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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 4  |  Issue : 1  |  Page : 116-118

Cytomorphology of giant chondroid syringoma of the abdominal wall: A case report


Department of Pathology, Kempegowda Institute of Medical Sciences (KIMS), Bangalore, Karnataka, India

Date of Web Publication2-Jun-2016

Correspondence Address:
Hemalata Mahantappa
Department of Pathology, Kempegowda Institute of Medical Sciences (KIMS), BSK II Stage, Bangalore - 560 070, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-4848.183369

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  Abstract 

Chondroid syringoma is a rare benign adnexal skin tumor arising commonly in the head and neck regions. Literature on cytological findings of chondroid syringoma is scarce. We present a case of a 40-year-old male with a giant chondroid syringoma presenting as a slow growing, painless, firm mass on the anterior abdominal wall of 1 year 6 months duration. The case was diagnosed cytologically and later confirmed on histopathological examination.

Keywords: Chondroid syringoma, cytology, mixed tumor, skin tumor


How to cite this article:
Mahantappa H, Ravindra S, Ranganna R, Krishnamurthy T. Cytomorphology of giant chondroid syringoma of the abdominal wall: A case report. Arch Med Health Sci 2016;4:116-8

How to cite this URL:
Mahantappa H, Ravindra S, Ranganna R, Krishnamurthy T. Cytomorphology of giant chondroid syringoma of the abdominal wall: A case report. Arch Med Health Sci [serial online] 2016 [cited 2022 Jan 26];4:116-8. Available from: https://www.amhsjournal.org/text.asp?2016/4/1/116/183369


  Introduction Top


Chondroid syringoma is a rare skin adnexal tumor. Usual location is the head and neck regions, and the size range of the tumor is 0.5-3 cm. Rarely they can grow to a very large size.[1] There are very few reports on cytological findings of chondroid syringoma.[2],[3] It is now widely accepted that fine-needle aspiration cytology (FNAC) is useful in the diagnosis of skin adnexal tumors. We report here the cytomorphology of a large chondroid syringoma located on the abdominal wall with histopathological confirmation.


  Case Report Top


A 40-year-old male presented with a painless and slow-growing mass on the anterior abdominal wall of 1 year 6 month duration. The swelling was firm, nontender, mobile, attached to the skin, and measured 8 cm × 6 cm × 5 cm. The overlying skin was stretched and there was no ulceration. A clinical diagnosis of dermoid cyst was made and sent for FNAC. Excision was suggested in view of the large size. Wide excision of the mass was performed and it was sent for histopathological examination.

Cytology

The aspirate was scant and mucoid. Smears were prepared and stained with hematoxylin and eosin (H&E), Papanicolaou, and May-Grunwald Giemsa (MGG) stains. The smears were cellular showing both epithelial and mesenchymal components. The epithelial/myoepithelial cells were seen in cohesive clusters, groups, in papillae with cells clinging to the central myxochondroid matrix, and scattered singly. The cells were of small to medium size with well-defined cell borders having scant-to-moderate amounts of cytoplasm. The nuclei were round to oval with fine stippled chromatin [Figure 1]. The chondromyxoid stroma was evident at places [Figure 2]. Cytological diagnosis of chondroid syringoma was offered.
Figure 1: Papillary arrangement with epithelial cells clinging to central chondromyxoid matrix material [pap ×100]

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Figure 2: Chondromixoid stroma and small-to-medium epithelial cells with scant cytoplasm, bland nuclei with fine chromatin [pap ×400]

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Gross

The specimen measured 8 cm × 6 cm × 5 cm with an attached ellipse of skin measuring 4 cm × 3 cm. The outer surface was nodular and cut section was grey white with glistening areas [Figure 3]a and [Figure 3]b.
Figure 3: (a and b) Gross of chondroid syringoma [outer nodular surface and cut section]

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Microscopy

It was an encapsulated neoplasm comprising of epithelial/myoepithelial and mesenchymal components in varying proportions. The epithelial cells were cuboidal, arranged in cords, ducts, tubules, sheets, and glandular pattern in a stroma of chondromyxoid and fibrocollagenous type confirming the diagnosis of chondroid syringoma (eccrine type) [Figure 4].
Figure 4: Section showing epithelial cells and chondromyxoid stroma [hematoxylin and eosin (H&E) ×100]

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  Discussion Top


Chondroid syringoma is a rare skin adnexal tumor of eccrine/apocrine type.[4] The incidence of chondroid syringoma is low and has been reported in 0.01-0.098%.[5] The term was introduced by Hirsh and Helwig in 1961, which is now widely accepted to replace the older term “mixed tumor” of the skin.[6] They also proposed histopathological criteria for diagnosis. It is thought to originate from both secretory and ductal segments of the sweat glands. It is usually seen in middle aged or older males. Clinically, presents as slow-growing, painless, firm, subcutaneous or intracutaneous nodule. The size ranges 0.5-3 cm. There are a few case reports of larger lesions. Hardisson et al. described a giant chondroid syringoma in the axilla that measured 8.3 cm × 7.6 cm × 6.3 cm almost similar to our case.[1] The lesions are commonly seen in the head and neck regions, particularly, on cheeks, nose, or lips. Rarely, it can develop on the limbs, axillary region, abdomen, penis, vulva, and scrotum.[7] The current case is located on the abdominal wall and the size was 8 cm × 6 cm × 5 cm. Clinically, it may be confused with other lesions such as dermoid or sebaceous cyst or neurofibroma.[7]

