British Journal of Radiology (2007) 80, e27-e29
© 2007 British Institute of Radiology
doi: 10.1259/bjr/55828940
MRI appearance of multiple eccrine spiradenoma
Y-D Han, MD
1
Y Huan, MD
1
J-L Deng, MD
2
Y-G Zhang, MD
3 and
C H-S Zhang, MD
4
Departments of 1Radiology, 2Nuclear Medicine and 4Pathology, Xijing Hospital, Xi'an, 710032 and 3Department of Dermatology, Tangdu Hospital, Xi'an, PR China
Correspondence: Mr Yue-Dong Han, Department of Radiology, Xijing Hospital, Xi'an, 710032, PR China. E-mail: Hanyuedong{at}126.com
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Abstract
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Multiple eccrine spiradenoma is one of the rarest tumours of the sweat gland. We report a case of multiple eccrine spiradenoma that was distributed in several parts of the body. On MRI the lesions presented with multiple dispersive foci with clear circumferences in the cutis and the subcutaneous tissue. The lesions showed low signal intensity on T1 weighted images, and high signal intensity on short tau inversion recovery images. Although the signal intensities of the lesions were not characteristic in this patient, multiple eccrine spiradenoma should be included in the differential diagnosis of the lesions in the cutis and the subcutaneous tissue.
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Introduction
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Eccrine spiradenoma is a rare tumour of the sweat gland. It is usually solitary and small in the cutis and the subcutaneous tissue. As with other lesions in the cutis and the subcutaneous tissue, few cases describing the imaging findings of eccrine spiradenoma have been reported. We report the MR findings in a case of multiple eccrine spiradenoma which distributed in several parts of the body.
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Case report
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A 24-year-old woman presented with a 12-year history of extensively painless lesions that occurred in a zosteriform distribution in the regions of the bilateral face, neck, upper limbs, left trunk and thigh. During the past several years, the number and the size of the lesions increased gradually, and some of them grew into small masses. At physical examination, the soft nodules measuring 0.3 cm
2 cm were palpated on the above areas. MRI revealed extensive nodules in the cutis and subcutaneous tissue of these areas. The lesions, scattered, with some of them clustered, were separated from each other with relatively clear margination. They showed low signal intensity (Figure 1a
) on T1 weighted images (repetition time (TR)/echo time (TE) 500/14), and high signal intensity (Figure 1b,c) on short tau inversion recovery images (STIR, TR/TE/inversion time (TI), 2500/40/160).
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Figure 1. A 24-year-old woman with 12-year history of painless papules in the bilateral upper limbs, face, neck, left thorax and thigh. (a) Transverse T1 weighted MR image (repetition time (TR)/echo time (TE), 500/14) of the upper neck shows diffuse lesions (arrow) with low signal intensity in dermis and subcutaneous tissue. (b) Transverse short tau inversion recovery (STIR, TR/TE/inversion time (TI), 2500/40/160) image of the upper neck shows diffuse lesions (arrow) with high signal intensity in dermis and subcutaneous tissue. (c) Coronal STIR (TR/TE/TI, 2500/40/160) image of the left thorax and limb shows diffuse lesions (arrow) with high signal intensity in dermis and subcutaneous tissue.
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Multiple eccrine spiradenoma was suspected and then it was confirmed by biopsy and pathology. Microscopically, a collagenous pseudocapsule was observed. The tumour was mainly composed of small dark cells with high-density cytoplasm and large clear cells with low-density cytoplasm (Figure 2). The final histological diagnosis was benign multiple eccrine spiradenoma.
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Figure 2. A 24-year-old woman with 12-year history of painless papules in the bilateral upper limbs, face, neck, left thorax and thigh. Photomicrograph (original magnification, x200, haematoxylin-eosin stain) shows a characteristic biphasic population of an outer rim of small cells with darkly staining nuclei surrounding larger cells with pale cytoplasm.
