Case Letter
Reactive eccrine syringofibroadenoma triggered by thermal damage: case report
Roberto Rheingantz da Cunha Filhoa,
, Lucas José Quiocab, Graziela Junges Crescente Rastellic, José Fillus Netod
Corresponding author
a School of Medicine, Universidade do Oeste de Santa Catarina, Joaçaba, SC, Brazil
b Universidade do Oeste de Santa Catarina, Joaçaba, SC, Brazil
c Department of Pathology, Faculdade Evangélica Mackenzie Paraná, Curitiba, PR, Brazil
d Department of Basic Pathology, Biological Sciences Sector, Universidade Federal do Paraná, Curitiba, PR, Brazil
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"resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 433 "Ancho" => 750 "Tamanyo" => 43439 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Anatomopathological examination: anastomosing epithelial cords of cuboid cells forming trabeculae in fibrous stroma that extend from the epidermis to the deep dermis (Hematoxylin & eosin, ×20).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Eccrine syringofibroadenoma (ESFA) is a rare tumor that consists of the proliferation of ductal structures that resemble the acral portion of the eccrine sweat glands. It was first described by Mascaró in 1963, and there are just over 70 published cases in the literature.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Although histologically distinct, the clinical presentation of ESFA is variable, from a solitary papule, plaque, or nodule to multiple lesions, with a predilection for the limbs of older patients.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> There is no consensus regarding its pathogenesis: tumor, hamartoma, or reactive hyperplasia.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This report adds unprecedented aspects, as it demonstrates the association of ESFA with thermal damage and successful treatment using topical corticosteroids.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The authors report the case of a 71-year-old male, retired and without comorbidities. He reported the use of heat-generating plaster, consisting of iron powder, activated carbon, vermiculite, potassium chloride, and water (Fenaflan Patch®) to treat pain in the lateral region of the right thigh. However, there was a local reaction with burning and heat sensation, which caused the patient to remove the plaster before the indicated time. In the following days, he developed erythematous papules and a vegetating plaque, sometimes friable and bleeding, with mild pruritus. It progressed for three months, reaching the size of 4 cm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A 5-mm punch biopsy was performed. The anatomopathological examination revealed anastomosing epithelial cords of cuboid cells forming trabeculae embedded in fibrous and myxoid stroma, which were highly vascularized from the epidermis to the deep dermis. The diagnosis of reactive type ESFA was confirmed (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Clobetasol in 0.05% cream was administered with occlusive application once a day for 20 days, with a fully effective response. The post-inflammatory residual erythema resolved completely within a few months.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The most current classification of ESFA includes five subtypes: solitary; multiple without skin changes; nevoid associated with ectodermal dysplasia; multiple associated with Schöpf syndrome; and the reactive subtype, associated with neoplastic or inflammatory dermatoses.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The literature presents the occasional description with other entities, both inflammatory and neoplastic, including bullous pemphigoid, palmoplantar erosive lichen planus, psoriasis, congenital syphilis, nevus sebaceous, chronic skin ulcer, basal cell carcinoma, and squamous cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The reactive type is probably triggered by tissue damage and, in the process of repair and remodeling, there is hyperplasia in response to the damage.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, this is the first report in the literature to associate thermal injury as the triggering factor for ESFA.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Histopathology assessment is necessary for diagnostic confirmation, the eccrine ducts may or may not be demonstrated. Immunohistochemistry can help in difficult cases, with cells often positive for keratin 6 and 19, as well as filaggrin.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">There is no consensus regarding treatment. The literature presents reports of etretinate therapy, surgery, radiotherapy, and laser; however, there are no reports of treatment with clobetasol or other topical corticosteroids.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The resolution of the present case occurred very quickly, with total regression in 20 days. The combination of the anti-inflammatory, antiproliferative, vasoconstrictor, and mitotic activity reduction effects of corticosteroids were probably determinant in the effective response to therapy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Roberto Rheingantz da Cunha Filho: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Lucas José Quioca: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature; critical review of the manuscript.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Graziela Junges Ascending Rastelli: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature; critical review of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">José Fillus Neto: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-03-04" "fechaAceptado" => "2020-05-13" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Cunha Filho RR, Quioca LJ, Rastelli GJC, Fillus Neto J. Reactive eccrine syringofibroadenoma triggered by thermal damage: case report. An Bras Dermatol. 2021;96:255–6.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Universidade do Oeste de Santa Catarina, Joaçaba Campus, SC, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 564 "Ancho" => 750 "Tamanyo" => 33773 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Vegetating plaque and erythematous and pinkish papules grouped in the lateral region of the right thigh.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 433 "Ancho" => 750 "Tamanyo" => 43439 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Anatomopathological examination: anastomosing epithelial cords of cuboid cells forming trabeculae in fibrous stroma that extend from the epidermis to the deep dermis (Hematoxylin & eosin, ×20).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 547 "Ancho" => 750 "Tamanyo" => 99171 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Anatomopathological examination: fibrous stroma in the middle and deep dermis (Hematoxylin & eosin, ×100).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leprosy-associated eccrine syringofibroadenoma of Mascaro" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 21 | 15 | 36 |
| 2024 October | 129 | 72 | 201 |
| 2024 September | 156 | 92 | 248 |
| 2024 August | 200 | 118 | 318 |
| 2024 July | 189 | 111 | 300 |
| 2024 June | 146 | 71 | 217 |
| 2024 May | 112 | 67 | 179 |
| 2024 April | 118 | 87 | 205 |
| 2024 March | 117 | 75 | 192 |
| 2024 February | 114 | 84 | 198 |
| 2024 January | 64 | 45 | 109 |
| 2023 December | 75 | 69 | 144 |
| 2023 November | 101 | 106 | 207 |
| 2023 October | 71 | 79 | 150 |
| 2023 September | 70 | 68 | 138 |
| 2023 August | 67 | 28 | 95 |
| 2023 July | 59 | 40 | 99 |
| 2023 June | 66 | 44 | 110 |
| 2023 May | 51 | 19 | 70 |
| 2023 April | 62 | 12 | 74 |
| 2023 March | 69 | 57 | 126 |
| 2023 February | 56 | 41 | 97 |
| 2023 January | 40 | 41 | 81 |
| 2022 December | 45 | 34 | 79 |
| 2022 November | 57 | 48 | 105 |
| 2022 October | 115 | 65 | 180 |
| 2022 September | 45 | 70 | 115 |
| 2022 August | 43 | 46 | 89 |
| 2022 July | 44 | 57 | 101 |
| 2022 June | 47 | 57 | 104 |
| 2022 May | 33 | 49 | 82 |
| 2022 April | 39 | 54 | 93 |
| 2022 March | 44 | 69 | 113 |
| 2022 February | 24 | 34 | 58 |
| 2022 January | 53 | 72 | 125 |
| 2021 December | 43 | 68 | 111 |
| 2021 November | 41 | 67 | 108 |
| 2021 October | 54 | 79 | 133 |
| 2021 September | 53 | 76 | 129 |
| 2021 August | 43 | 65 | 108 |
| 2021 July | 43 | 52 | 95 |
| 2021 June | 78 | 80 | 158 |
| 2021 May | 127 | 97 | 224 |
| 2021 April | 402 | 267 | 669 |
| 2021 March | 77 | 53 | 130 |
| 2021 February | 15 | 15 | 30 |
| 2021 January | 3 | 2 | 5 |
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