Letter – Dermatopathology
Eccrine syringofibroadenoma: report of two exuberant cases
Camila Schlang Cabral da Silveira
, Luiz Felipe Oliveira Santos, Marcella Leal Novello D’Elia, Daniel Lago Obadia
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Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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(A) Previamente ao tratamento. (B) Dermatoscopia: lacunas rosas com septos claros. (C) Resultado após quatro meses da ressecção por <span class="elsevierStyleItalic">shaving</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Camila Schlang Cabral da Silveira, Luiz Felipe Oliveira Santos, Marcella Leal Novello D’Elia, Daniel Lago Obadia" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Camila Schlang Cabral da" "apellidos" => "Silveira" ] 1 => array:2 [ "nombre" => "Luiz Felipe Oliveira" "apellidos" => "Santos" ] 2 => array:2 [ "nombre" => "Marcella Leal Novello" "apellidos" => "D’Elia" ] 3 => array:2 [ "nombre" => "Daniel Lago" "apellidos" => "Obadia" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059624000187" "doi" => "10.1016/j.abd.2022.10.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624000187?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275224000213?idApp=UINPBA00008Z" "url" => "/26662752/0000009900000003/v1_202404300449/S2666275224000213/v1_202404300449/pt/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S0365059624000059" "issn" => "03650596" "doi" => "10.1016/j.abd.2023.06.008" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "891" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Tropical/Infectious and parasitic dermatology</span>" "titulo" => "Cutaneous leishmaniasis on the malar region suggesting squamous cell carcinoma in two elderly patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "472" "paginaFinal" => "475" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2451 "Ancho" => 2508 "Tamanyo" => 861380 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 2. (A) An infiltrative plaque of small ulcers and crusts in the right cheek, and a satellite lesion in the nasal border (black arrow). (B) The patient presented great improvement with 1.5 g of liposomal amphotericin. A lasted lesion (white arrow) was treated with cryosurgery using an open probe. (C) Histopathology showing pseudoepitheliomatous hyperplasia and a granulomatous infiltrate in the dermis (Hematoxylin & eosin, 4×). (D) Rare round structures inside macrophages suggesting amastigotes forms can be seen (red arrowhead) (Hematoxylin & eosin, 100×). The insert (right-up corner) shows four amastigotes inside a macrophage.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Roberto Bueno Filho, Juliana Idalgo Feres, Natalia de Paula, Sebastião Antonio de Barros Júnior, Ana Maria Roselino" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Roberto" "apellidos" => "Bueno Filho" ] 1 => array:2 [ "nombre" => "Juliana Idalgo" "apellidos" => "Feres" ] 2 => array:2 [ "nombre" => "Natalia de" "apellidos" => "Paula" ] 3 => array:2 [ "nombre" => "Sebastião Antonio de" "apellidos" => "Barros Júnior" ] 4 => array:2 [ "nombre" => "Ana Maria" "apellidos" => "Roselino" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275224000092" "doi" => "10.1016/j.abdp.2024.02.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275224000092?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624000059?idApp=UINPBA00008Z" "url" => "/03650596/0000009900000003/v1_202404281408/S0365059624000059/v1_202404281408/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0365059624000126" "issn" => "03650596" "doi" => "10.1016/j.abd.2023.02.011" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "898" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Dermatopathology</span>" "titulo" => "An unusual Wolf’s isotopic response: myelodysplastic syndrome with acute myeloid leukemia developed on herpes zoster lesions" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "465" "paginaFinal" => "467" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 946 "Ancho" => 3341 "Tamanyo" => 728315 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Negative immunohistochemical staining for CD20 (A), Myeloperoxidase (MPO) (B) and CD117 (C) (×200).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Yu Zhu, Wei Wu" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Yu" "apellidos" => "Zhu" ] 1 => array:2 [ "nombre" => "Wei" "apellidos" => "Wu" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275224000183" "doi" => "10.1016/j.abdp.2024.02.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275224000183?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059624000126?idApp=UINPBA00008Z" "url" => "/03650596/0000009900000003/v1_202404281408/S0365059624000126/v1_202404281408/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter – Dermatopathology</span>" "titulo" => "Eccrine syringofibroadenoma: report of two exuberant cases" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "467" "paginaFinal" => "471" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Camila Schlang Cabral da Silveira, Luiz Felipe Oliveira Santos, Marcella Leal Novello D’Elia, Daniel Lago Obadia" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Camila Schlang Cabral da" "apellidos" => "Silveira" "email" => array:1 [ 0 => "milsilveira@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Luiz Felipe Oliveira" "apellidos" => "Santos" ] 2 => array:2 [ "nombre" => "Marcella Leal Novello" "apellidos" => "D’Elia" ] 3 => array:2 [ "nombre" => "Daniel Lago" "apellidos" => "Obadia" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1259 "Ancho" => 1675 "Tamanyo" => 379475 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">At ×400 magnification. Eccrine duct lumen inside the epithelial cord.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Eccrine syringofibroadenoma (ESFA) is a rare benign adnexal tumor that arises from the excretory portion of the eccrine sweat glands.