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(6) and usually metastasized through the lymphatics (7). Histologically, eccrine epithelioma is described as above and may also demonstrate S-100 protein, monoclonal anti-keratin antibodies and CEA (6), usually the cytoplasmic vacuolization as mentioned in the results is associated with clear cell syringoma.
Since the lesion had been present for over sixty years without evidence of metastasis and because of the difficulty in performing a large scalp resection in the presence of an extensive subcutaneous arteriovenous network only the distal stalk and mass were ligated. This proved to yield a good cosmetic appearance due to the involution of the previously highly vascular stalk. Several of the previously reported lesions had been present for a number of years, were greater than 5 cm in diameter and had multiple recurrences after therapy. Therapy formerly consisted of excision and possibly radiation and chemotherapy.
This is a case of extremely large eccrine epithelioma of greater than sixty years duration without evidence of metastasis. The tumor appears to be aggressive at the confined site of the scalp possibly only limited in size by the vascular supply and has not spread per chance due to the maintained tissue integrity. Treatment in the past may have been for cosmetic or curative reasons and may have inadvertently assisted the tumor in spreading to other areas. Other documented cases may not have had the exact histopathology as reported here and may have therefore obviated the different therapeutic regimens.
REFERENCES
1. Freeman RG, and Winkleman, RK. Basal Cell Tumor with Eccrine Differentiation (Eccrine Epithelioma). Archives of Dermatology 1969;100:234-242.
2. Mass MC, Medenica M. Cutaneous Adnexal Tumors and Cysts: A Review Part II - Tumors with Apocrine and Eccrine Glandular Differentiation and Miscellaneous Cutaneous Cysts. Pathology Annual 1987;22 Pt 1:225-276.
3. Stout AP, Cooley GE. Carcinoma of Sweat Glands. Cancer 1951;4:521-536.
4. Cooper PH. Carcinoma of Sweat Glands. Pathology Annual 1987;22 Part 1:83-124.
5. El-Domeri AA, Brasfield RD, Huvos AG, Strong EW. Sweat Gland Carcinoma: A Clinico-Pathologic Study of 83 Patients. Annuals of Surgery 1971;73:270-274.
6. McKee PH, Fletcher CD, Rasbridge SA. The Enigmatic Eccrine Epithelioma (Eccrine Syringomatous Carcinoma). American Journal of Dermatopathology 1990;12:552-561.
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