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First described in 1963, eccrine syringofibroadenoma (ESFA) is a rare benign tumor that proliferates with differentiation toward ductal eccrine structures. There are many clinical presentations, including plaques, papules, verrucous plaques, keratotic tumors, and solitary tumors. The age of onset varies, with presentation between 16 and 80 years; however, solitary lesions are seen most commonly in the seventh and eighth decades. Here, we present the case of a 72-year-old woman referred to our outpatient clinic with a nodule on her leg. The histopathology result was ESFA. The lesion regressed after six cryotherapy sessions. Physicians should consider the possibility of ESFA and must remember its malignant potential in elderly patients.

Background: Malignant nodular hidradenoma (MNH) is an infrequent, highly malignant, primary skin tumour derived from eccrine sweat glands. Most tumours occur in elderly individuals. MNH has very poor prognosis, high recurrence and a high rate of metastases. The best method of treatment is still unclear: radical surgical excision is widely used, and selective lymph node dissection is also suggested. The value of the adjuvant radiotherapy and chemotherapy has not been confirmed., Patients and Treatment: Seven MNH patients (4 men, 3 women, age 60-87 years) were treated between 1991 and 2007 in the Dermatology Unit of San Donato Hospital of Arezzo and in the Section of Dermatology of University of Siena, Italy. Tumours varied from 0.8 to 4.4 cm in size. All patients underwent local excision; five also had lymph node dissection. One patient underwent adjuvant radiotherapy, and three received chemotherapy., Results: Six of seven patients died, with survival varying from 15 to 45 months. Distant metastases occurred in two patients. Survival time was inversely proportional to the size of the tumour., Conclusions: MNH is an aggressive tumour and should be diagnosed and excised as early as possible. Histological parameters are paramount, but correct diagnosis also calls for attention to clinical presentation and any history of recurrence or recent enlargement of long-standing lesions. In our experience, radiotherapy and chemotherapy do not seem to prolong survival.

A 70-year-old woman presented with signs and symptoms consistent with nasolacrimal duct obstruction. MRI revealed a medial canthal mass with orbital and intracranial extension. The patient was treated with wide surgical excision, chemotherapy, and radiation. A diagnosis of malignant hidradenoma of the medial canthus was confirmed by histopathology. Despite aggressive therapy, the patient developed metastatic disease and died within 1 year.

Tumours of eccrine sweat glands are uncommon, with complex classification and different terms used even for the same tumour. Therefore, for practical purposes, it may be sufficient to differentiate between benign and malignant. Malignant eccrine hidradenoma has a predilection for head and neck, with high incidence of recurrence following surgical excision and also regional and distant metastases. We describe a case, which presented as a medical emergency with symptoms of severe anaemia and acute heart failure secondary to intermittent bleeding from a huge ulcerative neck lesion, which was subsequently diagnosed as eccrine hidradenocarcinoma. The tumour was successfully treated with complete surgical excision and reconstruction followed by radiotherapy. Two years postoperatively, the patient is very well with no sign of recurrence.

Background: Eccrine spiradenoma is a well-differentiated benign tumor of the sweat glands. Malignant change arising within eccrine spiradenoma is rare., Objective: We describe a patient with malignant eccrine spiradenoma exhibiting both carcinomatous and sarcomatous differentiation., Methods: Case report and literature review., Results: A 37-year-old woman noted enlargement of a left axillary tumor that had been present for 20 years. The tumor was resected and the specimen, measuring 3.0 cm x 1.5 cm, revealed an encapsulated benign eccrine spiradenoma as well as an undifferentiated carcinoma possessing both carcinomatous and sarcomatous components. A transition zone was evident between the benign eccrine spiradenoma and the undifferentiated carcinoma, suggesting that the latter had arisen from the benign tumor. The malignant areas consisted principally of undifferentiated carcinoma (70%), although squamous cell carcinoma (10%), adenocarcinoma (10%), and chondrosarcomatous (10%) components were also present. Numerous mitotic figures were noted within the areas of malignant change, suggesting that the tumor was aggressive in nature. The patient died of systemic metastases 7 months after diagnosis., Conclusion: Although eccrine spiradenomas are usually benign, they can, on rare occasions, undergo malignant transformation. This case report describes one such occurrence of malignant transformation of a benign eccrine spiradenoma that unfortunately resulted in the patient's death from systemic metastases 7 months after diagnosis.

Malignant eccrine spiradenomas (MESs) are rare tumors arising from previously benign eccrine spiradenomas. A review of the literature reveals only 25 published reports of malignancy arising from eccrine spiradenoma and no prior reports of an MES of the scalp. The tumors have a metastasis rate of >50 per cent in reported cases with high resultant mortality rates. We present the first case report of a single MES of the scalp. Multiple resections were required for local control. Both magnetic resonance imaging and lymphoscintigraphy were used to assess regional spread. A review of the literature follows to include histopathology, diagnosis, and both surgical and adjuvant therapeutic options.

Malignant eccrine spiradenoma is an exceedingly rare tumor. A case of a 72-year-old women with this highly aggressive malignancy arising from a long-standing lower leg lesion is reported. Management during the course of disease included surgery, radiation therapy (RT), hyperthermic limb perfusion chemotherapy, and chemotherapy. The patient died of her disease, with widespread metastatic disease 20 months after the diagnosis. A review of the literature is presented, and treatment considerations are summarized.

A case of chondroid syringoma of scalp is reported. The case is of particular interest because of repeated recurrence with bone and dural infiltration.

The clinicopathologic features of sweat gland carcinomas in three girls and one boy, aged 7 months to 10 years, are presented. The histologic and ultrastructural features suggested malignant clear cell acrospiromas. Rapid extensive metastases developed in two and early local recurrence in one. No obvious effect of chemotherapy was noted in disseminated disease. Wide local excision is advised because of the risk of local lymphatic infiltration.

The diagnostic identification of sweat gland carcinomas is hampered by their rarity and their histologic resemblance to various visceral tumors, leading to confusion with metastatic lesions. In this series, 14 cases of eccrine carcinoma in five male and nine female patients, ranging in age from 13 to 84 years, are described. Ten tumors strongly resembled infiltrating ductal adenocarcinomas of the breast, and were thus classified as ductal. Three had a prominent mucinous matrix, similarly explaining their categorization as mucinous carcinomas. Finally, one neoplasm was a classic eccrine porocarcinoma. Four patients with ductal eccrine carcinomas suffered metastasis, and a 50% mortality rate was observed among this group of ten cases. In contrast, only one of three mucinous carcinomas metastasized, although all of these lesions recurred locally, as did the single porocarcinoma. None of the latter four neoplasms proved fatal. The results of conventional special stains in these 14 cases are discussed, and histologic features that they shared, and which may be utilized in distinguishing eccrine carcinomas from benign sweat gland tumors, are presented.