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Spiradenocarcinoma, or malignant eccrine spiradenoma (MES), is a rare sweat gland tumor originating from eccrine sweat glands. To the best of our knowledge, only two cases of MES of the external auditory canal have been reported to date. Here, we report a third case of MES located in the external auditory canal.

Background: Malignant eccrine spiradenoma is one of the rarest sweat-gland tumors. Here, we describe a rare case of low grade malignant eccrine spiradenoma located at the vulva. Case presentation: The vulvar lesion was described as a mass measured 3.5 cm and located in the dermis and subcutis with no attachment to the epidermis. The neoplasm was arranged in ragged sheets or solid nodules sometimes with focal necrosis. The tumor cells had hyperchromatism, pleomorphism, and prominent nucleoli with high mitotic index and KI-67 estimated at 70-80%. Conclusions: It's only the fifth case of malignant eccrine spiradenoma localized at the vulva. This is the first time that an HPV genotyping was made in this type of lesion with no HPV found while the p16 expression was diffuse. Moreover, it's the first time that a p53 mutation is detected by sequencing in this location., SCOPUS: ar.j, info:eu-repo/semantics/published

Malignant eccrine spiradenomas are exceedingly rare and aggressive tumours normally arising in long-standing benign eccrine spiradenomas. We present a case of malignant eccrine spiradenoma (MES) that was initially misdiagnosed as carcinoma of unknown origin in spite of extensive workup to look for primary and presented with a large exophytic tumour on the right side of his chest wall, which had fungated. Radiological imaging of the chest region revealed extensive involvement of the local tissues. Patient underwent wide local excision with a 1 cm margin along with right-sided axillary lymph node dissection. Histopathological findings were consistent with MES with tumour deposits in multiple lymph nodes in the axilla. Our case report shows MES is a rare and aggressive cancer, which is difficult to diagnose, highly aggressive with propensity to involve the lymph nodes. May present with local recurrence and also develop distant metastases significantly compromise the quality of life of the patient. It requires the surgeons to have a high index of suspicion for its initial diagnosis, and a multidisciplinary management with surgery, radiotherapy, and chemotherapy is required for complete treatment and needs close follow up.

Malignant eccrine spiradenoma is an extremely rare skin tumor of sweat gland origin. In most cases, it arises in pre-existing benign eccrine spiradenoma. We report an additional case of malignant eccrine spiradenoma. The present case is of a 75-year-old man with malignant eccrine spiradenoma developed in the right shoulder. He had a 6-year history of a recurrent mass that was removed 2 years ago. The patient then underwent a complete excision. The gross pathologic specimen showed a large cutaneous and subcutaneous multinodular tumor, measuring 6 cm in maximal dimension. Microscopically, there were two distinct morphological components: a benign eccrine spiradenoma and a malignant eccrine spiradenoma of low grade with extensive necrosis. Different histologic patterns were observed such as cylindromatous features. Morphological differentiation in malignant eccrine spiradenoma is variable, sometimes with almost complete loss of eccrine differentiation. Extensive sampling to look for a probable previously benign component is necessary. In the other hand, malignant changes can be easily missed without adequate sampling.

Malignant eccrine spiradenoma (MES) is an extremely rare cutaneous malignant tumour. An 86-year-old man presented at our hospital with an enlarging tumour on the dorsum of the left hand. An excisional biopsy was taken and histological examination showed a solid island of cells of two distinct types: cells with abundant cytoplasm and oval vesicular nuclei, and small round cells with less cytoplasm and hyperchromatic nuclei with a high frequency of mitosis. We diagnosed this tumour as MES. Although we did not perform further treatment because of the patient's age, there was no sign of recurrence or metastasis in the 2 years of follow-up after excisional biopsy. We reviewed cases of malignant eccrine spiradenoma in the English and Japanese literature and found that 'sarcomatous' or 'squamous' change in histopathology was significantly correlated with a poorer prognosis. It is therefore important for treatment planning to evaluate the entire specimen histologically.

Malignant eccrine spiradenoma is a rare neoplasm generally arising from long-standing benign eccrine spiradenomas; it is rarely seen on the scalp. A 27-year-old woman with a malignant eccrine spiradenoma of the scalp, which had occurred 8 months after the inadequate excision of a benign eccrine spiradenoma, was treated at our hospital. The patient underwent lymphoscintigraphy. A biopsy of the sentinel lymph nodes in the right periparotid and left occipital regions was performed, and the nodes showed no metastases. The tumor with its large subcutaneous extension and the outer table of the cranium were removed. A split-thickness skin graft was applied on the exposed inner table. At 24 months' follow-up, there has been no tumor recurrence. We report a case of a malignant eccrine spiradenoma of the scalp with cranial involvement that arose from an inadequately removed, long-standing, benign eccrine spiradenoma in a young patient. Also, we review the existing literature on malignant eccrine spiradenoma of the scalp.

