Case and Research Letter
Malignant Spiradenoma: a Giant Cutaneous Adnexal Tumor
Espiradenoma maligno: un tumor gigante de los anexos cutáneos
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C) (H&E ×40) y D) (H&E ×40): células con citoplasma claro y escaso, que delimitan luces glandulares tubulares; en otras zonas, las células muestran menos diferenciación, con predominio claro de células basaloides, hipercromáticas y con escaso citoplasma, sin formación de estructuras ductales y con mitosis; se muestra calcificación. El estroma exhibe edema y canales vasculares dilatados y congestivos.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.F. Ruiz-González, R. Quiñones-Venegas, R. Valdes-Rodriguez, G. Solís-Ledezma" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J.F." "apellidos" => "Ruiz-González" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Quiñones-Venegas" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Valdes-Rodriguez" ] 3 => array:2 [ "nombre" => "G." 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Buena respuesta a ciclosporina" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1597 "Ancho" => 1000 "Tamanyo" => 251948 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A-C, Multiple erythematous-brownish papules on the trunk and upper and lower extremities. D, Detail of a lesion on the left thigh, showing central atrophy with a well-defined, slightly elevated, keratotic border.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Montes-Torres, C. Camarero-Mulas, D. de Argila, C. Gordillo, E. Daudén" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." 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Ruiz-González, R. Quiñones-Venegas, R. Valdes-Rodriguez, G. Solís-Ledezma" "autores" => array:4 [ 0 => array:3 [ "nombre" => "J.F." "apellidos" => "Ruiz-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "R." "apellidos" => "Quiñones-Venegas" "email" => array:1 [ 0 => "ricardoquiv@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" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Valdes-Rodriguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "G." "apellidos" => "Solís-Ledezma" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Instituto Dermatológico de Jalisco «Dr. José Barba Rubio», Secretaría de Salud Jalisco, Zapopan, Jalisco, Maxico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermatology Department, Temple Itch Center, Temple University School of Medicine, Philadelphia, Estados Unidos" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Espiradenoma maligno: un tumor gigante de los anexos cutáneos" ] ] "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" => 1342 "Ancho" => 2369 "Tamanyo" => 783978 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A and B, Nodules of epithelial cells that, in some areas, have a peripheral population of cells with a basaloid appearance. A, Hematoxylin and eosin (H&E), original magnification ×4; B, H&E, original magnification ×10. C and D, Cells with scant, clear cytoplasm lining tubular glandular lumina; in other areas, the cells show less differentiation, with a clear predominance of hyperchromatic basaloid cells with scant cytoplasm. No ductal structures are formed. Mitoses are present. Calcification is present and the stroma shows edema and dilated and congested vascular channels. H&E, original magnification ×40 in both images.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Spiradenocarcinoma is a very rare malignant tumor that arises from a preexisting spiradenoma of a sweat gland.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 72-year-old woman with a history of systemic hypertension. She came to our outpatients for a tumor that had appeared 40 years earlier and that had increased progressively in size; this growth had accelerated over the previous 6 years. The tumor was situated over the middle third of the left clavicle and measured 13<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>cm. It was firm to palpation, had a smooth and shiny surface with telangiectasias, well-defined borders, and was not adherent to deeper planes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). It was not tender. There were no palpable lymph nodes. The patient denied weight loss.