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Discussion
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Eccrine spiradenoma is a benign tumour of the sweat gland typically located in the superficial and deep cutis, occasionally in the subcutaneous tissue. The tumour arises from eccrine glands, a type of sweat gland that is distributed throughout the body [1]. Clinically, the lesion is often a solitary nodule that can be as large as 5 cm. The type with multiple nodules is very rare and the masses may present in a linear pattern, or a zosteriform [2–4]. The tumour, which is usually covered by normal or blue epidermis, usually occurs in patients aged 20–40 years, with men and women being equally affected [1, 4]. It has a predilection for developing in the upper thorax, but has also been described as a tumour occurring elsewhere in the body, such as scalp, shoulder and face [1]. Malignant variants are rare [5, 6]. Although the diagnosis of eccrine spiradenoma can be suggested based upon the clinical findings above, biopsy should still be performed in order to achieve a final pathological result [1–6].
Histologically, eccrine spiradenoma locates in the cutis and subcutaneous tissue with clear margination. The tumour is highly cellular and composed of two cell types: small darkly staining basaloid cells and larger, pale cells. Ultrastructural observations often showed an intracellular lumen with numerous microvilli in larger pale-staining cells [1].
MRI is a non-invasive method for evaluating the cutis and subcutaneous diseases [7–11]. The skin fat layers beneath the cutis and down to the level of muscles, which are usually useful in depicting the pathology, can be well visualized in the images [7–11]. The MRI demonstration of sweat gland tumours has previously been reported as a subcutaneous cystic mass or a solid nodule, which was localized with low signal intensity on T1 weighted images and high, or occasionally intermediate to high, signal intensity on T2 weighted and STIR images [8, 10–13]. In our patient, however, the lesions were diffusely located in several parts of the body. Not only did the clinical extent of the multiple tumours correspond well with that on MRI, but also more lesions were demonstrated on MRI than were clinically detected as the lesions in the subcutaneous tissue could be clearly delineated. The signal intensities of the lesions might be the result of the large clear cells with low-density cytoplasm and abundant capillaries. To the best of our knowledge, this is the first MR report of multiple eccrine spiradenoma. Although the signal intensities of the lesions were not characteristic, just as those reported in earlier studies, the extent and depth of the tumour invasion, which are complementary to clinical staging, can be clearly depicted on MRI [8, 11–13]. Besides eccrine spiradenoma, the possibility of other lesions should also be considered in the differential diagnosis of the multiple cutaneous and subcutaneous masses. For example, superficial neurofibromas, which are common in neurofibromatosis 1 (NF1) and usually involve the subcutaneous tissue down to the level of fascia, tend to be asymmetric and classically appear as discrete nodules or fascicular masses that sometimes demonstrate target like signal intensity [14, 15].
Close follow-up is recommended because malignant eccrine spiradenoma almost always arises from a long-standing benign cutaneous lesion [6, 16, 17]. So far, there is still no MR report of the malignant transformation of a benign eccrine spiradenoma or malignant eccrine spiradenoma, which usually behaves in an aggressive fashion [6, 16]. However, the use of MRI might be helpful in the follow-up of the lesions, especially the deep masses and their target biopsy to the most suspicious malignancies. In this aspect, MRI is superior to other imaging such as ultrasound in that the soft tissue contrast resolution of the former is higher than the others.
Eccrine spiradenoma is a benign skin adnexal neoplasm. The choice of treatment is relatively easy for a solitary mass which can be completely resected, whereas it is very difficult for the multiple nodules distributed throughout the body [1–4]. In our patient, radiation therapy was performed once on some areas of the lesions, but no marked efficacy was achieved. It was therefore stopped for fear that additional injury occur in the course of treatment of so many lesions. After 15 months of follow-up, there has been no evidence of malignant transformation. Although the prognosis of patients is generally good, malignant transformation of a benign eccrine spiradenoma can occur in a few of the tumours, and some of them can lead to the patient's death [6, 16, 17].
Received for publication September 13, 2005.
Revision received February 4, 2006.
Accepted for publication March 6, 2006.
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Abstract
Introduction
