Eccrine gland involvement in Krabbe's disease

Summary Lysosomal storage inclusions were observed in skin eccrine gland secretory and myoepithelial cells in three cases of Krabbe's disease. In addition to storage there were numerous degenerative changes, occasionally resulting in cell necrosis. These findings suggest a generalized nature of the storage process in this lysosomal enzymopathy and point to high galactocerebroside turnover in eccrine gland epithelium. This knowledge may be of value in the biopsy diagnosis of Krabbe's disease.     

A Case of Primary Cutaneous Mucinous Carcinoma with Neuroendocrine Differentiation

Primary cutaneous mucinous carcinoma is a rare malignant tumor that originates from the deepest portion of the eccrine sweat duct. Common sites of involvement are the face and scalp. Biopsy shows dermal epithelial cell islands embedded in mucin pools separated by fibrous septae. It is difficult to differentiate this tumor histologically from metastatic adenocarcinoma. Recurrence after excision is common but metastases are rare. We report a primary cutaneous mucinous carcinoma with neuroendocrine differentiation on the right cheek of a 63-year-old man.     

Malignant eccrine breast spiradenoma. A case report and literature review

IntroductionEccrine spiradenomas are rare adnexal tumours of the skin that originate in the sweat glands. There are only three cases, including ours, diagnosed as malignant transformation in the breast.Presentation of caseWe present a case of an asymptomatic 48 year old woman in whom the lesion was detected on the basis of breast cancer prevention programme. The metastatic study detection and the sentinel lymph node biopsy were negative so wide excision of the mass was performed with no further treatment. After 32 months of follow-up, there is no evidence of recurrent or metastatic disease in our patient.DiscussionThe lesions usually show a typical history of a long-standing unchanged cutaneous solitary nodule that becomes enlarged. The imaging findings of breast eccrine spiradenomas have not been clearly demonstrated. Diagnosis is based in histopathological findings of malignant focus.A large list of uncommon dermatological skin malignancies and breast benign lesions can mimic malignant eccrine spiradenomas (MES); therefore, determination of inmunophenotype allows narrowing differential diagnosis. Distant metastases portend an ominous prognosis. The mainstay of treatment is surgical removal with wide excision margins. Radiation and hyperthermic chemotherapy can also be administered to prevent focal recurrence. Due to the high risk of developing metastases, close follow up of these patients for early detection of recurrence should be carried out.ConclusionEccrine spiradenomas are rare adnexal tumours of the skin. Intraparenquimatous breast location is especially infrequent. Diagnosis is based on histopathological examination. MES metastasizes (40%), so a close follow up is recommended.     

Tattoos do not affect exercise-induced localised sweat rate or sodium concentration

ObjectivesSkin tattoos have been shown to reduce localised sweat rate and increase sweat sodium concentration ([Na⁺]) when sweating is artificially stimulated. This study investigated whether similar responses are observed with exercise-induced sweating.DesignUnblinded, within-participant control, single trial.MethodsTwenty-two healthy individuals (25.1 ± 4.8 y (Mean ± SD), 14 males) with a unilateral tattoo ≥11.4 cm² in size, ≥2 months in age, and shaded ≥50% participated in this investigation. Participants undertook 20 min of intermittent cycling (4 × 5 min intervals) on a stationary ergometer in a controlled environment (24.6 ± 1.1 °C; 64 ± 6% RH). Resultant sweat was collected into absorbent patches applied at two pairs of contralateral skin sites (pair 1: Tattoo vs. Non-Tattoo; pair 2: Control 1 vs. Control 2 (both non-tattooed)), for determination of sweat rate and sweat [Na⁺]. Paired samples t-tests were used to determine differences between contralateral sites.ResultsTattoo vs. Non-Tattoo: Neither sweat rate (Mean ± SD: 0.92 ± 0.37 vs. 0.94 ± 0.43 mg·cm⁻²·min⁻¹, respectively; p = 0.693) nor sweat [Na⁺] (Median(IQR): 37(32–52) vs. 37(31–45) mM·L⁻¹, respectively; p = 0.827) differed. Control 1 vs. Control 2: Neither sweat rate (Mean±SD: 1.19 ± 0.53 vs. 1.19 ± 0.53 mg·cm⁻²·min⁻¹, respectively; p = 0.917) nor sweat [Na⁺] (Median(IQR): 29(26–41) vs. 31(25–43) mM·L⁻¹, respectively; p = 0.147) differed. The non-significant differences for sweat rate and [Na⁺] between Tattoo vs. Non-Tattoo were inside the range of the within participant variability (sweat rate CVi = 5.4%; sweat [Na⁺] CVi = 4.4%).ConclusionsSkin tattoos do not appear to alter the rate or [Na⁺] of exercise-induced sweating. The influence of skin tattoos on localised sweat responses may have previously been over-estimated.     