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It usually involves distal extremities in middle-aged to elderly patients,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> presenting as solitary or multiple, coalescent, firm, skin-colored verrucous nodules, of variable sizes.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is currently classified into five types: solitary lesions, multiple lesions associated with ectodermal dysplasia, lesions without additional cutaneous pathology, nevoid lesions and reactive lesions.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Clinical diagnosis is very difficult and, therefore, histopathological evaluation is essential.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Complete excision seems to be the definitive treatment.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The present report describes two cases of ESFA with an exuberant clinical presentation and diagnostic difficulty due to limited access to specialized services, albeit with excellent final results after excision by shaving.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 76-year-old hypertensive diabetic male patient was referred to the dermatology service due to a vegetative lesion around a painful ulcer on the right lateral malleolus that had been noticed in 2018. He denied triggering factors and reported a previous biopsy at an external service diagnosed as verruca vulgaris. Associated with the condition, he had lymphedema of the ipsilateral lower limb. He underwent treatment for the ulcer but showed progression of the vegetative lesion. On examination, there was a hypertrophic scar on the lateral region of the dorsum of the right foot and multiple hardened verrucous pink nodules measuring 9<span class="elsevierStyleHsp" style=""></span>cm in their largest diameter, which coalesced on the lower edge of the scar (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Dermoscopy showed no findings suggestive of malignancy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). A new biopsy was performed, followed by complete removal of the lesion, by shaving, after histopathological evaluation. The image (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C) shows the four-month postoperative period, without recurrence. Histopathology disclosed thin cords of cuboidal epithelial cells anastomosed in a network-like fashion in connection with the lower portion of the epidermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). A fibrovascular stroma was observed interspersing the epithelial cords (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). The cells that constituted the cords showed ductal differentiation (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>); findings compatible with ESFA. There was no evidence of malignant transformation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 2</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 61-year-old female diabetic patient was referred to the dermatology service due to the appearance of a vegetative lesion six years previously. She reported that the condition began as papular lesions that developed into a tumor on the dorsum of the right foot. On examination, there was a vegetative lesion measuring approximately 10<span class="elsevierStyleHsp" style=""></span>cm in its largest diameter, well demarcated, with serosanguineous exudate and a foul odor, associated with hardened edema and hyperchromia of the distal third of the limb (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>A). She denied triggering factors. An incisional biopsy was performed followed by serial shaving of the lesion until its complete excision, and healing by secondary intention (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>B and C), after histopathological confirmation of ESFA (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a> A and B). All surgical specimens were sent for pathological analysis, to exclude the possibility of malignant transformation.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">ESFA is a rare benign neoplasm that normally presents as a single, nodular, large asymptomatic plaque, but which can be multiple, coalescent, firm, skin-colored and verrucous in appearance at the margin of an ulceration.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Among the findings of the physical examination, a possible characteristic of the affected region is the “mossy leg” aspect,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> a characteristic observed in the reported cases. The lesion has a predilection for distal extremities but can affect other sites.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The origin is not well defined, but it is associated with the proliferation of adnexal epithelial cells that form ducts,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> which arise from the excretory portion of the eccrine sweat glands.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">ESFA is divided into five types according to morphology, number of lesions and associated factors.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The solitary subtype is the most common,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> represented by the appearance of a verrucous mass or single non-hereditary nodule located on the lower limbs of elderly patients.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This description seems to fit the patient in the second case report, who had only one lesion on the lower limb, and no association with previous trauma or heredity. The first patient had a chronic ulcer, difficult to heal, was diagnosed with diabetes and lymphedema, suggesting the reactive subtype, which typically affects the acral region and is secondary to a chronic inflammatory or neoplastic lesion, having been previously described in association with ulcers, lymphedema and diabetic foot.