Case for Diagnosis
Tumors Distributed Linearly Near the Scapula in a Young Man
Tumoraciones con distribución lineal en la región escapular de un varón joven
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Morales-Conde, J. Raya-Maldonado, B. García-Bravo, J.J. Ríos-Martin" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Morales-Conde" "email" => array:1 [ 0 => "macarena.moralesconde@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Raya-Maldonado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "B." "apellidos" => "García-Bravo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.J." "apellidos" => "Ríos-Martin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumoraciones con distribución lineal en la región escapular de un varón joven" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 680 "Ancho" => 905 "Tamanyo" => 95441 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 22-year-old man consulted the dermatology department with a lesion on his right scapula. The lesion had been present since birth, was sometimes painful, and bled with friction. He reported that the lesion had been treated with cryotherapy when he was an adolescent. Nevertheless, the lesion persisted and had gradually increased in size.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The lesion comprised several papules and tumors arranged linearly on the right scapula. These were pink, differed in size between 0.5 and 3<span class="elsevierStyleHsp" style=""></span>cm in diameter, and had a pedunculated base. The spherical parts were covered with smooth, shiny skin, and many had a marked layer of yellowish, blackish hyperkeratosis that was spiked and crateriform in appearance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The whole lesion measured 9.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology revealed numerous cystic lesions that were invaginated from the epidermis and several exophytic papillomatous lesions covered by squamous epithelium with hyperkeratosis. The deepest area comprised a double-layered epithelium (the internal layer formed by cylindrical cells and the external layer formed by cuboidal myoepithelial cells). The underlying stroma was rich in plasma cells (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What is your diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Congenital linear syringocystadenoma papilliferum.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Given that the lesion was causing the patient some discomfort, we removed it surgically using shave excision and electrocoagulation. No recurrences have been observed in the last 2 years.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Syringocystadenoma papilliferum is an uncommon benign hamartomatous adnexal tumor.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> While its pathogenesis remains unclear, it is thought to result from pluripotent cells with eccrine differentiation and, more frequently, apocrine differentiation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The tumor typically affects children and adolescents; in fact, it is congenital in half of all cases.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Clinical presentation is variable, ranging from a solitary papule (the most common manifestation) to several nodules arranged linearly, as in the present case, and often with a hyperkeratotic center. During adolescence, it tends to increase in size and become more verrucous.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The most common locations are the scalp, face, and neck (75%).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Less common sites include the abdomen, arm, axilla, breast, back, buttock, and vulva. The lesion has been reported on the back in only 4 cases.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Syringocystadenoma papilliferum may appear alongside other benign adnexal tumors, such as tubular apocrine adenoma, hidradenoma papilliferum, and trichoblastoma.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> In 30% of cases, the tumor originates within a nevus sebaceus of Jadassohn.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Basal cell carcinoma has been reported in 10% of cases. Other, more unusual associated malignant neoplasms include squamous cell carcinoma and syringocystadenocarcinoma papilliferum.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Ulceration and/or rapid growth are indicative of malignant transformation.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The differential diagnosis should include basal cell carcinoma, squamous cell carcinoma, and cysts.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Diagnosis must be confirmed by biopsy. Hematoxylin-eosin staining reveals epithelial projections toward the dermis with tubular structures that connect to the surface and are composed of a double layer of cells: the external layer comprises cuboidal cells and the internal layer cylindrical cells. The stroma is rich in plasma cells.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment is based on surgical excision, although CO<span class="elsevierStyleInf">2</span> laser treatment is a good alternative when the location makes surgery difficult.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-01-24" "fechaAceptado" => "2018-04-08" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Morales-Conde M, Raya-Maldonado J, García-Bravo B, Ríos-Martin JJ. Tumoraciones con distribución lineal en la región escapular de un varón joven. Actas Dermosifiliogr. 2019;110:683–684.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 680 "Ancho" => 905 "Tamanyo" => 95441 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 680 "Ancho" => 905 "Tamanyo" => 256944 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin staining in both histology images.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of syringocystadenoma papilliferum of eyelid with literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. 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Gopichandani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0019-5154.117354" "Revista" => array:5 [ "tituloSerie" => "Indian J Dermatol" "fecha" => "2013" "volumen" => "58" "paginaInicial" => "409" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24082220" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant linear syringocystadenoma papilliferum of the back" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Kar" 1 => "J.K. Kar" 2 => "S. Maiti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0378-6323.90978" "Revista" => array:5 [ "tituloSerie" => "Indian J Dermatol Venereol Leprol" "fecha" => "2012" "volumen" => "78" "paginaInicial" => "123" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22199090" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011000000008/v1_201910050935/S1578219019302252/v1_201910050935/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011000000008/v1_201910050935/S1578219019302252/v1_201910050935/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019302252?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 7 | 17 |
| 2024 October | 69 | 58 | 127 |
| 2024 September | 69 | 31 | 100 |
| 2024 August | 98 | 57 | 155 |
| 2024 July | 88 | 40 | 128 |
| 2024 June | 85 | 35 | 120 |
| 2024 May | 71 | 30 | 101 |
| 2024 April | 69 | 32 | 101 |
| 2024 March | 67 | 28 | 95 |
| 2024 February | 57 | 33 | 90 |
| 2024 January | 58 | 30 | 88 |
| 2023 December | 55 | 22 | 77 |
| 2023 November | 57 | 31 | 88 |
| 2023 October | 54 | 27 | 81 |
| 2023 September | 47 | 38 | 85 |
| 2023 August | 29 | 20 | 49 |
| 2023 July | 33 | 34 | 67 |
| 2023 June | 35 | 24 | 59 |
| 2023 May | 39 | 17 | 56 |
| 2023 April | 27 | 32 | 59 |
| 2023 March | 45 | 33 | 78 |
| 2023 February | 40 | 26 | 66 |
| 2023 January | 34 | 31 | 65 |
| 2022 December | 42 | 45 | 87 |
| 2022 November | 32 | 30 | 62 |
| 2022 October | 26 | 20 | 46 |
| 2022 September | 23 | 43 | 66 |
| 2022 August | 46 | 41 | 87 |
| 2022 July | 23 | 46 | 69 |
| 2022 June | 15 | 26 | 41 |
| 2022 May | 30 | 44 | 74 |
| 2022 April | 36 | 27 | 63 |
| 2022 March | 42 | 58 | 100 |
| 2022 February | 31 | 34 | 65 |
| 2022 January | 44 | 50 | 94 |
| 2021 December | 28 | 49 | 77 |
| 2021 November | 34 | 38 | 72 |
| 2021 October | 41 | 46 | 87 |
| 2021 September | 28 | 34 | 62 |
| 2021 August | 20 | 29 | 49 |
| 2021 July | 14 | 11 | 25 |
| 2021 June | 13 | 21 | 34 |
| 2021 May | 23 | 34 | 57 |
| 2021 April | 51 | 65 | 116 |
| 2021 March | 34 | 27 | 61 |
| 2021 February | 34 | 24 | 58 |
| 2021 January | 18 | 19 | 37 |
| 2020 December | 22 | 16 | 38 |
| 2020 November | 11 | 22 | 33 |
| 2020 October | 14 | 14 | 28 |
| 2020 September | 14 | 9 | 23 |
| 2020 August | 19 | 20 | 39 |
| 2020 July | 8 | 11 | 19 |
| 2020 June | 22 | 14 | 36 |
| 2020 May | 7 | 6 | 13 |
| 2020 April | 11 | 8 | 19 |
| 2020 March | 16 | 7 | 23 |
| 2020 February | 3 | 2 | 5 |
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