Case for Diagnosis
Asymptomatic Lesion on the Nasal Ala
Lesión asintomática en ala nasal
L.C. Arango-Duque
, M. Yuste-Chaves, M. Rodríguez-González
Corresponding author
Servicio de Dermatología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
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"apellidos" => "Rodríguez-González" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión asintomática en ala nasal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1492 "Ancho" => 1187 "Tamanyo" => 177504 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×20.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of an otherwise healthy 27-year-old woman who was seen for an asymptomatic lesion on the right nasal ala that had developed several years earlier. The lesion had begun to grow rapidly over the previous few months.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">On physical examination there was a well-defined, firm, skin-colored papular lesion measuring 0.4<span class="elsevierStyleHsp" style=""></span>cm in diameter on the right nasal ala. Several months later, the lesion had increased in size and become a more exophytic, indurated nodule with occasional superficial telangiectasias (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology revealed a nodular lesion with an expansive growth pattern and well-defined borders (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The lesion consisted of nests of cuboidal epithelial cells without atypia that formed occasional glandular lumina associated with a stroma that was myxoid in some areas (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Chondroid syringoma (mixed tumor of the skin).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course</span><p id="par0030" class="elsevierStylePara elsevierViewall">Complete resolution of the tumor was achieved by excision under local anesthetic.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Chondroid syringoma is a rare cutaneous or subcutaneous tumor that presents as a painless, slow-growing lesion that most often arises on the head and neck and typically affects adult men. The size of these lesions ranges between 0.5<span class="elsevierStyleHsp" style=""></span>cm and 3<span class="elsevierStyleHsp" style=""></span>cm in diameter, although they can occasionally be larger.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> They are also known as mixed tumors of the skin because of the histologic similarities with pleomorphic adenoma or mixed salivary gland tumors.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The term chondroid syringoma was coined by Hirsch and Helwig in 1961, though the tumor was first described by Billroth in 1859 as a nosologic entity with the same histopathological properties as salivary gland tumors. Headington later classified chondroid syringomas as eccrine or apocrine according to their histologic appearance.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">These tumors are generally benign and have an incidence of 0.01% to 0.098% of excised skin tumors.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> No relationship between chondroid syringoma and sun exposure has been reported in the literature despite the predominance of these tumors on sun-exposed areas.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A rare malignant form of chondroid syringoma has been described in the literature. In contrast to the benign form, malignant chondroid syringoma occurs mainly in women (mean age at onset, 54 years; range, 13-89),<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> predominantly on the limbs. Lymphatic and visceral metastases are common, occurring in 42% and 40% of patients, respectively.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> When these types of metastasis develop, they present adenocarcinoma-type characteristics and lose the ability to form chondroid stroma.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Dermoscopy shows no specific features.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Histology reveals well-defined nests of polygonal cells containing tubulo-alveolar and glandular structures within a fibroadipose, chondroid, myxoid, or hyaline stroma. Periodic acid-Schiff and Alcian blue staining is positive.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a> The eccrine type presents only 1 layer of cuboidal cells with small lumina, while the apocrine type involves tubular, cystic, ramified lumina lined by 2 layers of cells. Staining is usually positive for cytokeratin, S-100, epithelial membrane antigen, vimentin, actin, glial fibrillary acidic protein, and p63.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The benign form of chondroid syringoma does not present atypia, mitoses, or pleomorphism and does not recur. However, the malignant form, which does not arise from a previously benign lesion,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> is characterized by cytologic atypia, mitoses, poorly defined borders, satellitosis, and necrosis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> Some authors also refer to an atypical form when the data on malignancy are not conclusive.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The definitive treatment for these tumors is surgery.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a> Fine-needle aspiration biopsy can be used for diagnosis before the operation, but excision biopsy is the most useful technique.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> As these lesions are lobular, it is important to include a margin of normal skin to ensure complete excision and avoid recurrence.