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The clinicopathology of 13 cases of chondroid syringoma were examined. The ages of the patients ranged from 26 to 86 years, with an average of 48 years. There were eight males and five females. Ten tumors out of the thirteen appeared on the face. Only one patient out of ten was suspected of recurrence in follow-up information. Histologically, all tumors consisted of epithelial cells, chondroid or myxoid matrix, and other strumal elements. The tumors were histologically classified into two types; twelve tumors had tubular and cystic lumina lined by two layers of epithelial cells, and only one case had small lumina lined by only a single layer. By an immunohistochemical study with a PAP method, positive stainings of keratin were observed in all cases, and S-100 protein in all but one. Ultrastructurally, the tumor cells showed features of an epithelial cell. Some ultrastructural differences were noted between two types of chondroid syringoma. Type I tumor cells had many tonofilaments in cytoplasm, but cytoplasmic filaments in type II were of the intermediate-type.

A case of chondroid syringoma associated with hidrocystoma-like changes was investigated by histology, immunohistochemistry and electron microscopy. Chondroid syringoma was histologically compatible with apocrine mixed tumor, and hidrocystoma-like changes did not fulfill diagnostic criteria of either eccrine hidrocystoma or apocrine hidrocystoma. However, epithelial cellular elements composing both chondroid syringoma and hidrocystoma-like changes suggested, immunohistochemically and electron microscopically, differentiation into eccrine gland. The lesions of both had an apparent transition of ductal structures of chondroid syringoma into hidrocystoma-like changes. Therefore, chondroid syringoma and hidrocystoma-like changes in this case may be organized as a peculiar type of cutaneous appendage tumor differentiating toward eccrine gland.

The ultrastructure of a chondroid syringoma is described. The tumor nests are formed by clumps, solid cords and tubular structures distributed diffusely throughout a stroma of varying density. Two different types of cells form this tumor: dark cells forming the inner layer of the tubuloalveolar and ductal structures and having epithelial features, and light cells which form the outer layer of the tubular structures and show myoepithelial differentiation. The myoepithelial cells seem to be responsible for the production of the chondroid areas and thus the mixed appearance of the tumor. The epithelial cells forming the solid nests of the tumor show intracytoplasmic luminal formation and other features that favor the origin of chondroid syringoma from the eccrine sweat gland duct.

Sweat gland tumors are uncommon, and yet the chondroid syringoma (mixed tumor of the skin) appears most frequently on the faces of adults. Clinicians diagnosing and treating diseases of the head and neck should be aware of these tumors. A case of the chondroid syringoma in the upper lip is reported; the clinical features, histology, treatment, and follow-up are discussed.

A case of chondroid syringoma in the palm, probably the fourth to be reported, is presented. There was a large cystic cavity in the center of the tumor. The peculiar findings of hyaline, myxoid, or chondroid degeneration of the abundant stroma were observed histologically. This tumor should be considered in the differential diagnosis of painless, slow-growing palm tumors.

The ultrastructural features of a chondroid syringoma (mixed tumor of skin) are presented. The tumor consisted of groups of epithelial cells, ductal structures, and cells lying individually within a cartilaginous matrix. Many of these latter cells were indistinguishable morphologically from true chondrocytes. Some of these chondroid cells showed positive staining for cytokeratin using the immunoperoxidase technique. Transitional cells with characteristics intermediate between epithelial and chondroid cells are noted.

The case of a 38-year-old white man with a chondroid syringoma in the left side of the upper lip is reported. Histochemical study of the lesion showed that the morphologic distributions of the neutral mucosubstances, sulfated acid mucopolysaccharides, and elastic fibers in the reported case were similar to those of mixed salivary gland tumor. The recently reported ultrastructural and immunohistochemical features of chondroid syringoma are also discussed in an effort to clarify its histogenesis.

A series of 10 sweat-gland carcinomas is reported. The ages of the patients at presentation ranged from 12 to 79 years. Three of the tumours had shown long latent periods with a mass present for up to 20 years. Prognosis proved to be related to the histological subtype. Thus, two papillary syringocystadeno-carcinomas, one recurring cylindroma, one hybrid cylindroma/adenoid cystic carcinoma and two mucoid carcinomas were apparently all cured by surgery. Two mucoepidermoid carcinomas and one histologically malignant chondroid syringoma were not only histologically, but also clinically, malignant. The last case, a chondroid syringoma of benign histology, proved nevertheless to be malignant clinically.

