438 • sereflican et al.
Giant Chondroid Syringoma of the Breast Betul Sereflican, MD,* Betul Kizildag, MD,† Ozlem Kar Kurt, MD,‡ Murat Sereflican, MD,§ Nadir Goksugur, MD,* and Cetin Boran, MD¶ *Department of Dermatology, Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey; † Department of Radiology, Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey; ‡Department of Chest Disease, Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey; §Department of Otorhinolaryngology, Bolu Koroglu State Hospital, Bolu, Turkey; ¶Department of Pathology, Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey
A
64-year-old man presented with a large painless mass on his left breast. The lesion had grown slowly over the period of about 15 years. Dermatological examination showed a 12 9 8 cm, nontender, firm, plurilobulated nodule covered by normal skin (Fig. 1). There was no axillary lymphadenopathy. A CT scan was performed to define the extent of the lesion. The CT imaging study demonstrated 9 9 6.7 9 6.3 cm, well circumscribed lobular mass that showed macro calcifications inside and its periphery (Fig. 2). The mass presented subcutaneous location in the breast adipose tissue. Adjacent epidermis seemed normal. There was no chest wall invasion, but compression into the pectoralis major muscle was seen. Histopathologic examination showed ductal structures and solid epithelial cell islands in myxoid stroma (Fig. 3). Ductal structures lined with two layers of epithelial cells. Stromal cells seemed to be embedded in a lacune in some locations such as cartilage tissue. Stroma was positively stained for alcian blue. There was no mitosis. Immunohistochemically; inner row of the epithelial cells exhibited epithelial membrane antigen (EMA) and pancytokeratin positivity (Fig. 4), outer rows expressed vimentin (Fig. 5). E-cadherin was particularly positive in the inner layer of epithelial cells. Cytokeratin positive cells were seen disorderly in stroma. These histopathological and immunohistochemical findings were consistent with chondroid syringoma. Chondroid syringoma is a rare skin adnexal tumor. Typical clinical presentation of these tumors is a slow-
growing, mobile, well-circumscribed subcutaneous or intracutaneous nodule in size from 0.5 to 3.0 cm. This asymptomatic tumor generally occurs on head and neck region. There are reported cases occurring over the trunk, back, extremities, scrotum, auditory canal, eyelid, toe, and shoulder. Giant chondroid syringomas
Figure 1. Firm, 12 9 8 cm mass covered by normal skin.
Address correspondence and reprint requests to: Betul Sereflican, Abant Izzet Baysal University, Medical Faculty, Department of Dermatology, 14280 Golkoy – Bolu, Turkey, or e-mail: [email protected] DOI: 10.1111/tbj.12421 © 2015 Wiley Periodicals, Inc., 1075-122X/15 The Breast Journal, Volume 21 Number 4, 2015 438–439
Figure 2. CT scan shows 9 9 6.7 9 6.3 cm well-circumscribed lobular mass.
Giant Chondroid Syringoma of the Breast • 439
Figure 3. Ductal structures and epithelial cell islands in chondromyxoid stroma (H&E, 9200).
Figure 4. Immunoexpression of pancytokeratin. Inner layers of epithelial cells showing pancytokeratin positivity (immunoperoxidase, 9200).
occurring at unusual sites such as shoulder, arm, thigh, and eyelid have been also reported. To the best of our knowledge, our case is the second described in the breast. The first one was a pedunculated mass on the breast of a woman. Histopathologically, ductal and tubuloalveolar structures, cuboidal cell lines,
Figure 5. Immunoexpression of vimentin. Outer layers of epithelial cells showing vimentin positivity (immunoperoxidase, 9200).
islands of cuboidal or polygonal cells in a myxoid, chondroid, adipocytic or fibrous stroma are significative configurations. The stroma stains positively for periodic acid-schiff and Alcian blue. Immunohistochemically, inner cell layers of tubuloglandular components stain positive with epithelial markers such as cytokeratin, EMA, and carcinoembryonic antigen. Outer cell layers express mesenchymal markers like stromal cells. Keratin, vimentin, desmin, and S-100 are focally positive in the stroma of the tumor. Malignancy in chondroid syringoma is uncommon. Malign chondroid syringomas may occur from the benign form, so the clinician must be awake especially when the tumor is larger and in atypical location. Histopathologically, our case showed no malign characteristics, but because of the tumor’s great size and aberrant location, our patient and the patients that show atypical clinical presentations must be kept close follow up. As chondroid syringoma on breast location is a very rare situation, the clinician may be forced to make correct diagnosis, so firm and slowly growing subcutaneous masses in breast must bring to mind chondroid syringoma.