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6</span></a> A specific type of eccrine remodeling or ductal repair, due to repeated damage to eccrine structures, is believed to be the pathogenesis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Histopathology is essential for diagnosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The formation of thin anastomosed epithelial cords, consisting of benign cuboidal epithelial cells with ductal differentiation, creates a network that connects with the lower portion of the epidermis;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> these cells are basaloid and smaller than the adjacent keratinocytes.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Rich fibrovascular stroma can be observed between the cords, containing plasma cells and ductal structures.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> There may or may not be lumen formation and discrete lymphocytic infiltrate.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Immunohistochemical analysis shows positivity with epithelial membrane antigen,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> carcinoembryonic antigen (CEA)<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and CK19, which identifies ductal differentiation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Some authors state that malignant transformation may occur in long-standing ESFA.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Areas of malignancy can easily be missed in incisional biopsies; therefore, complete excision is the treatment of choice,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> especially in cases of solitary lesions.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the two reported cases, it was decided to perform excision by shaving and regular outpatient monitoring of the lesion bed.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The relevance of the cases lies in the rarity of the disease, especially exuberant ones. Both cases showed a delay in the diagnosis, in the first due to a divergent histopathological diagnosis and in the second, due to difficulty in accessing a service capable of carrying out the investigation. Knowledge about the disease and diagnostic possibilities, considering the clinical presentation, helps to guide investigation and treatment more appropriately.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors’ contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Camila Schlang Cabral da Silveira: Drafting and editing of the manuscript; design and planning of the study; collection, analysis and interpretation of data; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; approval of the final version of the manuscript.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Luiz Felipe Oliveira Santos: Drafting and editing of the manuscript; collection, analysis and interpretation of data; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; approval of the final version of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Marcella Leal Novello D’Elia: Drafting and editing of the manuscript; design and planning of the study; collection, analysis and interpretation of data; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; approval of the final version of the manuscript.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Daniel Lago Obadia: Drafting and editing of the manuscript; design and planning of the study; collection, analysis and interpretation of data; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; approval of the final version of the manuscript.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 2" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Financial support" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Authors’ contributions" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-09-01" "fechaAceptado" => "2022-10-27" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.</p>" ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1416 "Ancho" => 3341 "Tamanyo" => 474243 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1. (A) Prior to treatment. (B) Dermoscopy: pink lacunae separated by white septa. (C) Outcome four months after excision by shaving.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1248 "Ancho" => 3341 "Tamanyo" => 1198005 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0070" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology of Case 1 stained with Hematoxylin & eosin. (A) ×20 magnification, showing a network of epithelial cords connected to the epidermis. (B) At ×200 magnification, the fibrovascular stroma is observed between the epithelial cords.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1259 "Ancho" => 1675 "Tamanyo" => 379475 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">At ×400 magnification. Eccrine duct lumen inside the epithelial cord.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1711 "Ancho" => 3341 "Tamanyo" => 929097 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0080" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Case 2. (A) Prior to treatment. (B) One month after the first shaving resection in the proximal region of the lesion. (C) One month after complete excision.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1244 "Ancho" => 3341 "Tamanyo" => 1330887 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0085" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Histopathology of Case 2, stained with Hematoxylin & eosin. (A) ×20 magnification, showing a network of epithelial cords connected to the lower portion of the epidermis. (B) ×400 magnification, showing eccrine duct lumen inside an epithelial cord.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case report of reactive solitary eccrine syringofibroadenoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.K. Tiwary" 1 => "J. Firdous" 2 => "D.K. Mishra" 3 => "S.S. 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