We examined a case of Chondroid Syringoma of the upper lip region of a 51-year-old male.Chondroid Syringoma is rare or mixed tumor of the skin and a benign neoplasm of the sweat glands that appears to be composed of a mixture of epithelial and mesenchymal tissues.It is usually located on the skin of the head and neck, with the nose, cheek and upper lip are the commonest sites.It occurs frequently in males, M: F ratio being 2. 17: 1. The tumor appears as small, painless, dermal or subcutaneous non-ulcerated, solitary, firm, and may remain unchanged for many years.

Two cases of eccrine tumour of sweat gland origin found in the hand are presented. They were on-tender rounded masses of eight months to two years duration, beneath and adherent to the pidermis but movable on underlying tissue. The pre-operative diagnosis in each case was that of sebaceous cyst. Histology revealed one to be an eccrine spiradenoma and the other a chondroid syringoma. The lesions were considered unusual in that such tumours usually occur on the trunk, head and back and are rarely found in the hand.

Two cases of benign chondeoid syringoma of the hand are described. Both patients did not have this tumor in the differential diagnosis at the time of operation. The importance of this tumor lies in its recognition. Eighty-two percent of the malignant chondroid syringomas occur in the extremities, and the differences in benign versus malignant presentation are discussed.

A case of malignant chondroid syringoma of skin with widespread metastases is recorded. Several features of mixed tumors are discussed, and the pertinent literature is reviewed.

Summary A case of metastasizing chondroid syringoma of the scalp is reported in which the secondar-ies showed the characteristics of the primary tumour. We were unable to find a similar case report in the literature. The lesion was well circumscribed and lobulated, with nests of epithelial cells at the periphery of the lobules and a relatively acellular chondroid or mucinous matrix centrally. It differed from the usual descriptions of chondroid syringoma by exhibiting cellular pleomorphism, mitoses and islands of tumour cells away from the main tumour mass. These features may be useful in assessing the potential behaviour of chondroid syringomas.

Chondroid syringoma, also known as mixed tumour of the skin, is a relatively rare, usually benign tumour. A few malignant cases, especially in the lower extremities, have been published, but most of them behave in a benign fashion. A case of a middle-aged woman with surgically proved chondroid syringoma in the pretibial region is presented in this report with MRI and histological findings. Despite rapid growth over a short period of time and a location reportedly associated with malignancy, the histological features were benign.

Chondroid syringoma is a cutaneous mixed tumor of salivary-gland-type usually located in the head and neck region. It usually has a prominent chondroid component. Hirsch and Helwig1and Stout and Gorman2have reported the largest series of cases, 188 and 134 respectively. Aggressive or frankly malignant behavior is rare and has been observed in only five instances.1,3-6The presence of satellite nodules adjacent to the main mass and of cellular atypism and mitotic activity has been used as criterion of malignancy. Report of a Case A 15-year-old girl had a nodule in her left external auditory meatus that was excised but recurred three years later. She is now 21 years old and has no evidence of residual disease. Histologically, both the original lesion and the recurrence showed features of a chondroid syringoma (Fig 1, left and right), except for a moderate degree of pleomorphism and occasional mitoses

Mixed tumors of skin have been regarded by surgeons, dermatologists, and pathologists as intriguing curiosities for many years. Nasse is generally regarded as having described the first case in 1892.1Since that time there have been many sporadic reports. Lennox et al.2and Greeley et al.3have published extensive review articles. Stout4collected a large series and reported one case which he regarded as histologically malignant. Histochemical observations have recently been made by Laffargue.5In spite of the fact that there are now over 100 cases of mixed tumors of skin reported in the world's literature, there have been no attempts to further delineate the origin of these neoplasms other than to assume sweat-gland genesis. That a more thorough evaluation of these tumors has not been made for over 60 years is understandable for 2 reasons: first, series of 2 or more cases have been