The number of reports on cytomorphology of chondroid syringomas is less in the literature in English. Typically, the aspirate was thick and mucoid, and it microscopically showed two distinct components comprising epithelial and myoepithelial cells in a chondromyxoid stroma similar to the findings of pleomorphic adenoma of salivary gland.[2],[3] Mild nuclear atypia has been described and attributed to the degenerative process.[8] It is important to distinguish these changes from malignancy. A high nuclear-to-cytoplasmic ratio, nuclear pleomorphism, and prominent nucleoli in the epithelial cells have been described in malignant chondroid syringoma.[9] Kalyan Khan has reported cytological findings of chondroid syringoma with cystic change.[10] The present case showed both epithelial and stromal components in abundance on cytology. There was no atypia in the epithelial cells.

Histopathologically, these tumors have an admixture of epithelial and myoepithelial cells arranged in cords and tubules in a chondromyxoid to fibrous stroma. Our microscopic findings are similar to those proposed by Hirsch and Helwig.[6] Malignancy in chondroid syringoma is rare and appears to behave aggressively. The reported cases occurred in young female patients in extremities and torso. Tumors of larger size have greater risk of malignancy.[11] Hence, the larger lesions require thorough histopathological examinations of multiple bits to rule out malignancy. The features of malignancy in chondroid syringoma are cytologic atypia, invasion into surrounding normal tissue, increased mitotic activity, and necrosis.[12] In view of the larger size of the tumor in our case, thorough histopathological examination was done and malignancy was ruled out. Because of the risk of malignancy, total wide excision is the first line of treatment and regular follow-up is done to look for any local recurrence and any features of malignancy.


  Conclusion Top


FNAC is a well-recognized diagnostic modality, which can be readily used for skin tumors and tumor-like conditions, because it is a simple procedure that can be useful for both the patient and the preoperative surgical planning. Chondroid syringomas of large size, arising in unusual locations with typical cytomorphological features, can be confidently diagnosed cytologically.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Hardisson D, Linares MD, Nistal M. Giant chondroid syringoma of the axilla. J Cutan Med Surg1998;3:115-7.  Back to cited text no. 1
    
2.
Kumar B. Chondroid syringoma diagnosed by fine needle aspiration cytology. Diagn Cytopathol 2010;38:38-40.  Back to cited text no. 2
    
3.
Srinivasan R, Rajwanshi A, Padmanabhan V, Dey P. Fine needle aspiration cytology of chondroid syringoma and syringocystadenoma papilliferum. A report of two cases. Acta Cytol 1993;37:535-8.  Back to cited text no. 3
    
4.
Headington JT. Mixed tumors of the skin: Eccrine and apocrine types. Arch Dermatol 1961;84:989-96.  Back to cited text no. 4
    
5.
Mebazaa A, Trabelsi S, Denguezli M, Sriha B, Belajouza C, Nouira R. Chondroid syringoma of the arm: An unusual localization. Dermatol Online J 2006;12:14.  Back to cited text no. 5
    
6.
Hirsch P, Helwig EB. Chondroid syringoma. Mixed tumor of skin, salivary gland type. Arch Dermatol 1961;84:835-47.  Back to cited text no. 6
    
7.
Yavuzer R, Basterzi Y, Sari A, Bir F, Sezer C. Chondroid syringoma: A diagnosis more frequent than expected. Dermatol Surg 2003;29:179-81.  Back to cited text no. 7
    
8.
Dubb M, Michelow P. Cytologic features of chondroid syringoma in fine needle aspiration biopsies: A report of 3 cases. Acta Cytol 2010;54:183-6.  Back to cited text no. 8
    
9.
Mishra K, Agarwal S. Fine needle aspiration cytology of malignant chondroid syringoma: A case report. Acta Cytol 1998;42:1152-8.  Back to cited text no. 9
    
10.
Khan K. Chondroid syringoma: A case with unusual cytological findings. Indian J Dermatol 2013;58:157.  Back to cited text no. 10
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11.
Barnett MD, Wallack MK, Zuretti A, Mesia L, Emery RS, Berson AM. Recurrent malignant chondroid syringoma of the foot: A case report and review of the literature. Am J Clin Oncol 2000;23:227-32.  Back to cited text no. 11
    
12.
Bates AW, Baithun SI. Atypical mixed tumor of the skin: Histologic, immunohistochemical, and ultrastructural features in three cases and a review of the criteria for malignancy. Am J Dermatopathol 1998;20:35-40.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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