53歳の男性。約1年前，右鼠径部の皮下腫瘤に気づいた。表面の皮膚に変化無く，大きさも変わらないことより放置していた。近医にて切除され，malignant eccrine spiradenomaと診断され，当科紹介受診となり，入院となった。病理組織学的所見は，真皮内から皮下脂肪織にかけて限局性に腫瘍細胞の増殖を認め，索状・胞巣状に配列していた。腫瘍細胞はtwo-cell patternを示し，小型のbasaloid cellと大型の胞体の明るい細胞が混在していた。また良性のeccrine spiradenomaと考えられる成分は認められず，管腔構造が散見され，異常核分裂像も認められた。鑑別すべき疾患としてcylindrocarcinomaや原発性あるいは転移性のadenoid cystic carcinomaがあげられたが，発生部位や腫瘍胞巣周囲にヒアリン膜が見られないこと，免疫組織化学染色によりEMA，CEAが陰性であること，胸部X線，CTを含む全身検索の結果から否定され，malignant eccrine spiradenomaと診断した。治療は腫瘍拡大切除，右浅鼠径リンパ節郭清を同時に施行した。術後4年経過した現在，新たな再発，転移は認めていない。本邦報告例を集計し，考察を加えた。

Eccrine spiroadenocarcinoma is an extremely rare malignant eccrine gland tumor which may masquerade as other more common malignancies such as poorly differentiated squamous carcinoma or metastatic breast cancer. We report a case of an ulcerated axillary skin lesion with bulky adenopathy in a 77 year-old female with a prior history of ipsilateral triple negative breast carcinoma. The clear transition of benign spiradenoma to malignant carcinoma was essential to establishing a definitive diagnosis and treatment plan.

Ekrin spiradenoma ter bezi kökenli benign bir tümördür. Malign ekrin spiradenoma neredeyse daima daha önceden var olan bir spiradenoma lezyonundan gelişen nadir bir neoplazmdır. Bu yazıda daha önce benign ekrin spiradenoma tanısı konulmuş, dış kulak malign ekrin spiradenoması olan bir hasta sunuldu. Malign dönüşüm genellikle saldırgan davranış ile ilişkilendirilse de geniş eksizyon sonrası dört yıllık takipte nüks ve metastaz tespit edilmedi. Eccrine spiradenoma is a benign tumor of sweat gland origin. Malignant eccrine spiradenoma is a rare neoplasm which almost always arises from a pre-existing spiradenoma lesion. In this article, we present a patient with malignant eccrine spiradenoma of the auricula with a prior diagnosis as benign eccrine spiradenoma. Although malignant transformation is usually associated with aggressive behavior, we did not detect recurrence or metastasis in four years of follow-up after performing wide excision.

Malignant eccrine spiradenoma, or spiradenocarcinoma, is an exceedingly rare sweat-gland tumor, with only 102 reported cases. Low-grade carcinomas are especially rare with only a few cases reported. Because of the limited number of case reports, the biologic behavior of low-grade malignant eccrine spiradenoma is poorly understood and no evidence-based therapeutic approach is established. Here, the authors report a 29-year-old woman who presented with a history of left-sided facial lesions present since the age of 2 months. Histopathologic examination revealed multiple benign spiradenomas, several of which showed foci of low-grade malignant transformation evidenced by loss of the characteristic 2-cell population seen in the benign tumor component. Included are the clinical presentation, histopathologic description, and surgical decision making in an effort to guide recognition of this rare entity.

Malignant eccrine spiradenoma (MES) is an extremely rare aggressive tumor, firstly reported in 1972 by Dabska that can occur de novo or more commonly arise on a preexisting often long-standing eccrine spiradenoma. The latency period before malignant transformation ranges from 6 months to 70 years. To date, about 102 cases have been reported, mostly as single case report.