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We considered a soft-tissue tumor and therefore performed ultrasound study, which demonstrated a cystic lesion in the subcutaneous cellular tissue of the supraclavicular region; the muscle planes were not affected. The lesion was excised surgically, including the subcutaneous cellular tissue. The center of the tumor was pasty or semiliquid, and firm nodules were present at each pole.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Histology revealed nodules of epithelial cells that, in some areas, had a peripheral cell population with a basaloid appearance, and cells with scant clear cytoplasm that lined tubular glandular lumina. In other areas, the cells showed less differentiation, with a clear predominance of hyperchromatic basaloid cells with scant cytoplasm; no ductal structures were present. Mitoses were observed (1 per high-power field). Calcification was also observed and the stroma presented edema and dilated and congested vascular channels (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Based on these findings, we made a diagnosis of malignant spiradenoma. Eighteen months after the operation, there were no signs or images of recurrence.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Malignant spiradenoma is a rare tumor. Malignant tumors of the sweat glands account for approximately 0.005% of all skin tumors. Age at presentation varies from 21 to 92 years. In two thirds of patients, the diagnosis is made after age 50 years,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and only 1 pediatric case has been reported.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> The majority of patients describe a rapid growth of the tumor, a change in color, or ulceration, and this prompts them to seek medical care.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Diagnosis is based on clinical suspicion and is confirmed by histology, which shows malignant changes in areas of the spiradenoma.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Sometimes the diagnosis can be difficult, and histology of the whole tumor is required to be able to observe the architecture of the lesion.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> The benign part accounts for 5% to 40% of the tumor.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Some markers can be helpful to differentiate the malignant part; for example, in the malignant part, the Ki-67 proliferation index is increased whereas MYB expression is negative.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Four histologic patterns of spiradenocarcinoma have been described: 1, similar to salivary gland type basal cell adenocarcinoma, low grade; 2, similar to salivary gland type basal cell adenocarcinoma, high grade; 3, invasive adenocarcinoma, not otherwise specified; and 4, sarcomatoid (metaplastic) carcinoma.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Our patient presented a low-grade tumor similar to salivary gland basal cell adenocarcinoma.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Lymph-node and distant metastases reduce survival<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>; 17.5% of patients develop distant metastases or die from the disease.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Consensus has not yet been reached on the management of this tumor. The treatment of choice continues to be surgical excision with wide margins of 1 centimeter<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,9</span></a><span class="elsevierStyleSup">;</span> this is associated with a 19% likelihood of local recurrence.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Lymphadenectomy can help to improve the prognosis. Lymphadenectomy was performed in a series of 10 patients with lymph-node metastases<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>; 6 patients remained disease free. There is no difference in the prognosis of metastatic disease between surgery and surgery plus adjuvant therapy.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Malignant spiradenoma continues to be a relatively unknown entity, the diagnosis of which can be difficult. Diagnosis is histologic and is based on the observation of areas of spiradenoma associated with malignant changes. The prognosis is known to be poorer if metastases are present at the time of diagnosis, there is a high-grade histologic pattern, or an associated Brooke-Spiegler syndrome. Surgery remains the treatment of choice.