Nishikawa Yohei, Kaneko Takahide, Takiyoshi Noriko, Aizu Takayuki, Nakajima Koji, Matsuzaki Yasushi, Nakano Hajime, Sawamura Daisuke
Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8182, Japan.
J Dermatol Case Rep. 2009 Nov 28;3(3):38-40. doi: 10.3315/jdcr.2009.1033.
Eccrine poromas are relatively common slow-growing benign solitary adnexal tumors originating from the intraepidermal portion of the eccrine sweat duct (acrosyringium). Dystrophic calcification is rarely found in lesions of eccrine poroma, and only 2 cases of eccrine poroma with calcification have been reported thus far. In the present report, we describe another case of eccrine poroma with calcification occurring in the palm of the hand. Also, we show dermoscopic features of this case.
A 73-year-old man with hemiparesis, who had a 10-year history of tumor on his right palm, which was occasionally injured by a walking crutch, causing bleeding and ulceration. Physical examination revealed a pigmented dome-shaped tumor. Dermoscopic analysis revealed glomerular vessels, multiple pink-white structureless areas, and lacunae. Histological examination revealed that the tumor was composed of cords of tumor cells extending from the epidermis into the dermis. These were uniformly cuboidal cells with round, basophilic nuclei and dense vascular stromas with telangiectasia. The tumor showed cystic structures and calcification. The patient was diagnosed with Pinkus-type eccrine poroma on the basis of histological findings.
Although cutaneous neoplasms commonly associated with calcification are of follicular origin, it is known that dystrophic calcification may be triggered also in tumors of eccrine origin by multiple factors, including mechanical injury. Dermoscopy may be helpful in establishing clinical diagnosis of calcified eccrine poromas.
小汗腺汗孔瘤是相对常见的生长缓慢的良性孤立性附属器肿瘤，起源于小汗腺导管的表皮内部分（顶泌汗腺导管）。营养不良性钙化在小汗腺汗孔瘤病变中很少见，迄今为止仅报道了2例伴有钙化的小汗腺汗孔瘤。在本报告中，我们描述了另一例发生在手掌的伴有钙化的小汗腺汗孔瘤病例。此外，我们展示了该病例的皮肤镜特征。
一名73岁偏瘫男性，右手掌有10年肿瘤病史，偶尔被步行拐杖损伤，导致出血和溃疡。体格检查发现一个色素沉着的圆顶形肿瘤。皮肤镜分析显示有肾小球样血管、多个粉白色无结构区域和腔隙。组织学检查显示肿瘤由从表皮延伸至真皮的肿瘤细胞索组成。这些细胞均为立方形，核圆形、嗜碱性，血管间质致密且有毛细血管扩张。肿瘤呈现囊性结构和钙化。根据组织学检查结果，该患者被诊断为平卡斯型小汗腺汗孔瘤。
虽然通常与钙化相关的皮肤肿瘤起源于毛囊，但已知多种因素（包括机械损伤）也可能在起源于小汗腺的肿瘤中引发营养不良性钙化。皮肤镜检查可能有助于钙化性小汗腺汗孔瘤的临床诊断。
