lesions measured 15 mm in diameter. Our case differs from theirs because there were no disseminated lesions of syringoma. Therefore, we named our case plaque type syringoma. Microscopically, it showed "islands" of syringoma lesions. ACKNOWLEDGEMENT Mr. Hideo Uchimura took the ultraviolet photograph. REFERENCES 1) Hashimoto, K., DiBella, R.J., Borsuk, G.M. and Lever. W.F.: Eruptive hidradenoma and syringoma, Arch. Dermatol., 96: 500-519, 1967. 2) Ariyoshi, M. and Toshitani, S.: Syringoma restricted to both upper arms, Nishinihon J. Dermatol., 34: 426-427,1972. (in Japanese) 3) Kawashima, Y., Yakata, T., Mouri, N., Okada, Y. and Fukushiro, R.: Sweat organ tumors at the Department of Dermatology, Kanazawa University, Rinsho Dermatol., 20: 977-983,1978. (in Japanese) 4) Kikuchi, 1., Idemori, M., Uchimura, H. and Inoue, S.: Reflection ultraviolet photography in dermatology, J. Dermatol., 6: 81-85, 87-93, 1979.
