A Rare Case of Chondroid Syringoma Arising from the Lower Eyelid with Ectropion

Abstract

M ixed tumor of the skin was originally described by Billroth in 1859 1 as an entity histologically similar to the mixed tumor of the salivary glands. 2 In 1961, Hirsch and Helwig 3 introduced the term chondroid syringoma to describe this tumor, which is characterized by the presence of sweat gland elements lying within a cartilage-like stroma. 2 This benign skin adnexal tumor usually develops as a slowly growing intradermal or subcutaneous nodule on the face. This relatively uncommon tumor rarely affects the ocular adnexa. 2 To our knowledge, chondroid syringoma arising from the lower eyelid with severe ectropion is highly unusual. CASE REPORTA 61-year-old woman presented a painless and slowly developing mass (over 25 years) in the left lower eyelid with severe ectropion (Fig. 1). The mass was also exposed on the surface of the palpebral conjunctiva. Visual acuity, intraocular pressure, eye position, and ocular motility were all normal bilaterally. Our original differential diagnosis was dermoid, foreign body granuloma, hordeolum, and chondroid syringoma. The mass, measuring 31 ϫ 22 ϫ 19 mm, was extirpated en bloc, and the lower eyelid and palpebral conjunctiva were sutured to correct the ectropion under general anesthesia (Fig. 2). Histopathologic analysis revealed that the epithelial component had glandular features and a myxoid stromal component (Fig. 3). No atypical cells were visible. These findings were consistent with the diagnosis of chondroid syringoma (mixed tumor of the skin). Postoperative recovery was uneventful, and the tumor has not recurred during the past 5 years (Fig. 4).

Clinical and pathological study on mixed tumors of the skin

“…Billroth proposed the definition of benign MTS in 1859. [ 18 ] The literature reports that the incidence of MTS accounts for 0.01% to 0.098% of primary skin tumors and maybe even less. [ 1 – 4 ] MTS usually occurs in middle-aged men, predominantly on the head and neck.…”

Chondroid Syringoma of the Scalp: Case Report and Discussion of Clinical Features, Histopathology, and Treatment

“…During excision, it is important to obtain a specimen with margins free of tumor to prevent its recurrence. 1,4,6,7 As mentioned earlier, chondroid syringomas may originate either from apocrine or eccrine sweat glands, or they may evolve from entrapped ectopic cell rests of embrylogic origin stimulated to proliferate by an unknown factor. 3,4,7 Two histopathologic subtypes have been described: Chondroid syringomas of apocrine origin exhibit ducts, with lumina lined by two layers of epithelial cells; those of eccrine origin characteristically have ducts lined by a single layer of fl attened, cuboidal epithelial cells.…”

“…1 Hirsch and Helwig subsequently coined the term chondroid syringoma in 1961, thus providing tumors of sweat gland origin with their own unique identity. 1,2 Hirsch and Helwig proposed that chondroid syringomas originate from apocrine or eccrine sweat glands and are histopathologically distinct from pleomorphic adenomas, which originate from salivary glands. 3 Because of the morphologic and histopathologic similarities between chondroid syringomas and pleomorphic adenomas, they previously have been considered together.…”

“…Recurrence of these tumors most likely results from either inadequate excision or the existence of satellite tumor islands. 1,4,5 nontender, smooth, fi rm, and either subcutaneous or intradermal. Th eir pigmentation may appear identical to that of the surrounding skin, or they may exhibit a purplish or reddish hue.…”