Chondroid syringoma (mucinous hydradenoma) is a solitary chondroid-epithelial tumor of the skin of a benign nature. The primary elements are small nodules of dense elastic consistency that appear spontaneously on the previously unchanged skin of the trunk. They rise above the level of the dermis, have a smooth surface, have slow peripheral growth, sometimes ulcerate. The diagnosis is carried out by a dermatologist based on anamnesis and clinical manifestations using the results of histology, a scarification smear from the lesion and a punctate of the neoplasm. Treatment consists in surgical or electrosurgical excision of chondroid syringoma.
D23.9 Other benign skin neoplasms of unspecified localization
Chondroid syringoma is a benign tumor of eccrine sweat glands of mixed genesis. The heterogeneity of the chondroid syringoma, according to most dermatologists, is due to the fact that the eccrine sweat gland itself is located in the dermis, but its duct opens on the surface of the skin. This probably explains the mixed type of tumor cells, but there is absolutely no reliable confirmation of such a genesis.
P. Abenoza and A. Akkerman studied sweat glands in dermatology, who from 1979 to 1987 examined more than 800 thousand biopsies of sweat gland tumors and found only 5% of eccrine pathology in them. This indicates in favor of the rarity of chondroid syringoma and explains its poor knowledge. Chondroid syringoma has no age, seasonal, climatic and geographical features. The gender component is interpreted differently by various authors, which is associated with a mixed type of tumor. Some variants of chondroid syringoma are more common in women, others in men. The urgency of the problem is associated with insufficient knowledge of neoplasia and the possibility of its transformation into malignant syringocarcinoma.
Causes and pathogenesis
The triggers of the pathological process and the mechanism of its development are practically not studied. For unknown endogenous or exogenous reasons, with chondroid syringoma, the degeneration of the excretory duct of the eccrine sweat gland, passing through all layers of the epidermis and opening on the surface of the skin, spontaneously begins. Connective tissue, due to its lability, versatility, polymorphic cellular composition and close connection with the immune system, is involved in this process. There is an increase in the rate of mitotic cell division and their maturation. Cell differentiation is disrupted, their functions change.
The cells begin to produce substances that are not characteristic of them, resembling cartilage tissue, which forms the chondromucoid stroma of the tumor. Since the cells of the chondroid syringoma differ slightly from normal dermal cells in terms of differentiation, a tumor of a benign nature is formed. At the same time, the connection between cellular elements is lost, proliferative processes are intensified. Since the mass of cells grows in a limited area, a tumor forms on the surface of the skin in the form of a chondroid syringoma – a benign nodule. The damaged eccrine sweat gland stops working, which leads to a local violation of the sweating process.
In modern dermatology, there is no generally accepted classification of the pathological process, however, practical dermatologists use a classification of the disease, taking into account histological signs, to determine the degree of danger of chondroid syringoma malignancy and timely appointment of adequate therapy. According to the presence of flat cells in the chondroid syringoma , V. Lever and G. Schaumburg identified two possible variants in 1983:
- Tubular type is characteristic of chondroid syringoma, the elements of which consist of two layers of epithelial cells – internal prismatic and external flat, prone to proliferation and reproduction of the chondroid matrix, that is, capable of degeneration.
- The cystic type is characteristic of a single-layer chondroid syringoma, in the stroma of which basophils and mucoid substances are present, but there are no flat cells, which determines the benign nature of the tumor.
The primary elements of chondroid syringoma are small oval painless pinkish nodules with a glossy surface. Tumor-like formations are located intradermally or slightly rise above the surface of the skin. They are dough-like to the touch and are localized where there are sweat glands.
Most often, chondroid syringoma debuts on the skin of the trunk. Nodules have slow growth, are able to grow for years, rarely exceed 5 mm in diameter, sometimes have a translucent shell, are able to ulcerate. The appearance of primary elements is not accompanied by subjective symptoms or the appearance of a pronounced cosmetic defect and remains unnoticed for a long time for the patient, which is dangerous from the point of view of the possibility of transformation of the tumor into syringocarcinoma.
The clinical diagnosis of the disease is made by a dermatologist based on anamnesis and evaluation of symptoms in dynamics with an emphasis on impaired sweating function. The diagnosis of chondroid syringoma requires mandatory histological confirmation. As part of the tumor, the presence of epithelial cells and the proliferation of connective tissue with areas of mucinous and chondroid inclusions are detected.
A study of the nodule punctate or a biopsy is used. Cytology of smears-scarifiers from nodular eruptions is used (by analogy with smears-prints in cystic dermatoses). They make it possible to detect acantholytic cells in the tumor. Differentiate chondroid syringoma with a mixed tumor of the salivary glands, basal cell carcinoma, syringocarcinoma.
With a benign variant of chondroid syringoma, treatment is not required. The purpose of possible therapy is the correction of an aesthetic defect. Radical removal of chondroid syringoma is necessary when the first signs of malignancy appear: erosion of the nodule surface, crust formation. It is mandatory to consult an oncologist, surgeon and cosmetologist, after which chondroid syringoma can be removed by surgical operation.
Electrical dissection, electrocauterization, laser coagulation, surgical curettage are used. It must be remembered that the removal of the tumor can lead to hyperrubification, hyperpigmentation, the formation of persistent erythema, therefore, when aesthetic correction of the tumor using surgical techniques, the localization of the pathological process should be taken into account. The prognosis is favorable.