Cilj: Cilj je ovog rada prikazati slučaj vrlo rijetkog malignog tumora glave i vrata – malignog ekrinog spiradenoma, opisati kliničke i patohistološke karakteristike tumora, važnost rane dijagnoze s obzirom na konačni ishod te metode liječenja. Prikaz slučaja: U radu je opisan slučaj 46-godišnje pacijentice kojoj je dijagnosticiran hemangiom lijeve strane vrata te se 25 godina kontrolirala. Nekoliko mjeseci prije javljanja na Kliniku tvorba se naglo počela mijenjati. Na temelju ultrazvuka vrata, citopunkcije, magnetske rezonancije vrata i biopsije postavljena je sumnja na metastazu nepoznatog primarnog tumora. PET/CT-om nije otkriveno sijelo primarnog tumora te je tek kirurškim zahvatom i patohistološkom verifikacijom operacijskog preparata utvrđena definitivna dijagnoza malignog ekrinog spiradenima s metastazom u jednom regionalnom limfnom čvoru vrata. Pacijentica je poslijeoperacijski tretirana radiokemoterapijom. Šest mjeseci nakon liječenja utvrđene su multiple metastaze pluća, pleure, medijastinuma i jetre, pa je 3 mjeseca kasnije nastupio smrtni ishod. Rasprava i zaključak: U većini slučajeva ovaj rijedak tumor nastaje malignom transformacijom benignog ekrinog spiradenoma, premda može nastati i de novo. Rijetko se javlja u regiji glave i vrata. Dijagnoza se temelji na patohistološkom nalazu. Tumor pokazuje veliku sklonost lokalnim recidivima te regionalnim i udaljenim metastazama kada je prognoza loša. Liječenje je prvenstveno kirurško, dok je učinak radiokemoterapije upitan. Važno je bolest dijagnosticirati u ra- noj fazi, kada ne postoji regionalna i udaljena proširenost jer je tada stopa izlječenja vrlo visoka., Aim: To present a case of a very rare malignant head and neck tumor – malignant eccrine spiradenoma, describe the clinical and pathological characteristics of the tumor, as well as the importance of early diagnosis with respect to the ultimate outcome of these treatments. Case report: This paper describes the case of a 46-year-old patient who was di- agnosed with hemangioma of the left side of the neck, and was followed for 25 years. Few months before the patient came to the Clinic, the lesion suddenly began to change. Based on the neck ultrasound, fine-needle cytopuncture, MRI and biopsy a suspicion on a metastasis of unknown primary tumor was established. PET / CT has not discovered the location of the primary tumor and only surgery and histopathologic verification of operating sample established the definitive diagnosis of malignant eccrine spiradenoma with metastasis in a single regional lymph node. The patient was treated with postoperative radio- and chemotherapy. Six months after the treatment, multiple metastases of the lung, pleura, mediastinum, and liver were found and 3 months later fatal outcome occurred. Discussion and conclusion: In the majority of cases this rare tumor is caused by malignant transformation of benign eccrine spiradenoma, although it can appear de novo. It rarely occurs in the head and neck region. Diagnosis is based on pathohistological findings. The tumor shows a strong preference to local and regional recurrence and to distant metastases, the prognosis of which is poor. It is important to diagnose the disease at an early stage when there is no regional or distant spread because at that stage the survival rate is very high.

extremely rare sweat-gland tumour. Herein we aimed to present an 81-yearold woman with malignant eccrine spiradenoma repeated on the thigh and metachronous lung cancer. She presented with a palpable swelling in the right thigh region. Her systemic screening was normal and excisional biopsy was performed. A diagnosis of malignant eccrine spiradenoma was made. Thirty-two months later, the tumour recurred in the same region. The tumour was excised again. Lymph node metastasis was also detected in lymph node dissection. Fifteen months later, the tumour recurred again in the same place. In addition, lymph node metastasis and bone metastasis were found. Palliative radiotherapy was performed for the involvement of the right femur. The treatment for metachronous lung cancer could not be given because of the patient’s age and performance, and she could not be given additional treatment for the same reasons.