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> When treating the malignant form, surgery may be combined with adjuvant radiotherapy and chemotherapy, although the efficacy of these therapies has not been demonstrated.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "Histopathology" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] ] ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Arango-Duque LC, et al. Lesión asintomática en ala nasal. Actas Dermosifiliogr. 2012;103:827-8.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1380 "Ancho" => 1277 "Tamanyo" => 124547 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1492 "Ancho" => 1187 "Tamanyo" => 177504 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×20.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 935 "Ancho" => 1252 "Tamanyo" => 197512 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×100.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Siringoma condroide: revisión clínica e histológica de ocho casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 20 | 9 | 29 |
| 2024 October | 141 | 40 | 181 |
| 2024 September | 140 | 38 | 178 |
| 2024 August | 143 | 81 | 224 |
| 2024 July | 143 | 31 | 174 |
| 2024 June | 120 | 46 | 166 |
| 2024 May | 77 | 35 | 112 |
| 2024 April | 88 | 32 | 120 |
| 2024 March | 84 | 29 | 113 |
| 2024 February | 120 | 31 | 151 |
| 2024 January | 116 | 37 | 153 |
| 2023 December | 99 | 32 | 131 |
| 2023 November | 116 | 37 | 153 |
| 2023 October | 109 | 52 | 161 |
| 2023 September | 99 | 47 | 146 |
| 2023 August | 76 | 17 | 93 |
| 2023 July | 138 | 47 | 185 |
| 2023 June | 101 | 25 | 126 |
| 2023 May | 124 | 28 | 152 |
| 2023 April | 120 | 26 | 146 |
| 2023 March | 133 | 33 | 166 |
| 2023 February | 122 | 27 | 149 |
| 2023 January | 83 | 34 | 117 |
| 2022 December | 92 | 54 | 146 |
| 2022 November | 58 | 23 | 81 |
| 2022 October | 54 | 33 | 87 |
| 2022 September | 53 | 46 | 99 |
| 2022 August | 36 | 27 | 63 |
| 2022 July | 42 | 46 | 88 |
| 2022 June | 65 | 28 | 93 |
| 2022 May | 111 | 30 | 141 |
| 2022 April | 77 | 54 | 131 |
| 2022 March | 102 | 62 | 164 |
| 2022 February | 83 | 33 | 116 |
| 2022 January | 95 | 47 | 142 |
| 2021 December | 82 | 52 | 134 |
| 2021 November | 114 | 58 | 172 |
| 2021 October | 111 | 46 | 157 |
| 2021 September | 80 | 46 | 126 |
| 2021 August | 86 | 53 | 139 |
| 2021 July | 90 | 63 | 153 |
| 2021 June | 81 | 35 | 116 |
| 2021 May | 62 | 33 | 95 |
| 2021 April | 166 | 74 | 240 |
| 2021 March | 125 | 25 | 150 |
| 2021 February | 77 | 23 | 100 |
| 2021 January | 61 | 25 | 86 |
| 2020 December | 55 | 17 | 72 |
| 2020 November | 44 | 14 | 58 |
| 2020 October | 83 | 7 | 90 |
| 2020 September | 50 | 7 | 57 |
| 2020 August | 62 | 27 | 89 |
| 2020 July | 61 | 15 | 76 |
| 2020 June | 49 | 32 | 81 |
| 2020 May | 52 | 25 | 77 |
| 2020 April | 42 | 26 | 68 |
| 2020 March | 47 | 25 | 72 |
| 2020 February | 9 | 3 | 12 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 4 | 8 | 12 |
| 2019 November | 2 | 9 | 11 |
| 2019 October | 0 | 17 | 17 |
| 2019 September | 4 | 17 | 21 |
| 2019 August | 4 | 12 | 16 |
| 2019 July | 4 | 29 | 33 |
| 2019 June | 4 | 29 | 33 |
| 2019 May | 5 | 71 | 76 |
| 2019 April | 2 | 48 | 50 |
| 2019 March | 0 | 13 | 13 |
| 2019 February | 2 | 10 | 12 |
| 2019 January | 0 | 3 | 3 |
| 2018 December | 4 | 6 | 10 |
| 2018 November | 1 | 5 | 6 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 8 | 3 | 11 |
| 2018 August | 0 | 24 | 24 |
| 2018 July | 0 | 15 | 15 |
| 2018 June | 0 | 2 | 2 |
| 2018 May | 0 | 10 | 10 |
| 2018 April | 0 | 5 | 5 |
| 2018 March | 9 | 6 | 15 |
| 2018 February | 62 | 10 | 72 |
| 2018 January | 88 | 12 | 100 |
| 2017 December | 89 | 12 | 101 |
| 2017 November | 107 | 29 | 136 |
| 2017 October | 74 | 11 | 85 |
| 2017 September | 80 | 11 | 91 |
| 2017 August | 69 | 13 | 82 |
| 2017 July | 69 | 16 | 85 |
| 2017 June | 63 | 21 | 84 |
| 2017 May | 64 | 16 | 80 |
| 2017 April | 45 | 18 | 63 |
| 2017 March | 53 | 15 | 68 |
| 2017 February | 135 | 19 | 154 |
| 2017 January | 73 | 10 | 83 |
| 2016 December | 88 | 24 | 112 |
| 2016 November | 131 | 16 | 147 |
| 2016 October | 135 | 18 | 153 |
| 2016 September | 213 | 15 | 228 |
| 2016 August | 148 | 13 | 161 |
| 2016 July | 76 | 10 | 86 |
| 2016 June | 13 | 13 | 26 |
| 2016 May | 6 | 12 | 18 |
| 2016 April | 6 | 16 | 22 |
| 2016 March | 11 | 8 | 19 |
| 2016 February | 4 | 6 | 10 |
| 2016 January | 10 | 4 | 14 |
| 2015 December | 6 | 3 | 9 |
| 2015 November | 17 | 5 | 22 |
| 2015 October | 12 | 9 | 21 |
| 2015 September | 5 | 4 | 9 |
| 2015 August | 15 | 6 | 21 |
| 2015 July | 135 | 15 | 150 |
| 2015 June | 95 | 10 | 105 |
| 2015 May | 103 | 9 | 112 |
| 2015 April | 103 | 12 | 115 |
| 2015 March | 67 | 10 | 77 |
| 2015 February | 83 | 6 | 89 |
| 2015 January | 77 | 11 | 88 |
| 2014 December | 87 | 5 | 92 |
| 2014 November | 62 | 12 | 74 |
| 2014 October | 45 | 1 | 46 |
| 2014 September | 41 | 1 | 42 |
| 2014 August | 35 | 3 | 38 |
| 2014 July | 49 | 5 | 54 |
| 2014 June | 48 | 3 | 51 |
| 2014 May | 58 | 4 | 62 |
| 2014 April | 48 | 2 | 50 |
| 2014 March | 61 | 7 | 68 |
| 2014 February | 49 | 8 | 57 |
| 2014 January | 57 | 8 | 65 |
| 2013 December | 47 | 3 | 50 |
| 2013 November | 40 | 5 | 45 |
| 2013 October | 37 | 4 | 41 |
| 2013 September | 23 | 2 | 25 |
| 2013 August | 37 | 15 | 52 |
| 2013 July | 16 | 8 | 24 |
| 2013 June | 13 | 5 | 18 |
| 2013 May | 14 | 4 | 18 |
| 2013 April | 17 | 8 | 25 |
| 2013 March | 20 | 8 | 28 |
| 2013 February | 38 | 5 | 43 |
| 2013 January | 47 | 3 | 50 |
| 2012 December | 35 | 5 | 40 |
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