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LARGE NON MALIGNANT ECCRINE EPITHELIOMA: CASE REPORT
ORIGINAL WORK
This is a case report of a non malignant 17 cm by 12 cm occipital eccrine epithelioma which had been present for greater than sixty years. This locally aggressive tumor was fed by numerous subcutaneous arterial venous vessels. The mass was removed en bloc.
INTRODUCTION
Eccrine epitheliomas are rare occurrences in the literature. Reports of sweat gland tumors are confusing as a result of their diversity of nomenclature and the lack of individual tumor type specific characteristics tested. There have been only 12 acceptable cases reported of basal cell carcinoma with eccrine differentiation, with the first being described in 1969 by Freeman and Winkleman (1)
CASE REPORT
A 76 year old Caucasian female presented with increasing somnolence, slurring speech, elevated temperature and multiple metabolic abnormalities. Her past medical history included longstanding hypertension, insulin dependent diabetes mellitus, anxiety and agoraphobia. Initial physical exam revealed a 17 cm by 12 cm irregular ovoid occipital mass covered with skin, thin, scattered hair and numerous firm, round, erythematous appendages, the largest being 3 cm by 3 cm and ulcerated. The pulsatile mass had a 10 cm long and 10 cm in diameter thickened skin covered stalk. The stalk which was also pulsatile, attached the mass to the external occipital protuberance (fig. 1). The scalp over the calvarium contained numerous dilated draining veins. The mass itself, was oozing blood at several sites. An emergent CT scan was performed to delineate the intracranial and/or calvarium extent of the mass. The solid, homogeneous enhancing mass, with calcifications revealed no further extension either intra or extracranial (fig. 2). In light of the patient's poor medical condition angiography was not performed. Instead color duplex ultrasound was performed which uncovered three 0.5 cm vessels converging into the stalk.
Questioning of the family disclosed that the lesion first manifested itself during the patient's late teens and grew to the size of a walnut during her twenties. After that time the
patient covered the mass with a hair net and never mentioned the mass again. The family stated that the patient suffered no headaches, changes in mental status or irritation of the mass at any other time in the past. Continued medical work up revealed a picture of sepsis without indication of an additional site. Other studies including multiple modality radiographic imaging, revealed no other internal or external sites of neoplasm. The patient was then (Continued on page 56)
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