British Journal of Radiology (2006) 79, e59-e61
© 2006 British Institute of Radiology
doi: 10.1259/bjr/14399042
MRI of a benign chondroid syringoma
U Kerimoglu, MD
1
U Aydingoz, MD
1
O Ozkaya, MD
2
A E Aksu, MD
3 and
F B Ergen, MD
1
Departments of 1Radiology 2Pathology and 3Plastic and Reconstructive Surgery, Hacettepe University School of Medicine, 06100 Ankara, Turkey
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Abstract
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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.
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Introduction
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Chondroid syringoma is a rare, non-melanoma type of skin tumour that originates from the sweat glands, with reported incidence rates varying from 0.01% to 0.1% [1]. It demonstrates sweat gland features with a cartilage-like stroma [1]. Although its histological findings are well described, the radiological features of subcutaneous chondroid syringoma have been reported only on two cases [2, 3]. We report here MRI findings of a case with histologically proven subcutaneous chondroid syringoma.
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Case report
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A 53-year-old woman presented with a nodular subcutaneous mass, which had grown slowly during the last 4 years at the proximal right pretibial region. It was painless and mobile, but had grown rapidly and started to become firm and itchy with a purplish overlying skin in the last 4 months (Figure 1
). MRI was performed in a 0.5-T unit (Philips Gyroscan, Best, The Netherlands) with a dedicated extremity (knee) coil. Transverse T2 weighted (repetition time (TR): 4872 ms, echo time (TE): 100 ms, field of view (FOV): 21 cm), sagittal short tau inversion recovery (STIR) (TR: 1400 ms, TE: 30 ms, inversion time (TI): 120 ms, FOV: 22 cm), pre- and post-contrast sagittal T1 weighted (TR: 500 ms, TE: 20 ms, FOV: 22 cm), and transverse fat-saturated T1 weighted (TR: 525 ms, TE: 19 ms, FOV: 23 cm) MR images (Figure 2) revealed a 3 cm x 2.7 cm x 2 cm, well-circumscribed, lobular mass that enhanced diffusely after intravenous gadolinium administration (Figure 2c). The lesion demonstrated low signal intensity with a hyperintense focal nodular area anteriorly on T1 weighted images (Figure 2a), heterogeneous intensity with cystic areas on T2 weighted images and diffusely high signal intensity on STIR images (Figure 2b). No oedema was seen around the lesion. A wide excisional biopsy was performed and, on histological examination, the tumour was confined to the dermis and the subcutaneous tissue. It comprised multiple lobular structures and circumscribed by a fibrous capsule. The epithelial component was mixed with cartilaginous, fibrous and myxoid stroma. The epithelial cells were arranged as solid masses or formed tubular structures where two rows of cuboidal cells rimmed the tubular luminal surface (Figure 3). There were no atypical mitoses or necrosis. Mitoses were rare. The surgical bed was clear of any tumoural cells.
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Figure 2. (a) Sagittal T1 weighted image reveals a well-circumscribed hypointense lesion associated with a hyperintense focus (arrow) in its anterior aspect. (b) Sagittal short tau inversion recovery (STIR) image demonstrates a homogeneously hyperintense mass (arrow) featuring hypointense septa. (c) Transverse T1 weighted image with fat saturation after intravenous contrast administration displays a heterogeneous diffuse enhancement of the lesion (arrow).
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Figure 3. Photomicrograph shows a nodular neoplasm surrounded by a fibrous capsule(long white arrow), an epithelial component mixed with a basophilic cartilaginous component (short white arrow), and glandular structures (black arrow) (haematoxylin and eosin, x40).
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Discussion
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Skin tumours are classified as melanoma and non-melanoma types [2]. Chondroid syringoma, a non-melanoma type of skin tumour, is so rare that it is not in the usual list of radiological differential diagnoses of soft tissue tumours and is being diagnosed histologically [1, 2, 4]. Most chondroid syringomas are benign with a slow progression over years [5, 6].
Chondroid syringomas usually present as a solitary, asymptomatic subcutaneous nodule, mainly seen in males. The malignant tumours which are seen mostly in extremities and torso are also slowly growing nodules, but have a higher incidence in females like our patient [4, 7]. They infiltrate regional lymph nodes and metastasise to bones and visceral organs [1]. Such infiltration and metastases were not present in our case. Malignant lesions are usually larger than 3 cm, but there are also published benign cases that measure larger than 4 cm [5]. Rapid growth over a short time, as in our patient, is characteristic for malignant chondroid syringomas [4, 5, 7]. Interestingly, the mass in our patient was histologically benign.
