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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
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Year : 2018  |  Volume : 22  |  Issue : 3  |  Page : 415-417
 

Eccrine poroma: Insights of its occurrence and differentials in the maxillofacial region


1 Department of Oral Pathology and Microbiology, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
2 Department of Pathology, Parul Institute of Medical Sciences and Research, Vadodara, Gujarat, India
3 Department of Oral and Maxillofacial Surgery, Pandit Deendayal Upadhyay Dental College, Solapur, Maharashtra, India

Date of Submission25-Sep-2018
Date of Acceptance09-Oct-2018
Date of Web Publication14-Dec-2018

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomfp.JOMFP_243_18

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How to cite this article:
Shah AK, Shah AN, Patil SB. Eccrine poroma: Insights of its occurrence and differentials in the maxillofacial region. J Oral Maxillofac Pathol 2018;22:415-7

How to cite this URL:
Shah AK, Shah AN, Patil SB. Eccrine poroma: Insights of its occurrence and differentials in the maxillofacial region. J Oral Maxillofac Pathol [serial online] 2018 [cited 2019 Jun 16];22:415-7. Available from: http://www.jomfp.in/text.asp?2018/22/3/415/247378





   Introduction Top


A poroma is a benign tumor arising from the acrosyringium (the intraepidermal part of a sweat gland duct). This report describes the case of an eccrine poroma (EP) involving the right thigh. However, EP can involve any cutaneous surface. A poroma usually presents as a slow-growing ulcerated nodule. In the head-and-neck region, it mimics other common tumors arising from dermal adnexal structures. Microscopic examination of the lesion enables final diagnosis of such cases. Poromas are not commonly encountered by oral and maxillofacial specialists because of their low frequency in the head-and-neck region. However, occasionally, the oral and maxillofacial region may exhibit these lesions.[1],[2],[3],[4] Oral and maxillofacial specialists should be familiar with the clinicopathological features of such lesions. This case report discusses the clinical and microscopic features of EPs.


   Case Report Top


A 64-year-old woman presented with a gradually enlarging painless mass on the medial aspect of the right thigh. The patient's history revealed that the lesion has been small since its appearance, but. It had gradually increased in size over 18 months. A pedunculated growth was observed involving the skin of the medial aspect of the right thigh [Figure 1]a. The lesion showed multiple papillary projections of a violaceous hue. The lesion on palpation was nontender and firm to touch. Based on our findings, a working diagnosis of a benign skin tumor was made.
Figure 1: (a) Pigmented polypoid lesion involving the medial aspect of the right thigh, (b) excised lesion exhibiting a cauliflower-like surface, (c) proliferation of poroid cells against the background of loosely arranged stroma (H&E, ×4) (d) tumor cells showing oval vesicular nuclei and moderate amounts of cytoplasm. Note vague duct-like structures with eosinophilic material in their lumina (black arrow) (H&E, ×40)

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The lesion was completely excised under local anesthesia and submitted for pathological examination. The length, width and thickness of the excised specimen were 35 mm, 18 mm and 14 mm, respectively. It was brown with a cauliflower-like surface [Figure 1]b. A narrow stalk was also visible at the inferior aspect of it. The cut surface of the tumor was gray-white, smooth, firm and homogeneous.

A microscopic examination of the lesion revealed proliferation of epidermal cells in the form of broad anastomosing cords extending into the dermis. The border between the epithelial proliferation and the stroma was well defined. The tumor cells showed round-to-ovoid vesicular nuclei and moderate amounts of cytoplasm. Occasional duct-like structures were also identified. The supporting stroma consisted of loosely arranged collagen fibers, numerous blood vessels and fibroblasts and exhibited a moderate chronic inflammatory response [Figure 1]c and [Figure 1]d. The microscopic findings suggested that the lesion was an EP.

The tumor cells revealed cytoplasmic expression of cytokeratin (CK)-5, CK-14, carcinoembryonic antigen and epithelial membrane antigen [Figure 2]a,[Figure 2]b,[Figure 2]c,[Figure 2]d.
Figure 2: (a) Tumors cells showing cytoplasmic expression of cytokeratin-5 (immunohistochemical, ×40), (b) tumor cells showing cytoplasmic extension of cytokeratin-14. Note the staining of basal cells of the epidermis as an internal control (immunohistochemical, ×40) (c) cytoplasmic and membranous staining of epithelial membrane antigen in tumor cells (immunohistochemical, ×40), (d) cytoplasmic expression of carcinoembryonic antigen by tumor cells (immunohistochemical, ×40)

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The postoperative course was uneventful. The patient was followed up monthly for 6 months. Two years later, the patient was symptom free with no evidence of recurrence.


