Eccrine syringosquamous metaplasia

Abstract

A 7 year‐old male child presented with erythematous erosive plaques affecting the upper and lower eyelids of the left eye and extending to the cheek. Crustations over the right nostril were also evident. His general health status was normal. His medical history revealed that he was suffering from chronic myeloid leukemia for which he was receiving cyclic pulse therapy of cytarabine, doxorubicin and prednisone. It was noticed that the skin eruption was activated after each cycle and faded in 2–3 weeks to reappear after the next cycle but it never really cleared completely. The clinical differential diagnosis included herpes simplex, contact dermatitis, neutrophilic eccrine hidradenitis (NEH) and atypical fungal infection. The investigations included a complete blood count which showed a picture of improving leukemia with a total leucocytic count of 60 000/cc, RBCs count 3.7 × 106/cc, and platelet count of 110 000/cc. His hemoglobin was 9% The differential leucocytic count was as follows: basophils 0; eosinophils 4; blast cells 0; promyelocytes 0; myelocytes 10; juvenile cells 7; staff cells 14; segmented 45; lymphocytes 18 and monocytes 2. Cultures for fungi were negative, and serological examination for HIV, herpes simplex (IgG and IgM) cytomegalovirus and Epstein‐Barr virus antibodies were within normal ranges. Examination of a skin biopsy taken from the periorbital lesions revealed the presence of numerous islands of squamous cells extending from the epidermis into the upper‐ and mid‐dermis. Some of the islands were typically present around sweat ducts. On higher magnification, the cells forming the islands and lining the ducts were found to have abundant eosinophilic cytoplasm and large pale nuclei with prominent nucleoli. Some of the cells were dyskeratotic and there were occasional mitotic figures. Sparse lymphoid cell infiltrate was found surrounding some of the squamous cell islands. Based on the findings of squamous metaplasia of the cells lining the sweat ducts as well as the resemblance of some islands to squamous cell carcinoma, the diagnosis of eccrine syringosquamous metaplasia was made. Apart from the use of topical antibiotic creams, the patient received no therapy for his condition. Spontaneous improvement occured within 18 days after initial presentation but it recurred after the next cycle of chemotherapy.

Diseases of cutaneous appendages

“…1506 Clinically it may mimic a herpetic infection. 1507 The occurrence of squamous metaplasia in patients receiving chemotherapy for various malignant tumors [1508][1509][1510][1511][1512][1513] has led to the suggestion that squamous syringometaplasia is at the non-inflammatory end of the spectrum of eccrine gland reactions induced by chemotherapy, and neutrophilic eccrine hidradenitis (see below) is at the inflammatory end. 1509 It has also been induced by the tyrosine kinase inhibitors imatinib 1514 and sunitinib.…”

Neutrophilic dermatoses occurring in oncology patients

“… § AML is the most common NEH‐associated malignancy (> 67%); other hematologic malignancies include CLL, CML, ALL, Hodgkin's disease, and non‐Hodgkin's lymphoma. NEH‐associated solid tumors include testicular carcinoma, Wilms’ tumor (nephroblastoma), breast carcinoma, lung carcinoma, osteosarcoma, and esophageal carcinoma 2,12,22–25 …”

“…NEH-associated solid tumors include testicular carcinoma, Wilms' tumor (nephroblastoma), breast carcinoma, lung carcinoma, osteosarcoma, and esophageal carcinoma. 2,12,[22][23][24][25] ¶AML is the most frequent SS-associated hematologic malignancy; others include lymphoma (Hodgkin's and non-Hodgkin's), myelodysplastic syndromes, CLL, hairy cell leukemia, myeloma, acute leukemia, and myeloproliferative disorders (CML, agnogenic myeloid metaplasia/ myelofibrosis, and polycythemia). Cancers of the genitourinary organs, breast, and gastrointestinal tract are the most frequent SS-associated solid tumors; some of the others include pulmonary carcinoma, cancer of the head and neck organs, melanoma, and tumors with unknown primaries.…”

Chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia: Reappraisal of epidemiological, clinical, and pathological features

“…[1][2][3][4] It has been described in association with multiple well-defined entities as an incidental finding, and it is particularly seen in patients receiving chemotherapy for various malignant neoplasms (Table I). 5 In 1997 and 1996, Valks et al 6 and Prussick 7 respectively suggested the existence of a characteristic clinical pattern exclusively affecting the intertriginous areas, together with the presence of ESS as the main histologic feature.…”