British Journal of Ophthalmology, 1986, 70, 580-583

Eccrine spiradenoma of eyelid: case report

B K AHLUWALIA,l A K KHURANA,' A D CHUGH,' and V G MEHTANI2

From the Departments of'Ophthalmology and 2Pathology Medical College and Hospital, Rohtak, India

SUMMARY A case report is presented of eccrine spiradenoma, a benign sweat gland tumour which,though not uncommon generally, is rare in the eyelid. The possibility of sweat gland tumour shouldbe kept in mind in the diagnosis of eyelid tumours.

The eccrine spiradenoma is a benign neoplasm of theskin first described by Kersting and Helwig,' whoconsidered it to be a derivative of eccrine sweatglands. It usually presents as a solitary, intradermal,and painful nodule, the commonest sites being thechest and face.' In the available literature we couldfind no case of eccrine spiradenoma of the eyelids.The following case report may therefore be the firstfrom India.

Case report

A 55-year-old female presented in June 1984 with anodule in left upper lid for the last two and a halfyears, which had been gradually increasing in size. Ithad ulcerated six months previously, causing painand bleeding. The swelling measured 2.4 x 2 x 1.2cm and involved lateral half of the left upper lid (Fig.1). The growth was firm to hard in consistency andtender to touch. In an area 1 cm x 0-6 cm near the lidmargin, including anterior half of the lid margin, theswelling was ulcerated. The margins of the ulcer wereundermined, and the floor showed healthy granula-tion tissue.An ophthalmic examination revealed nothing

abnormal except for early lenticular opacities, andthe patient's vision was 6/18 in both the eyes. Ageneral physical examina,tion also showed nothingabnormal. There was no enlargement of auricular,cervical, or submandibular lymph nodes; the liverand lungs were normal.

Clinically an epithelioma of the eye lid was sus-pected, and a full-thickness wide excision of the leftupper eyelid including the growth was carried out

Correspondence to Dr A K Khurana, 354 Housing Board Colony,Rohtak-12 4001, India.

under local anaesthesia. Reconstruction of the upperlid was from a lower lid flap by the techniquesuggested by Cutler and Beard.2 Figs 2 and 3 a, bshow the first and second stages of the reconstructionoperation.

BIOPSY REPORTGross description. The specimen submitted to thepathology department comprised a portion of excisedlid and surrounding soft tissues measuring together3-0 x 2.5 x 1-4 cm. The overlying skin revealed anulcer which measured 1-0 cm x 0-5 cm and was skinthickness deep. On palpation a mass could be feltbeneath the skin. Bisection revealed a lobulatedand circumscribed tumour underneath skin whichmeasured 2*2 x 1.8 x 1 cm. It was grey-white, firm,and had a rubbery surface.

Microscopic description (Figs 4 and 5). Sectionsstained with haematoxylin and eosin showed atumour comprising lobules of various sizes in thecorium. It had a sharply contrasting deep basophilia

Fig. 1 Eccrine spiradenoma of left upper eyelid cliniresembling squamous cell epithelioma.

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Fig. 2 FirststageofCutler-Beard pro- Figs. 3 a, b Six weeks after thesecond stage ofreconstruction procedure with eyescedurefor upper eyelid reconstruction. open (a) and closed (b).

and did not connect with the overlying epidermis.The surrounding connective tissue was normal.The parenchymal tumour cells were of two types,arranged mostly in cords, whorls, and pseudo-glandular formation. Cells of one type were large,light staining, closely packed, and at places sur-rounding a central lumen. Cells of the other typewere small with compact nuclei, and mainly arrangedat the periphery. In general there was insignificantinflammatory reaction within the tumour and thesurrounding tissues, but in the area immediatelybeside and below the ulcer an extensive mononuclearcell infiltrate was noted. The histopathology wassuggestive of eccrine spiradenoma.

Fi1g. 4 1 umour lobules present in the corium, with sharplycontrasting deep basophilia (H-E, x 80).

Discussion

Tumours arising from the sweat apparatus of theeyelid are uncommon, and the differences in theirstructure have given rise to much confusion. A widevariety of descriptive terms have been applied tothem.'3 Histologically there are two subdivisions ofthe sweat glands-eccrine and apocrine. Eccrineglands are present throughout the skin but are mostabundant in the palms, soles, and axillae. In theeyelid they are present both at the lid margin and inthe dermis over the surface of the eyelid. On theother hand apocrine glands are found in only a fewareas, mainly the axillae, round the nipples, andin the anogenital region, with occasionally a few onthe abdomen and chest. Apart from these they arepresent as modified glands in the eyelids, breast, andexternal ear canal, where they are known as Moll'sglands, mammary glands, and ceruminous glandsrespectively. Kersting and Helwig' enumerated sixsweat gland tumours without further grouping themaccording to type or portion of the sweat apparatusinvolved or the nature of the proliferation. In accord-ance with the nature of the growth Lever4 classifiedsweat gland tumours into four groups-hamartomas,adenomas, benign epitheliomas, and primary epi-theliomas-but without taking account of part of thesweat apparatus involved. This was considered byAllen,' who divided these tumours into two groups-ductal (syringal) and glandular. These were furtherdivided by eccrine and apocrine differentiation. Theeccrine spiradenoma falls into the category of benignepitheliomas according to the classification of Lever4and is ductal in origin, being also termed a lobularsyringoma.Whatever classification or nomenclature is