Cilj: Cilj je ovog rada prikazati slučaj vrlo rijetkog malignog tumora glave i vrata – malignog ekrinog spiradenoma, opisati kliničke i patohistološke karakteristike tumora, važnost rane dijagnoze s obzirom na konačni ishod te metode liječenja. Prikaz slučaja: U radu je opisan slučaj 46-godišnje pacijentice kojoj je dijagnosticiran hemangiom lijeve strane vrata te se 25 godina kontrolirala. Nekoliko mjeseci prije javljanja na Kliniku tvorba se naglo počela mijenjati. Na temelju ultrazvuka vrata, citopunkcije, magnetske rezonancije vrata i biopsije postavljena je sumnja na metastazu nepoznatog primarnog tumora. PET/CT-om nije otkriveno sijelo primarnog tumora te je tek kirurškim zahvatom i patohistološkom verifikacijom operacijskog preparata utvrđena definitivna dijagnoza malignog ekrinog spiradenima s metastazom u jednom regionalnom limfnom čvoru vrata. Pacijentica je poslijeoperacijski tretirana radiokemoterapijom. Šest mjeseci nakon liječenja utvrđene su multiple metastaze pluća, pleure, medijastinuma i jetre, pa je 3 mjeseca kasnije nastupio smrtni ishod. Rasprava i zaključak: U većini slučajeva ovaj rijedak tumor nastaje malignom transformacijom benignog ekrinog spiradenoma, premda može nastati i de novo. Rijetko se javlja u regiji glave i vrata. Dijagnoza se temelji na patohistološkom nalazu. Tumor pokazuje veliku sklonost lokalnim recidivima te regionalnim i udaljenim metastazama kada je prognoza loša. Liječenje je prvenstveno kirurško, dok je učinak radiokemoterapije upitan. Važno je bolest dijagnosticirati u ra- noj fazi, kada ne postoji regionalna i udaljena proširenost jer je tada stopa izlječenja vrlo visoka., Aim: To present a case of a very rare malignant head and neck tumor – malignant eccrine spiradenoma, describe the clinical and pathological characteristics of the tumor, as well as the importance of early diagnosis with respect to the ultimate outcome of these treatments. Case report: This paper describes the case of a 46-year-old patient who was di- agnosed with hemangioma of the left side of the neck, and was followed for 25 years. Few months before the patient came to the Clinic, the lesion suddenly began to change. Based on the neck ultrasound, fine-needle cytopuncture, MRI and biopsy a suspicion on a metastasis of unknown primary tumor was established. PET / CT has not discovered the location of the primary tumor and only surgery and histopathologic verification of operating sample established the definitive diagnosis of malignant eccrine spiradenoma with metastasis in a single regional lymph node. The patient was treated with postoperative radio- and chemotherapy. Six months after the treatment, multiple metastases of the lung, pleura, mediastinum, and liver were found and 3 months later fatal outcome occurred. Discussion and conclusion: In the majority of cases this rare tumor is caused by malignant transformation of benign eccrine spiradenoma, although it can appear de novo. It rarely occurs in the head and neck region. Diagnosis is based on pathohistological findings. The tumor shows a strong preference to local and regional recurrence and to distant metastases, the prognosis of which is poor. It is important to diagnose the disease at an early stage when there is no regional or distant spread because at that stage the survival rate is very high.

Background. Reports in the literature reveal that malignant eccrine spiradenomas (MES) are exceedingly rare, and represent aggressive tumors arising in long-standing benign eccrine spiradenomas (ES). Objective. We present a de novo case of MES of the nose, in contrast to reports in the literature of progression from long-standing benign lesions. Methods. Case report and brief review of the literature. Results. Our case was accepted as de novo MES because there was no evidence of ES on pathologic examination. It was treated by surgical excision with 1 cm tumor-free margins. No recurrence or complications were observed for 2 months, but long-term follow-up could not be performed because the patient died of adenocarcinoma of the colon. Conclusion. Although previously reported lesions have arisen in long-standing benign ESs, usually on the trunk or extremities, this report shows that MES may occur as a primary malignant tumor and may occur in unusual locations such as the nose.

Malignant eccrine spiradenomas are exceedingly rare tumors. They can arise from a preexisting eccrine spiradenoma or occur as a primary malignant tumor. Clinical features of these tumors may include a history of enlargement in a previously stable lesion. Tumor can be of low or high grade. Low-grade malignant eccrine spiradenoma has a better prognosis. We present a malignant eccrine spiradenoma arising from a preexisting eccrine spiradenoma, which has an infrequent localization between lateral edge of nose and medial canthus.