Definitive diagnosis of chondroid syringomas is established with histological examination after total excision [1, 5]. Histological diagnosis is usually straightforward, although they can be misdiagnosed as dermoid, sebaceous cysts, neurofibromas and dermatofibromas, and basal cell carcinomas and squamous cell carcinomas [1, 2, 5].
Radiological features of chondroid syringomas are not as suggestive as the histological findings. Both of the two reported cases of chondroid syringomas in the literature, where radiological features were mentioned, had undergone MRI and one had additional radiographs and CT [2, 3]. One of the cases had a superficial chondroid syringoma like our patient [2], while the other had a deep soft tissue mass in the ankle [3]. The former, a palmar tumour, displayed intermediate signal intensity on proton-weighted MR images and high signal intensity with a heterogeneous appearance on T2 weighted images, associated with mainly high signal intensity interspersed with regions of intermediate signal on STIR sequence [2]; however, there was no mention of intravenous contrast administration for this patient. The latter case presented as a subfascial multilobulated ankle lesion, which demonstrated a hyperintense area displaying hypointense septa on T2 weighted images and inhomogeneous enhancement after intravenous contrast administration [3]. Obviously, these findings are not specific and can be seen in any kind of soft tissue tumour. Although MRI findings in our case resembled some of the features described in these patients, the presence of a focus of increased signal intensity on pre-contrast T1 weighted images was unique in our patient. This focus suggested the presence of melanin or haemorrhage within the lesion and a tentative diagnosis of a soft tissue sarcoma with melanocytic differentiation was made. Histological examination, however, did not disclose the presence of either melanin or a focus of haemorrhage.
MRI helped to visualize the borders and the extension of the lesion in our patient. Although the findings did not specify the diagnosis of chondroid syringoma, MRI is very helpful in visualizing the invasion of the tumour and the involvement of the deep structures [2]. Although, in retrospect, our case has presented with the suspicious findings for malignant behaviour such as tumour involvement of the lower extremity (pretibial region) and rapid growth, there was no histological evidence of vascular space invasion and lymph node infiltration. Still, we believe the gender of our patient and the location of the tumour necessitate the follow up of the case for an increased risk of recurrence and metastasis.
In conclusion, chondroid syringoma needs to be considered in the differential diagnosis of the lower extremity soft tissue masses despite its rare incidence. The features of our patient suggest that rapid growth over a short time does not necessarily imply a malignant histology. As is the case with many soft tissue tumours, unfortunately, MRI findings are not characteristic.
Received for publication June 9, 2005.
Revision received August 9, 2005.
Accepted for publication September 2, 2005.
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References
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- Yavuzer R, Basterzi Y, Sari A, Bir F, Sezer C. Chondroid syringoma: a diagnosis more frequent than expected. Dermatol Surg 2003;29:179–81.[CrossRef][Medline]
- Nicolaou S, Dubec JJ, Munk PL, O'Connell JX, Lee MJ. Malignant chondroid syringoma of the skin: magnetic resonance imaging features. Australas Radiol 2001;45:240–3.[CrossRef][Medline]
- Adachi T, Oda Y, Sakamoto A, Saito T, Tamiya S, Hachitanda Y, et al. Mixed tumor of deep soft tissue. Pathol Intern 2003;53:35–9.
- Sheikh SS, Pennanen M, Montgomery E. Benign chondroid syringoma: report of a case clinically mimicking a malignant neoplasm. J Surg Oncol 2000;73:228–30.[CrossRef][Medline]
- Sungur N, Uysal A, Gumus M, Kocer U. An unusual chondroid syringoma. Dermatol Surg 2003;29:977–9.[CrossRef][Medline]
- Terrill RQ, Groves RJ, Cohen BM. Two cases of chondroid syringoma of the hand. J Hand Surg (Am) 1987;12:1094–7.
- Barnett MD, Wallack MK, Zuretti A, Mesai L, Emery RS, Berson AM. Recurrent malignant chondroid syringoma of the foot: a case report and review of the literature. Am J Clin Oncol 2000;23:227–32.[Medline]
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Abstract
Introduction
