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Secondary malignancies are an important cause of morbidity and mortality in childhood cancer survivors. Salivary gland tumors account for about 6% of the second cancers. The majority of these are mucoepidermoid carcinomas (MEC) of the parotid gland. We report the clinical and pathological features of a rarer histological type, acinic cell carcinoma (ACC), in a childhood acute lymphoblastic leukemia (ALL) survivor. The behavior of secondary ACC appears similar to primary tumor and similar treatment may be adopted. Early recognition and complete resection is important for achieving a good outcome. Careful monitoring for recurrence or a third malignancy is needed., ((c) 2007 Wiley-Liss, Inc.)

Eccrine syringofibroadenoma of Mascaro is a rare benign tumour. There are five subtypes, one of which is known to occur in reaction to inflammatory and neoplastic dermatoses. We describe a patient with previous lepromatous leprosy presenting with multiple flesh-coloured verrucous plaques over the right foot. Histology was consistent with eccrine syringofibroadenoma. To our knowledge, this is the first reported case of multiple eccrine syringofibroadenomata occurring in association with leprosy. The tumours in this case are most likely reactive in nature, subsequent to multiple traumatic events with tissue remodelling in an insensate foot affected by leprosy. It is less probable that the tumours are a result of scarring from recurrent infections. We also raise the possibility of a neuroeccrine interaction, with sympathetic neuropathy in leprosy as a contributing factor in the pathogenesis.

Poroid hidradenoma (PH), a less common subtype of poroid neoplasm (PN) than eccrine poroma (EP), has not been immunohistochemically studied before. Six cases of PH (four solitary PH and two PH coexisted with other types of PN) were included in the study. Fifteen cases of EP were also included for comparison. Hematoxylin and eosin, Masson-Zimmerman silver stain, and a variety of immunohistochemical stains were used. Microscopically, PH is not connected to the epidermis. All six PH contained small poroid cells and larger, paler cuticular cells. Some PH showed separate or clusters of sebocytes (2/6), horn cysts (1/6), juxtaposed lymphoid follicles in the stroma (1/6) and foci of keratohyaline granules (2/6), none of which was seen in the 15 EP. Immunohistochemically, the keratin distribution of PH was very similar to that of EP. PH has a very small number of Langerhans cells (significantly lower than the overlying epidermis, P=0.045), and a sparse deposition of melanin. We conclude that except the location, the histopathological and immunochemical differences between PH and EP were small. Sebaceous differentiation in two PH lesions suggested the possibility of an apocrine origin. The deeper parts of eccrine apparatus other than basaloid cells may have been more actively involved in the histogenesis of PH.

A 72-year-old woman with a burn scar on the calves of both legs developed an ulcer on her right heel, surrounded by multiple verrucous nodules and plaques. She had experienced similar verrucous lesions on both legs in the burn scar areas. Although the clinical diagnosis was Marjolin's ulcer, histologically the ulcer region showed thick fibrous tissue without any atypical epithelial cells. The verrucous lesions were consistent with the diagnosis of eccrine syringofibroadenoma (ESFA). Moreover, an ESFA-like growth pattern was seen in the elevated margin of the ulcer. Our findings suggest that these lesions developed as a result of reactive eccrine duct hyperplasia followed by skin tissue remodelling.

Nevus sebaceus (NS) of Jadassohn is usually a verrucous plaque on the scalp or face that arises secondary to disordered development of epithelial, pilar, sebaceous, and apocrine structures. The emergence of neoplasia is a late stage in the natural history of NS. Although most neoplastic proliferations are benign, several malignant tumors have arisen in this lesion. We describe the first case of a benign spiradenoma arising in an NS on the scalp in a 72-year-old Caucasian woman. Reexcision was recommended to prevent the development of a second neoplastic process and to avoid the rare occurrence of a malignant transformation of the existing neoplasia. The patient declined reexcision and remains under observation. The spectrum of tumors arising in NS are described and are categorized according to behavior. Syringocystadenoma papilliferum is the most commonly observed benign growth, whereas basal cell carcinoma is the most frequently seen malignant process. The signs of tumor development (benign or malignant) within an NS are reviewed, and treatment recommendations are provided. The clinical course of rare and unique aggressive neoplasms originating in NS is summarized.

Tubulopapillary hidradenoma is a benign sweat gland tumor that appears as a well-defined, superficially located dermal nodule. It combines ductal as well as apocrine and eccrine glandular differentiation. Microscopically, the tumor is composed of tubular structures that characteristically show intraluminal non-villous papillary projections and a peripheral myoepithelial cell layer. A tumor that is histologically and immunohistochemically identical to tubulopapillary hidradenoma occurred in the mandible of a 73-year-old man and resulted in considerable diagnostic difficulty. The neoplasm developed in a mandibular cyst and recurred 5 years after initial enucleation. This is the first report of a central (intraosseous) sweat gland adenoma of the mandible. The differential diagnosis and possible histogenesis are discussed.

We describe a patient who developed a porocarcinoma in the nail bed. His profession had exposed him to X-rays for many years, resulting in chronic radiodermatitis of several digits on both hands. He displayed an ulcer in the lateral nail fold of the right third digit which extended into the nail bed. The histology of the lesion was consistent with malignant eccrine poroma. Porocarcinoma has not been previously published in this location and this tumor must be considered in differential diagnosis of subungual malignant tumors.

A case of some neoplastic lesions of the skin of the back, arisen on undamaged skin, in a patient who underwent therapeutic pneumothorax and was submitted to several fluoroscopic examinations for pulmonary tuberculosis many years ago, is reported and discussed. An attempt of evaluation of the exposure to the ionizing radiations received by the interscapular region of the patient is made. The malignant clear-cell hidradenoma is a very rarely observed carcinoma: nine cases have been so far described.

Clinico-morphological characteristics of 105 acrospiromas surgically removed within 10 last years is presented. In 6 patients the tumour was considered as a malignant acrospiroma which, according to the literature and the authors' material, is prone to recurrence. The features of a diagnostic significance are discussed in detail: the development of tumour in the cyst, growth of squamous cells and clear (due to the glycogen) cells, formation of structures resembling the sweat glands ducts. Electron-microscopic examination indicates the histogenetic link of acrospiroma with the elements of sweat gland ducts (intracytoplasmic ducts, periluminal cells, the lack of clear signs of secretion). All this relates also to the tumour described in the literature as a clear-cell hydradenoma.

A 70-year-old white man developed 7 eccrine poromas in an area of chronic radiation dermatitis of his right lower extremity over a period of 37 years. To our knowledge, multiple eccrine poromas unequivocally linked to chronic X-ray damage are hitherto unreported.