Porom eccrines D23.L

Author: Prof. Dr. med. Peter Altmeyer

Co-Autor: Dr. Michael Hambardzumyan

Our authors

Last updated on: 29.10.2020

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Synonym(s)

Acrospirome; Borst-Jadasson epithelioma; dermal duct tumor; Eccrine Poroma; Poroakanthoma

History
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Pinkus, 1956

Definition
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The term "Porom" is misleading, historically overloaded and is still interpreted differently today. The definition is generally accepted: benign adnexal tumor with "eccrine" (and apocrine) differentiation, which probably originates from a pluripotent stem cell at the transition from the dermal to the intraepidermal part of the glandular duct.

Classification
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  • Eccrine poromas can develop intraepidermally (intraepidermal poroma - historical name: Hidroakanthoma simplex, see also Borst-Jadassohn phenomenon).
  • A second type grows broadly along the surface epithelium, broadly basal solid or reticulated into the papillary epidermis (juxtapidermal eccrine poroma).
  • A third type is the dermal eccrine poroma, which spreads predominantly in the dermis without broad relation to the surface epithelium. The dermal eccrine poroma was also commonly called "dermal duct tumor".

Occurrence/Epidemiology
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The proportion of all sweat gland tumours is about 10%.

Manifestation
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40th to 60th year of age, especially in men.

Localization
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Mainly localized on the soles of the feet, palms of the hands, less frequently on the head and neck, also on the remaining integument (Sawaya JL et al. 2014). Exceptional is the multiple occurrence (eccrine poromatosis).

Clinical features
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Little characteristic clinical picture. Solitary, asymptomatic, sharply defined, raised, 1-4 mm to 3 cm in size, sometimes stalked, possibly slightly reddened, unpigmented, broadly basal nodule or nodule or a corresponding plaque. The mostly unpigmented tumour is skin-coloured to brownish-red in colour. Especially in cystic forms, a blue-black discoloration may occur as a result of bleeding. Eccrine poromas can occur together with a sebaceous nevus or develop secondarily in a sebaceous nevus.

Histology
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  • Delimited compact or reticulated, uniform cell proliferation from cuboid keratinocytes with small, hyperchromatic nuclei and a uniform eosinophilic, glycogen-rich (PAS-positive) cytoplasm. In sections, light-cell complexes are also found. The poroma can express tubular structures (more rarely ductal). In case of ductal differentiation, the carcinoembryogenic antigen (CEA) is detectable. In tubular structures, decapitation phenomena can often be detected (indication of an apocrine genesis of this poroma). The tumour parenchyma is surrounded by a hyalinised stroma.
  • Circumscribed beet-like cell necroses in malignant (not in eccrine poroma!) tumours are frequent (necrosis en masse) and are to be regarded as an indication of their malignancy, since perfusion is no longer guaranteed due to rapid growth, resulting in a reduced supply of cell necroses. Ductal structures differentiate focally. Sebocyte differentiations at the base of the tumor are rare.

Differential diagnosis
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Therapy
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It is a histological random diagnosis. Excision with a safety margin of 1-2 mm is curative.

Progression/forecast
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Favourable; rarely a malignant degeneration into a porocarcinoma can be observed.

Note(s)
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The additional name "eccrine" is widely used in the current literature and is still used here in contrast to follicular poroma. However, the addition "eccrine" is incorrect, as only about half of the "eccrine" poromes are of eccrine origin. The rest is apocrine. Some authors use the term acrospiroma as an umbrella term for the hidroakanthoma simplex and the eccrine poroma. This term is also dispensable.

Literature
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  1. Del Pozo J et al (1999) Porokeratotic eccrine ostial and dermal duct naevus: treatment with carbon dioxide laser. Br. J Dermatol 141: 1144-1145
  2. Dogra S et al (2002) Porokeratotic eccrine ostial and dermal duct nevus: unilateral systematized involvement. Pediatric Dermatol 19: 568-569
  3. Eckert F et al (1991) The Eccrine Porom. dermatologist 42: 692-699
  4. Kamiya H et al (2001) Apocrine poroma: review of the literature and case report. J cutan Pathol 28: 101-104
  5. Holden B et al (2002) Malignant eccrine acrospiroma with metastasis to the parotid. Ear Nose Throat J 81: 352-155
  6. Kakinuma H et al (2002) Eccrine poroma: another cause of a pigmented scalp nodule. Br J Dermatol 146: 523
  7. Kuo HW et al (2003) Pigmented eccrine poroma: a report of two cases and study with dermatoscopy. Dermatol Surge 29: 1076-1079
  8. Kurokawa M et al (2001) Eccrine poromas in a patient with mycosis fungoides treated with electron beam therapy. Br J Dermatol 145: 830-833
  9. Mahalingam M, Byers HR (2000) Intra-epidermal and intra-dermal sebocrine adenoma with cystic degeneration and hemorrhage. J Cutan cathode 27: 472-475
  10. Pinkus H, Rogin JR, Goldman P (1956) Eccrine poroma. Arch Dermatol 74: 511-521
  11. Reier AR et al (2002) MR imaging appearance of plantar eccrine acrospiroma (sweat gland tumor). AJR Am J Roentgenol 179: 1079-1080
  12. Sassmannshausen J et al (2000) Porokeratotic eccrine ostial and dermal duct nevus: a case report and review of the literature. J Am Acad Dermatol. 43: 364-367
  13. Sawaya JL et al (2014) Poroma: a review of eccrine, apocrine, and malignant forms. Int J Dermatol 53:1053-1061.

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Last updated on: 29.10.2020