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Case Report

Malignant eccrine acrospiroma with nodal and bone metastasis

Burhan Wani, Shiekh Aejaz Aziz, Mohmad Hussain Mir, Gull Mohammad Bhat, Abdul Rashid Lone
Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar 190011, Kashmir, India.
Correspondence to: Dr. Burhan Wani, Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar 190011, Kashmir,
India. E-mail: burhan4187@gmail.com

A B S T R AC T
Acrospiromas are cutaneous tumors of sweat duct differentiation. Although various eccrine sweat gland tumours including
benign acrospiroma are widely reviewed, malignant acrospiroma is rarely reported. Clinically, they resemble other cutaneous
lesions and the primary treatment is wide local excision with or without lymph node dissection. The efficacy of adjuvant
chemotherapy and radiation therapy requires further investigation.

Key words: Acrospiroma; metastasis; chemotherapy; radiotherapy

INTRODUCTION right inguinal region. The swelling was firm in consistency
and mildly tender. There was another mass 2 cm below
Acrospiroma represents a group of benign ductal tumors this measuring 3 cm × 2 cm, firm in consistency, mobile,
of the eccrine sweat glands that sometimes are connected non-tender with normal overlying skin, felt to be a lymph
to the skin, ranging from solitary plaques to exophytic node clinically.
papules or dermal nodules. Malignant acrospiroma (Syn:
[1]
malignant nodular/clear cell hidradenoma, malignant clear The patient was operated on and excision of the mass
cell acrospiroma, clear cell eccrine carcinoma, primary along with inguinal nodal dissection. Pathology revealed
mucoepidermoid cutaneous carcinoma) comprises a dermal appendage neoplasm (acrospiroma -- of hydra
group of rare epidermal, juxta-epidermal, and dermal adenoma type), well-circumscribed, with mitotic figures
ductal carcinomas that may coexist with their benign (< 2/hpf). No necrosis was seen. Nodal tissue showed
counterparts and have the potential for regional lymph metastasis from the same tumor [Figures 1 and 2]. The
node and, very rarely, distant metastases. The primary patient was put on regular follow up and no adjuvant
[2]
treatment is wide local excision with or without lymph chemo/radiotherapy was given in view of lack of clear
node dissection. We describe a case of a malignant benefits from either of these modalities.
[3]
acrospiroma involving inguinal region with metastases
to inguinal lymph nodes and bones in a 37-year-old man
despite initial wide local excision. Although various However, patient was lost to follow up and presented 1
year later with swelling in same area. The swelling had
eccrine sweat gland tumors including benign acrospiroma
have been widely reviewed, malignant acrospiroma is appeared 4 months earlier and gradually increased in size,
rarely reported and thus the literature on their response to associated with mild discomfort. Examination revealed
chemotherapy is limited. a firm, smooth swelling, not adherent to skin, round in
shape with dimensions of 6 cm × 5 cm in the right inguinal
CASE REPORT region.

A 37-year-old man presented at our medical oncology Computed tomography (CT) with contrast of chest,
outpatient department with complaints of a mass in the abdomen and pelvis revealed a well-defined soft tissue
right inguinal region for over 1 year with no history of density lesion in the right inguinal region, with minimal
antecedent trauma. The mass gradually increased in size fat stranding. The lesion showed mild heterogenous
and was associated with mild discomfort. There was no enhancement [Figure 3].
skin ulceration or discharge. Examination revealed a
rounded mass adherent to skin with diameter of 4 cm in This is an open access article distributed under the terms of the Creative
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How to cite this article: Wani B, Aziz SA, Mir MH, Bhat GM, Lone
AR. Malignant eccrine acrospiroma with nodal and bone metastasis. J
DOI: Cancer Metastasis Treat 2016;2:255-8.
10.20517/2394-4722.2015.92
Received: 18-12-2015; Accepted: 30-03-2016.
©2016 Journal of Cancer Metastasis and Treatment ¦ Published by OAE Publishing Inc. 255