   Discussion Top


Poromas comprise a group of benign adnexal neoplasms that show proliferation of cells of the terminal portions of sweat gland duct (poroid cells). EPs were first described by Pinkus et al. in 1956.[5] The apocrine equivalent of a poroma has also been described.[6] Although poromas can occur on almost any cutaneous site, they predilect acral locations. Poromas are most commonly seen on the soles and palms, probably because of the high density of sweat glands in these sites. They are not commonly encountered in the head-and-neck region. The presence of multiple poromas is known as poromatosis.[7]

The frequency of appendageal skin tumors in the head-and-neck region is 0.08%.[8] Few reports have described the occurrence of poroma in the head-and-neck region. In the maxillofacial region, such lesions may be confused with other common cutaneous lesions such as basal cell carcinoma and seborrheic keratosis. [Table 1] shows the salient clinical and microscopic features that differentiate poromas from other cutaneous lesions arising in the maxillofacial region. Thus, appendageal skin tumors should be included in the list of differential diagnoses for cutaneous growths arising on the face.
Table 1: Differential diagnosis of eccrine poroma in the maxillofacial region

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Moore et al. compared the poromas arising on the extremities with those arising in the head-and-neck region. They reported that the poromas arising on the extremities are usually pigmented and they may be painful, may exhibit bleeding, produce discharge and grow rapidly. By contrast, poromas in the head-and-neck region are less likely than those on the extremities to exhibit pigmentation, bleed, produce discharge, cause pain and grow rapidly.[6] Similar to Moore's report, our patient's tumor showed pigmentation. However, it showed slow growth and did not cause pain, produce discharge or exhibit hemorrhage. Few reports have described rapid growth of poromas during pregnancy also.[9] Some EPs (approximately 18%) transform into malignant lesions, namely eccrine porocarcinomas.[10] Thus, complete surgical removal and subsequent microscopic examination are necessary. We also recommend that patients with EP should be followed up postoperatively to prevent the recurrence because recurrence may be a predisposing factor for transformation to malignancy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mahajan RS, Parikh AA, Chhajlani NP, Bilimoria FE. Eccrine poroma on the face: An atypical presentation. Indian J Dermatol 2014;59:88-90.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Bae MI, Cho TH, Shin MK, Jeong KH. An unusual clinical presentation of eccrine poroma occurring on the auricle. Indian J Dermatol 2015;60:523.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Snow SN, Reizner GT. Eccrine porocarcinoma of the face. J Am Acad Dermatol 1992;27:306-11.  Back to cited text no. 3
    
4.
Moore TO, Orman HL, Orman SK, Helm KF. Poromas of the head and neck. J Am Acad Dermatol 2001;44:48-52.  Back to cited text no. 4
    
5.
Pinkus H, Rogin JR, Goldman P. Eccrine poroma-tumor exhibiting features of the epidermal sweat duct unit. JAMA Dermatol 1956;74:511-21.  Back to cited text no. 5
    
6.
Sawaya JL, Khachemoune A. Poroma: A review of eccrine, apocrine, and malignant forms. Int J Dermatol 2014;53:1053-61.  Back to cited text no. 6
    
7.
Madhukara J, Jayaseelan E, Correa M. Atypical facial eccrine poromatosis - Effective treatment with topical atropine. Indian J Dermatol 2006;51:53-4.  Back to cited text no. 7
  [Full text]  
8.
Saha A, Das NK, Gharami RC, Chowdhury SN, Datta PK. A clinico-histopathological study of appendageal skin tumors, affecting head and neck region in patients attending the dermatology OPD of a tertiary care centre in Eastern India. Indian J Dermatol 2011;56:33-6.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Moon J, Lee JS, Park HS, Yoon HS, Cho S. Eccrine poroma with rapid growth during pregnancy: A case report and review of the literature. Ann Dermatol 2018;30:222-5.  Back to cited text no. 9
    
10.
Robson A, Greene J, Ansari N, Kim B, Seed PT, McKee PH, et al. Eccrine porocarcinoma (malignant eccrine poroma): A clinicopathologic study of 69 cases. Am J Surg Pathol 2001;25:710-20.  Back to cited text no. 10
    


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