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measuring 1 to 2&#46;5<span class="elsevierStyleHsp" style=""></span>cm in the left upper extremity following a line of Blaschko&#46; Central umbilication was seen in several lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#44; B&#41;&#46; She was misdiagnosed at another hospital with verruca vulgaris&#44; laser was used to remove some of the lesions but soon recurred&#46; One of the lesions was surgically excised and histopathology was performed&#46; Features of SCAP were identified&#44; with the tumor located in the superficial layer of the dermis without connection to the overlying epidermis&#44; composed of cystadenoma-like structures and folded papillary structures&#46; The cystic spaces and papillary structures were lined with single columnar epithelium and surrounded by a layer of small cuboidal myoepithelial cells&#44; forming a special double-layer structure &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#44; D&#41;&#46; DNA tested for Human Papillomavirus &#40;HPV&#41; was negative&#46; After excision&#44; there was no recurrence or new lesions at the 3-month and 6-month follow-ups&#46; As the patient did not want to excise the other papules&#44; we arranged for a subsequent visit after 6 months&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">SCAP was first described by Stokes in 1917&#46; The pathogenesis of SCAP remains unclear&#44; HPV DNA and mutations in the RAS&#47;mitogen-activated protein kinase signaling pathway have been detected&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> In our case we failed to identify HPV infection though the lesions show verrucous growths&#46; SCAP frequently arises in puberty within organoid nevi in the head and neck region&#46; As far as we have observed&#44; there have been 17 previous cases of linear SCAP reported in the literature in English&#44; and only two of these cases developed in adults&#44; aged 21 and 34 respectively&#46; The reported 17 cases include 10 females and 7 males&#44; 6 cases occurred in the head and neck&#44; 5 cases were in the trunk&#44; 5 cases were in the extremities and one case was in the inguinal fold&#46; In the extremities&#44; 3 were found on the leg and 2 on the upper limb&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> The unique features of our case are Blaschkolinear distribution&#44; the localization on the upper limb&#44; late-onset in an adult&#44; and the tumor without connection to the overlying epidermis&#46; So far&#44; neither organoid naevus nor epidermal naevus has been demonstrated in the linear form of SCAP&#46; Therefore&#44; multiple linear SCAP may represent a distinct clinical form&#44; the relationship of linear SCAP with organoid naevus or other adnexal tumors needs further investigation&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0020" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author&#39;s contributions</span><p id="par0025" class="elsevierStylePara elsevierViewall">Ming Yao&#58; Pathological analysis&#44; article writing and figure editing&#59; literature search&#59; approval of the final version of the manuscript&#59; data collection&#44; analysis and interpretation&#59; critical review of the manuscript&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Lang Rao&#58; Pathological analysis&#44; article writing and figure editing&#59; concept determination&#59; approval of the final version of the manuscript&#59; data collection&#44; analysis and interpretation&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Letter - Clinical
Linear synngocystadenoma papilliferum of the limb: a rare localization of an uncommon tumour
Ming Yao1, Lang Rao1,
Corresponding author
495593793@qq.com

Corresponding author.
Department of Dermatology, Chengdu Second People's Hospital, Chengdu, Sichuan Province, China
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#44; B&#41; Several normochromic papules&#44; some with a warty surface&#44; with a diameter of about 1 &#8764; 2&#46;5<span class="elsevierStyleHsp" style=""></span>cm on the left upper limb&#44; arranged in a linear pattern&#46; &#40;C&#41; The tumor is located in the superficial dermis without connection to the overlying epidermis&#44; composed of cystadenoma-like structures and folded papillary structures&#46; &#40;Hematoxylin &#38; eosin&#44; &#215;40&#41;&#46; &#40;D&#41; The cystic spaces and papillary structures are lined with single columnar epithelium and surrounded by a layer of small cuboidal myoepithelial cells&#44; forming a special double-layer structure&#46; &#40;Hematoxylin &#38; eosin&#44; &#215;400&#41;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Syringocystadenoma Papilliferum &#40;SCAP&#41; is a benign adnexal neoplasm that most frequently arises from an organoid nevus on the head and neck&#46; It usually occurs during childhood or adolescence&#44; varying in morphological character from smooth and flat to verrucous form&#46; Most reported cases in the literature are single lesions presenting as a solitary raised warty plaque&#44; and less commonly multiple papules&#46; Here we report a case of multiple SCAP with a warty surface presenting on the limb distributed along a Blaschko line and without pre-existing lesions in an adult&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 45-year-old female presented with several pink nodules on the left upper limb for seven years&#46; The lesions were pruriginous and prone to bleed after scratching&#46; Physical examination revealed multiple&#44; verrucous papules&#44; measuring 1 to 2&#46;5<span class="elsevierStyleHsp" style=""></span>cm in the left upper extremity following a line of Blaschko&#46; Central umbilication was seen in several lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#44; B&#41;&#46; She was misdiagnosed at another hospital with verruca vulgaris&#44; laser was used to remove some of the lesions but soon recurred&#46; One of the lesions was surgically excised and histopathology was performed&#46; Features of SCAP were identified&#44; with the tumor located in the superficial layer of the dermis without connection to the overlying epidermis&#44; composed of cystadenoma-like structures and folded papillary structures&#46; The cystic spaces and papillary structures were lined with single columnar epithelium and surrounded by a layer of small cuboidal myoepithelial cells&#44; forming a special double-layer structure &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#44; D&#41;&#46; DNA tested for Human Papillomavirus &#40;HPV&#41; was negative&#46; After excision&#44; there was no recurrence or new lesions at the 3-month and 6-month follow-ups&#46; As the patient did not want to excise the other papules&#44; we arranged for a subsequent visit after 6 months&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">SCAP was first described by Stokes in 1917&#46; The pathogenesis of SCAP remains unclear&#44; HPV DNA and mutations in the RAS&#47;mitogen-activated protein kinase signaling pathway have been detected&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> In our case we failed to identify HPV infection though the lesions show verrucous growths&#46; SCAP frequently arises in puberty within organoid nevi in the head and neck region&#46; As far as we have observed&#44; there have been 17 previous cases of linear SCAP reported in the literature in English&#44; and only two of these cases developed in adults&#44; aged 21 and 34 respectively&#46; The reported 17 cases include 10 females and 7 males&#44; 6 cases occurred in the head and neck&#44; 5 cases were in the trunk&#44; 5 cases were in the extremities and one case was in the inguinal fold&#46; In the extremities&#44; 3 were found on the leg and 2 on the upper limb&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> The unique features of our case are Blaschkolinear distribution&#44; the localization on the upper limb&#44; late-onset in an adult&#44; and the tumor without connection to the overlying epidermis&#46; So far&#44; neither organoid naevus nor epidermal naevus has been demonstrated in the linear form of SCAP&#46; Therefore&#44; multiple linear SCAP may represent a distinct clinical form&#44; the relationship of linear SCAP with organoid naevus or other adnexal tumors needs further investigation&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0020" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author&#39;s contributions</span><p id="par0025" class="elsevierStylePara elsevierViewall">Ming Yao&#58; Pathological analysis&#44; article writing and figure editing&#59; literature search&#59; approval of the final version of the manuscript&#59; data collection&#44; analysis and interpretation&#59; critical review of the manuscript&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Lang Rao&#58; Pathological analysis&#44; article writing and figure editing&#59; concept determination&#59; approval of the final version of the manuscript&#59; data collection&#44; analysis and interpretation&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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