adopted, eccrine spiradenoma remains an estab-lished clinicopathological entity with a distinct histo-logical appearance. However, the possibility of aprimary basal cell epithelioma with eccrine differ-entiation and a lobular, hyalinised syringoma(cylindroma) should be included in the histologicaldifferential diagnosis. The former is identified by a

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B KAhluwalia, A K Khurana, A D Chugh and VG Mehtani

Fig. 5 Tumour parenchymaunder higher magnification. Largerlightly staining cells are closelypacked and appear to surround acentral lumen (left upper corner).In contrast (right side) smaller cellshave compact nuclei and arepresentat the periphery (H-E, x 650).

rim of basal cells arranged neatly in a radial patternstrongly reminiscent of the more or less verticallyarranged basal cells forming the lowermost layer ofthe normal epidermis. The latter is characterisedby conspicuous hyalinised bands of collagen sur-rounding and intertwining among the lobules and itscells.None of these features was seen in the present

tumour, which comprised lobules of variable sizeshaving sharply contrasting basophilia and two typesof tumour cells-one large light staining and closelypacked, the other with compact nuclei arrangedmostly at the periphery. In our case the microscopicalpicture is consistent with those described by otherauthors.' Munger et al.6 confirmed the eccrineorigin after an electron microscopy of a tumourhaving a similar light microscopic appearance.

Histochemistry and electron microscopy offer sup-plementary information. However, the criteria thatappear to be decisive in differentiating the normalstructures of the sweat apparatus are apparently notalways applicable to neoplasms. In general, amylo-phorylase, branching enzyme, succinic dehydro-genase, and leucine aminopeptidase are regarded asindicative of eccrine ducts and glands, whereas acidphosphatase and P-glucuronidase are stated to becharacteristic of apocrine glands.5 Yet cylindroma,which is clearly of eccrine origin, has been foundhistochemically by some investigators4 to suggest anapocrine origin.

Kersting and Helwig' and Munger et al.6 state thateccrine spiradenoma usually presents as a solitaryintracutaneous nodule, often tender to touch, but

occasionally there may be multiple tumours. In ourcase the clinical presentation as an ulcerated growthis quite different from the description of otherworkers.'6 Consequently a clinical diagnosis ofsquamous cell epithelioma (a common tumour of thelid margin) was made.Many classical cases of eccnne spiradenoma have

been reported. I" However, none of these authorsreported involvement of eyelids. Even Kersting andHelwig,' who showed eccrine spiradenoma to be adistinct clinicopathological entity in a series of 134cases, did not find a single tumour arising from theeyelid. However, certain other types of sweat glandtumours, such as porosyringoma7 and clear cell hidra-denoma or myoepithelioma,69 have been reported inrelation to eyelids. The rarity of the eccrine spira-denoma at that site made the present case worthreporting.

References

1 Kersting DW, Helwig EB. Eccrine spiradenoma. Arch Dermatol1956;73:199-227.

2 Cutler NL, Beard C. Reconstruction of upper lid. Am J Ophthal-mol 1955;39:1-7.

3 Duke-Elder S. System of ophthalmology. London: Kimpton,1974;13(1):458-63.

4 Lever WF. Myoepithelial sweat gland tumour, myoepithelioma:report of three cases with review of literture. Arch Dermatol1943;5:332-47.

5 Allen AC. Skin. In: Anderson WAD, Kissene JM, eds. Patho-logy. St Louis: Mosby, 1977:1866-70.

6 Munger BL, Bergham BM, Helwig EB. A light and electron-microscopic study of a case of multiple eccrine spiradenoma. JInvest Dermatol 1962;38:289-97.

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7 Tulman CS, Jack MK. Porosyringoma: report of a case. Am J 9 Liv Y. Histogenesis of clear cell papillary carcinoma of skin. AmJOphthalmol 1965;60:1116-21. Pathol 1949;25:93-103.

8 Boniuk M, Halpert B. Clear cell hidradenoma or myoepitheliomaof the eye lid. Arch Ophthalmol 1964;72:59-63. Acceptedforpublication 28 November 1985.

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