It comes in threes: A case of syringocystadenoma papilliferum associated with tubular apocrine adenoma and verruca in the axilla of a Filipino female

Authors: Maria Franchesca S. Quinio, MD, DPDS, Georgina C. Pastorfide, MD, FPDS, Marie Len A. Camaclang, MD

Abstract

Introduction: Syringocystoadenoma papilliferum (SCAP) is a benign adnexal tumor usually located in head and neck. The occurrence of SCAP in the axilla is uncommon. The occurrence of SCAP coexisting with two other histopathological types of tumors in one cutaneous lesion is unusual.  We presented the case of a syringocystoadema papilliferum associated with tubular apocrine adenoma (TAA) and verruca.

Case Summary: A 27-year-old Filipino female presented with a warty tumor on the left axilla. The lesion first appeared seven years ago as an acne-like papule that increased in size over the years. Physical examination revealed a solitary,  2.0 by 1.5 cm sized flesh-colored, fungating tumor with verrucous surface on the left axilla. An excision biopsy was done and the histopathologic examination revealed three distinctly different zones: the upper portion showed cystic invagination that extended downward from the epidermis composed of two layers of cells, while the dermal part of the tumor consisted of tubulo-glandular structures.  Our case showed the characteristic features of SCAP in the upper portion and TAA in the lower portion of the tumor. Furthermore,  papillary epidermal hyperplasia with koilocytes in the granular cell layer were noted suggesting a Human Papilloma Virus (HPV) infection.

Conclusion: We highlight the rare association of three different types of tumors occurring in one lesion and the atypical location of SCAP. Some investigators theorized SCAP and TAA might develop from pleuripotent appendegeal cells since they originate from eccrine and apocrine elements. Also, the association of SCAP with HPV infection needs further investigation.

 

Citation

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Keywords

syringocystoadema papilliferum, tubular apocrine adenoma, verruca

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