58歳男性。30年来の左上肢屈側に線状配列したeccrine spiradenomaのうちの1個が, 約半年間で母指頭大に急激に増大した。病理組織学的に, 真皮浅層に好塩基性の細胞とやや明るい細胞質を有する2種の細胞よりなるeccrine spiradenomaと異型細胞より構成された嚢腫様構造を同一切片内に認めた。両者の連続性は明らかでなかった。電顕では, 核は切り込みを有し, 核小体は明瞭で, 膨化したミトコンドリアが多数認められ, また細胞間には多数の微絨毛も認められた。以上の所見より, multiple eccrine spiradenomaから生じたmalignant eccrine spiradenomaと考えた。

UNLABELLED Malignant eccrine spiradenomas (MES) are exceedingly rare and their immunohistochemical and ultrastructural features have not been fully characterized. We studied two cases, one of them immunohistochemically and electron microscopically. Patient 1 had a 25-year history of multiple exophytic tumors involving the scalp, the skin of the face, and the torso. Of the lesions removed, ten were spiradenomas, two with malignant changes, and three were cylindromas. The malignant areas showed loss of tubular and nesting patterns, lack of two cell populations, and contained anaplastic cells with high mitotic rate. The immunohistochemical findings were consistent with eccrine differentiation. Patient 2 had a cystlike mass of long duration in the right groin. Histologically, the mass consisted of nodules of benign eccrine spiradenomas adjacent to a ductal-cystic mass lined by anaplastic cells, but areas of squamous and glandular differentiation were also present. CONCLUSIONS (a) Case 1 is probably the first reported MES associated with multiple spiradenomas and cylindromas. (b) Cytodifferentiation in MES is variable, sometimes with almost complete loss of eccrine differentiation. (c) Identification of adjacent spiradenomas may be required for definite diagnosis of MES. (d) Clinical history of longstanding lesions with recent fast growth warrants tissue diagnosis.

Malignant change in a benign eccrine spiradenoma is rare. Only 13 such cases have been previously reported. Two further cases are described herein, both of which were carcinosarcomas and arose in middle-aged women. In each case continuity was demonstrated between the benign and malignant epithelial components and the sarcomatous element. In case 1 the sarcomatous component showed osteocartilaginous and rhabdomyoblastic differentiation, whereas in case 2 only osteosarcoma was evident. To our knowledge, carcinosarcoma has not been previously described arising in eccrine spiradenoma. The literature regarding malignant eccrine spiradenoma is reviewed.

A case of a 60 year old man with malignant eccrine spiradenoma involving the perineum is described. Areas of typical eccrine spiradenoma were admixed with carcinomatous and sarcomatous elements. Immunohistochemical and ultrastructural analysis revealed no evidence of epithelial differentiation in the sarcomatous areas. The tumour qualified for the designation carcinosarcoma arising in eccrine spiradenoma. The clinical course was aggressive with rapid development of nodal and pulmonary metastases.

Malignant eccrine spiradenoma is an extremely rare sweat gland tumor. It may develop de novo or arise in pre-existing benign eccrine spiradenoma. However, most tumors are presented in the latter mode. The case of a 50-year-old man with malignant transformation from previously existing benign eccrine spiradenoma over his right lateral thigh is reported. Evidence for this diagnosis includes two distinct morphological components. One is the well demarcated, small round to oval benign eccrine spiradenoma and the other is the malignant element with sarcomatoid differentiation. Some foci of transition between the benign eccrine spiradenoma and the sarcomatoid part are evident and represents that the latter may arise from the former. Whether different morphological patterns influence the patients' outcome is still doubtful. However, the malignant eccrine spiradenoma is thought to have the capacity of metastasis and lethal potentiality.

Malignant eccrine spiradenoma (MES) is a very rare tumor. Tumors can be low grade or high grade. There are nine cases in the literature with systemic metastases. Of these, only one was low grade; the others had obvious features of high-grade malignancy such as pleomorphism, increased mitoses, and abnormal mitoses. Low grade MESs are more difficult to diagnose and are said to have a better prognosis. We report an additional case of low-grade MES with systemic metastases. It had a monotonous appearance with few mitotic figures and minimal pleomorphism. Vascular invasion was seen in both cases of low-grade MES and may be an important prognostic feature.

A 45-year-old man from Nigeria in generally good health presented with a giant occipital neoformation approximately 8 × 8 cm. The lesion, exophytic, ulcerated, bleeding, and foul-smelling, had first appeared 4 months earlier and had grown rapidly. There was another similar, smaller lesion near the original one, which was presumed to be an intransit metastasis. Contrast-enhanced computed tomography and positron emission tomography scans confirmed that the patient had already developed lung, bone, and kidney metastases.