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ruiz-González JF, Quiñones-Venegas R, Valdes-Rodriguez R, Solís-Ledezma G. Espiradenoma maligno: un tumor gigante de los anexos cutáneos. Actas Dermosifiliogr. 2016;107:259–260.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1037 "Ancho" => 1250 "Tamanyo" => 159464 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A firm, non-tender tumor with a smooth, shiny surface with telangiectasias. The borders of the tumor were well-defined and it was not adherent to deeper planes.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1342 "Ancho" => 2369 "Tamanyo" => 783978 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A and B, Nodules of epithelial cells that, in some areas, have a peripheral population of cells with a basaloid appearance. A, Hematoxylin and eosin (H&E), original magnification ×4; B, H&E, original magnification ×10. C and D, Cells with scant, clear cytoplasm lining tubular glandular lumina; in other areas, the cells show less differentiation, with a clear predominance of hyperchromatic basaloid cells with scant cytoplasm. No ductal structures are formed. Mitoses are present. Calcification is present and the stroma shows edema and dilated and congested vascular channels. H&E, original magnification ×40 in both images.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathology and Genetics of Skin Tumours" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "World Health Organization Classification of Tumours" "etal" => false "autores" => array:3 [ 0 => "P. LeBoit" 1 => "G. Burg" 2 => "D. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 3 | 14 |
| 2024 Octubre | 79 | 39 | 118 |
| 2024 Septiembre | 114 | 25 | 139 |
| 2024 Agosto | 128 | 51 | 179 |
| 2024 Julio | 127 | 37 | 164 |
| 2024 Junio | 122 | 56 | 178 |
| 2024 Mayo | 98 | 30 | 128 |
| 2024 Abril | 92 | 33 | 125 |
| 2024 Marzo | 80 | 26 | 106 |
| 2024 Febrero | 65 | 31 | 96 |
| 2024 Enero | 64 | 29 | 93 |
| 2023 Diciembre | 77 | 14 | 91 |
| 2023 Noviembre | 72 | 28 | 100 |
| 2023 Octubre | 66 | 18 | 84 |
| 2023 Septiembre | 80 | 33 | 113 |
| 2023 Agosto | 60 | 13 | 73 |
| 2023 Julio | 97 | 38 | 135 |
| 2023 Junio | 64 | 24 | 88 |
| 2023 Mayo | 54 | 22 | 76 |
| 2023 Abril | 58 | 27 | 85 |
| 2023 Marzo | 57 | 27 | 84 |
| 2023 Febrero | 58 | 17 | 75 |
| 2023 Enero | 36 | 25 | 61 |
| 2022 Diciembre | 53 | 36 | 89 |
| 2022 Noviembre | 45 | 41 | 86 |
| 2022 Octubre | 31 | 35 | 66 |
| 2022 Septiembre | 26 | 37 | 63 |
| 2022 Agosto | 24 | 35 | 59 |
| 2022 Julio | 25 | 25 | 50 |
| 2022 Junio | 16 | 27 | 43 |
| 2022 Mayo | 32 | 35 | 67 |
| 2022 Abril | 48 | 26 | 74 |
| 2022 Marzo | 43 | 36 | 79 |
| 2022 Febrero | 35 | 29 | 64 |
| 2022 Enero | 28 | 33 | 61 |
| 2021 Diciembre | 28 | 37 | 65 |
| 2021 Noviembre | 36 | 35 | 71 |
| 2021 Octubre | 43 | 45 | 88 |
| 2021 Septiembre | 28 | 39 | 67 |
| 2021 Agosto | 32 | 22 | 54 |
| 2021 Julio | 28 | 18 | 46 |
| 2021 Junio | 25 | 25 | 50 |
| 2021 Mayo | 37 | 25 | 62 |
| 2021 Abril | 72 | 37 | 109 |
| 2021 Marzo | 48 | 21 | 69 |
| 2021 Febrero | 47 | 28 | 75 |
| 2021 Enero | 31 | 12 | 43 |
| 2020 Diciembre | 16 | 18 | 34 |
| 2020 Noviembre | 33 | 27 | 60 |
| 2020 Octubre | 14 | 14 | 28 |
| 2020 Septiembre | 31 | 6 | 37 |
| 2020 Agosto | 21 | 13 | 34 |
| 2020 Julio | 12 | 15 | 27 |
| 2020 Junio | 38 | 28 | 66 |
| 2020 Mayo | 24 | 23 | 47 |
| 2020 Abril | 27 | 19 | 46 |
| 2020 Marzo | 32 | 13 | 45 |
| 2020 Febrero | 9 | 4 | 13 |
| 2019 Diciembre | 0 | 3 | 3 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Octubre | 1 | 0 | 1 |
| 2019 Septiembre | 1 | 0 | 1 |
| 2019 Julio | 0 | 2 | 2 |
| 2019 Junio | 0 | 4 | 4 |
| 2019 Mayo | 3 | 25 | 28 |
| 2019 Abril | 1 | 2 | 3 |
| 2019 Marzo | 0 | 3 | 3 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 1 | 0 | 1 |
| 2018 Agosto | 0 | 5 | 5 |
| 2018 Julio | 0 | 7 | 7 |
| 2018 Mayo | 0 | 1 | 1 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Febrero | 12 | 2 | 14 |
| 2018 Enero | 33 | 4 | 37 |
| 2017 Diciembre | 27 | 6 | 33 |
| 2017 Noviembre | 35 | 3 | 38 |
| 2017 Octubre | 29 | 7 | 36 |
| 2017 Septiembre | 22 | 6 | 28 |
| 2017 Agosto | 37 | 4 | 41 |
| 2017 Julio | 23 | 7 | 30 |
| 2017 Junio | 33 | 13 | 46 |
| 2017 Mayo | 41 | 13 | 54 |
| 2017 Abril | 24 | 8 | 32 |
| 2017 Marzo | 18 | 41 | 59 |
| 2017 Febrero | 25 | 9 | 34 |
| 2017 Enero | 17 | 12 | 29 |
| 2016 Diciembre | 26 | 21 | 47 |
| 2016 Noviembre | 37 | 16 | 53 |
| 2016 Octubre | 23 | 11 | 34 |
| 2016 Agosto | 1 | 1 | 2 |
| 2016 Junio | 0 | 1 | 1 |
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