Use of the vacuum-assisted closure device in enhancing closure of a massive skull defect

OBJECTIVES/HYPOTHESIS: The objective was to describe a novel technique for reconstructing the cranial vertex without the use of free tissue transfer. STUDY DESIGN: Case report, literature review, and discussion. METHODS: A 50-year-old woman presented from a remote Pacific Island community with a 12 x 14-cm, necrotic, grossly contaminated eccrine gland carcinoma of the cranial vertex that extended through the calvarium but did not invade the dura. Following tumor extirpation, the resulting bony defect was 10 x 12 cm in size, with a concomitant scalp defect of 14 x 16 cm. Free tissue transfer was impossible because of severe intimal peripheral vascular disease, posing a challenging reconstructive dilemma. After tumor resection, the bony edges were covered with local scalp flaps and the vacuum-assisted closure device was placed over the wound at a constant setting of -50 mm Hg. The vacuum-assisted closure device was changed three times per week for 3 weeks. RESULTS: A thick, 1-cm bed of granulation tissue developed over the dura, allowing temporary coverage by a split-thickness skin graft, and the scalp defect decreased in size by approximately 25%. The patient did not develop meningitis, headache, or localized infection as a result of placement of the vacuum-assisted closure device and tolerated the vacuum-assisted closure well. After a requisite period of healing, tissue expanders and calvarial reconstruction will be performed. CONCLUSION: Use of the vacuum-assisted closure device is a safe, reliable adjunct in the closure of large cranial defects with exposed dura and offers a novel reconstructive option for complex defects of the head and neck.     

Clear cell hidradenoma of the index finger

A patient with a benign clear-cell hidradenoma of the index finger is presented. Clear cell hidradenoma is a rare tumor originating from the eccrine sweat glands and infrequently appears on the hand.     

A Case of Eccrine Poroma with Multiple Transepidermal Elimination

The skin functions to eliminate foreign substances through the epidermis to the epidermal surface; this process is called transepidermal elimination (TEE). TEE has been observed in various skin tumors. We encountered a 64-year-old male patient with eccrine poroma with marked TEE. A dark brown nodular papule appeared on the anterior aspect of his right leg about 20 years ago and gradually expanded. Histopathologically, cell nests of poroma were extruded to the epidermal surface at several sites. No erosion was noted, and mild to moderate inflammatory cell infiltration was observed in the upper layer of the dermis. According to Mehregan's classification, the TEE phenomenon observed in our case may correspond to types 2 and 3.     

Giant vascular eccrine spiradenoma: report of a case with immunohistochemical study

We report a rare case of giant vascular eccrine spiradenoma (GVES) which developed in 56-yr-old Korean woman. It is a rare variant of eccrine spiradenoma (ES), which might be mistaken for angiomatous lesions in view of its florid vascularity and hemorrhagic features. Histogenesis of GVES is not clearly elucidated although it is known that ES presumably originates in the eccrine glands. To clarify the histogenesis of GVES, immunohistochemical stainings using various monoclonal antibodies were also performed. The tumor was composed of three types of cells, namely pale epithelial cells, small basal cells, and myoepithelial cells. Therefore, we conclude that GVES originated from eccrine gland and mainly differentiates toward secretory portion of secretory coil.