Malignant eccrine spiradenoma (MES) is a rare adnexal tumour derived from cutaneous sweat glands. We describe a case of MES arising on the tip of the right middle toe. The lesion had been managed as a non-specific chronic ulcer for 4 years. The lesion was treated by elective amputation. We wish to emphasise through this case report the importance of keeping this rare but potentially lethal tumour in mind when managing chronic non-healing ulcers in extremities.

A malignant eccrine spiradenoma (MES) of the hand is described in a patient who developed bilateral pulmonary metastasis more than 10 years later. A review of the literature including observations on clinical behavior and recommendations for treatment of this rare adnexal tumor is presented.

Malignant transformation in a benign eccrine spiradenoma is rare. Since it was first reported in 1972, 31 cases have been reported. Of these, six cases had sarcomatous components, mainly osteosarcomatous, and one had rhabdomyoblastic differentiation. A case is presented in which there were some small nodules of benign eccrine spiradenomas adjacent to a large nodule of malignant eccrine spiradenoma with leiomyosarcomatous components, determined by histologic and immunohistochemical studies.

Results: Ten-year OS and DSS rates were 54% and 97%, respectively. Unfavorable factors for OS were increasing age (hazard ratio [HR] 1.08; 95% confidence interval [CI], 1.07-1.09; P .001), distant metastases (3.26; 2.344.53; P .001), no surgical procedure (1.27; 1.01-1.59; P=.04), grade IV tumors (1.97; 1.18-3.28; P=.009), nodal metastases (2.19; 1.40-3.43; P=.001), and T3 tumors (1.37; 1.00-1.87; P=.04). Favorable factors for OS were a wide surgical excision (HR, 0.78; 95% CI, 0.68-0.89; P .001), female sex (0.73; 0.65-0.82; P .001), malignant eccrine spiradenoma (0.72; 0.53-0.99; P=.04), and histologic findings of sweat duct carcinoma (0.63; 0.440.90; P=.01). Unfavorable factors for DSS included N1 status (HR, 6.77; 95% CI, 2.11-21.68; P .001), distant metastases (12.24; 6.03-24.85; P .001), histologic findings of malignant eccrine spiradenoma (5.62; 1.2525.34; P=.02), and no surgical procedure (2.81; 1.097.23; P=.03). Favorable factors for DSS included female sex (HR, 0.52; 95% CI, 0.30-0.91; P=.02).

Two patients had carcinoma arising in eccrine spiradenoma. In both patients, recent changes in a long-standing cutaneous nodule prompted excision, and microscopic examination disclosed carcinoma intimately associated with and apparently arising from typical benign eccrine spiradenoma. One patient had lymph node metastasis.

Two cases of malignant eccrine spiradenoma of the hand are reported. This malignancy is potentially fatal and is believed to arise from preexisting, long-standing benign spiradenomas. These rare tumors should be considered in the hand surgeon's evaluation and management of any long-standing undiagnosed tumor of the hand. Benign spiradenomas should be excised completely and the patient followed carefully. Location and grade of established malignant tumors should dictate therapy.

Malignant eccrine spiradenoma (MES) is a rare malignancy of the eccrine sweat glands. It usually presents as a small, firm, reddish painful and small solitary nodule. Head and neck are rare locations. Etiology is unknown although previous trauma is believed to be an implicated factor. MES arises over a prior benign spiradenoma. Clinical behavior is aggressive with a high rate of recurrences and distant metastases. Prognosis is poor. Diagnosis is based on histological findings and treatment must be aggressive from the beginning to achieve the best results. Since Kersting and Helwig first described the case in 1956, and Beekley et al., reported its malignant transformation in 1971, only a few cases can be found in the literature. Based on these particular features we report a case of a 75-year-old man diagnosed on a MES that arises in a very unusual location, with a peculiar histopathology and behavior.

• Two patients are described in whom malignant transformation occurred within an eccrine spiradenoma. Their findings were compared with those of six similar patients from the literature, and a characteristic clinicopathologic picture was evident. The typical history was one of rapid enlargement of a cutaneous nodule of long standing. The neoplasms were composed, at least in part, of large, markedly atypical basaloid cells with numerous mitotic figures. Adjacent benign spiradenoma was observed microscopically in each case, and some of the carcinomas retained architectural features reminiscent of spiradenoma. One patient died of disseminated tumor, but follow-up was short or lacking in several cases. Malignant transformation of eccrine spiradenoma shares many clinical and pathologic features with malignant transformation of dermal cylindroma. (Arch Dermatol1985;121:1445-1448)