Giant Chondroid Syringoma of the Breast Betul Sereflican, MD,* Betul Kizildag, MD,† Ozlem Kar Kurt, MD,‡ Murat Sereflican, MD,§ Nadir Goksugur, MD,* and Cetin Boran, MD¶ *Department of Dermatology, Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey; † Department of Radiology, Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey; ‡Department of Chest Disease, Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey; §Department of Otorhinolaryngology, Bolu Koroglu State Hospital, Bolu, Turkey; ¶Department of Pathology, Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey
A
64-year-old man presented with a large painless mass on his left breast. The lesion had grown slowly over the period of about 15 years. Dermatological examination showed a 12 9 8 cm, nontender, firm, plurilobulated nodule covered by normal skin (Fig. 1). There was no axillary lymphadenopathy. A CT scan was performed to define the extent of the lesion. The CT imaging study demonstrated 9 9 6.7 9 6.3 cm, well circumscribed lobular mass that showed macro calcifications inside and its periphery (Fig. 2). The mass presented subcutaneous location in the breast adipose tissue. Adjacent epidermis seemed normal. There was no chest wall invasion, but compression into the pectoralis major muscle was seen. Histopathologic examination showed ductal structures and solid epithelial cell islands in myxoid stroma (Fig. 3). Ductal structures lined with two layers of epithelial cells. Stromal cells seemed to be embedded in a lacune in some locations such as cartilage tissue. Stroma was positively stained for alcian blue. There was no mitosis. Immunohistochemically; inner row of the epithelial cells exhibited epithelial membrane antigen (EMA) and pancytokeratin positivity (Fig. 4), outer rows expressed vimentin (Fig. 5). E-cadherin was particularly positive in the inner layer of epithelial cells. Cytokeratin positive cells were seen disorderly in stroma. These histopathological and immunohistochemical findings were consistent with chondroid syringoma. Chondroid syringoma is a rare skin adnexal tumor. Typical clinical presentation of these tumors is a slow-
growing, mobile, well-circumscribed subcutaneous or intracutaneous nodule in size from 0.5 to 3.0 cm. This asymptomatic tumor generally occurs on head and neck region. There are reported cases occurring over the trunk, back, extremities, scrotum, auditory canal, eyelid, toe, and shoulder. Giant chondroid syringomas
Figure 1. Firm, 12 9 8 cm mass covered by normal skin.
Address correspondence and reprint requests to: Betul Sereflican, Abant Izzet Baysal University, Medical Faculty, Department of Dermatology, 14280 Golkoy – Bolu, Turkey, or e-mail: [email protected] DOI: 10.1111/tbj.12421 © 2015 Wiley Periodicals, Inc., 1075-122X/15 The Breast Journal, Volume 21 Number 4, 2015 438–439
Figure 2. CT scan shows 9 9 6.7 9 6.3 cm well-circumscribed lobular mass.
Giant Chondroid Syringoma of the Breast • 439
Figure 3. Ductal structures and epithelial cell islands in chondromyxoid stroma (H&E, 9200).
Figure 4. Immunoexpression of pancytokeratin. Inner layers of epithelial cells showing pancytokeratin positivity (immunoperoxidase, 9200).
occurring at unusual sites such as shoulder, arm, thigh, and eyelid have been also reported. To the best of our knowledge, our case is the second described in the breast. The first one was a pedunculated mass on the breast of a woman. Histopathologically, ductal and tubuloalveolar structures, cuboidal cell lines,
Figure 5. Immunoexpression of vimentin. Outer layers of epithelial cells showing vimentin positivity (immunoperoxidase, 9200).
islands of cuboidal or polygonal cells in a myxoid, chondroid, adipocytic or fibrous stroma are significative configurations. The stroma stains positively for periodic acid-schiff and Alcian blue. Immunohistochemically, inner cell layers of tubuloglandular components stain positive with epithelial markers such as cytokeratin, EMA, and carcinoembryonic antigen. Outer cell layers express mesenchymal markers like stromal cells. Keratin, vimentin, desmin, and S-100 are focally positive in the stroma of the tumor. Malignancy in chondroid syringoma is uncommon. Malign chondroid syringomas may occur from the benign form, so the clinician must be awake especially when the tumor is larger and in atypical location. Histopathologically, our case showed no malign characteristics, but because of the tumor’s great size and aberrant location, our patient and the patients that show atypical clinical presentations must be kept close follow up. As chondroid syringoma on breast location is a very rare situation, the clinician may be forced to make correct diagnosis, so firm and slowly growing subcutaneous masses in breast must bring to mind chondroid syringoma.
