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The Nerve > Volume 1(1); 2015 > Article
Park, Lee, and Eom: Eccrine Poroma on the Scalp: A Case Report with MR Findings

Abstract

Eccrine poroma is a benign neoplasm thought to originate from the eccrine sweat glands. The majority of eccrine poroma occur on the hairless acral surface, and cases of eccrine poroma on the scalp are rare. Moreover, all these case reports describe only the histopathological, not radiological, features of eccrine poroma. Here, we first report the magnetic resonance (MR) findings in a rare case of scalp eccrine poroma.

INTRODUCTION

Eccrine poroma is a benign tumor originating from the epidermal sweat glands. This tumor generally occurs in middle-aged individuals and is mostly found on the sole or side of the foot, hands, and hair-bearing regions. However, eccrine poroma on the scalp is extremely rare, with 18 cases reported till date2,4-7,9-11,14). Poroma’s eccrine sweat glands which derived from Ductal epithelium usualy occurred palms of the hands and soles of feet which dense eccrine glands located9-11). Hidroacanthoma simplex, syringoacanthoma, syringofibroadenoma, and poroid hidradenoma which subtypes of poroma are rarely occurred in scalp1,3,12). All these case reports describe only the histopathological, not radiological, features of eccrine poroma. Here, we first report the magnetic resonance (MR) findings in a rare case of scalp eccrine poroma.

CASE REPORT

A 51-year-old woman presented with a gradually growing 5-cm round non-tender mass at the right parieto-occipital area with intermittent headache. On physical examination, no superficial lesion was found, but a nontender, palpable hard mass was detected. Our initial diagnosis was common lipoma. She wanted examination with MRI on scalp although the insurance did not be covered. Cranial MR imaging revealed a 5×2×5 cm3 inhomogeneous round mass in the parietal area with low signal intensity relative to gray matter on the T1-weighted image (T1WI), and a homogenous mass with iso signal intensity relative to gray matter on the T2WI. On administration of a contrast agent, the image revealed a partial heterogeneous contrast enhancement (Fig. 1). We performed a total surgical excision and biopsy; the histological diagnosis was an eccrine poroma. The tumor was composed of proliferating uniform basaloid, cuboidal cells punctuated by focal ducts and occasional cysts. These ducts were lined by eosinophilic cuticular material (Fig. 2).

DISCUSSION

Eccrine poroma appears as a single slow-growing, usually asymptomatic, soft, and has normal or pink-colored features and firm consistency5). Although the distal extremities such as the hands (palms), feet (soles), and fingers are common sites for these tumors, it has recently been reported that they might also arise in different lesions and on hairy locations of the body5). It composed of uppermost glandular ductal cells of eccrine origin which are keratinocytes from the lower portion of the acrosyringium of the eccrine duct2,4-6). On the other hand, this condition may superficially resemble a pyogenic granuloma, hypertrophic scar, hemangioma, dermatofibroma, or malignant melanoma5).
Eccrine poromas commonly develop in adults over the age of 40 and can occur secondarily within a nevus sebaceus. There is no familial component and no apparent predilection for sex or race5,6). The cause of eccrine poroma is not clear. Hyman and Brownstein5). reported cases that developed at sites exposed to trauma or radiation. Our patient had no history of trauma or radiation.
The feature of eccrine hidradenoma is that it has variable size. Hidroacanthoma simplex has poral cell aggravation in epidermis. Porocarcinoma has irregularly shaped nuclei and hyperchromatic malignant cell.1 In our case, histopathologic examination shows uniformly small cuboidal appearance and connection to intercellular bridge and by these features correspond to eccrine poroma.
The radiological features of skin tumor are not helpful for diagnosis with the exception of lipomas, which are tumors that can usually be diagnosed with MR imaging without requiring biopsy. If a lipoma does not have a typical feature that can be distinguished with MR imaging, it needs to be differentiated from other tumors. The MR imaging of other eccine tumors have been reported in the English literature although the location of tumors was not scalp. Reier et al.12) reported the case of a 60-year-old man with type 2 diabetes mellitus presented with a 3-year history of a painful mass in the mid plantar region of the left foot. MR imaging revealed showed low signal intensity on T1WIs and intermediate to high signal intensity on T2WIs and proton density-WIs. After administration of gadolinium, the tumor enhanced homogeneously. Han et al.4) described a case of multiple eccrine spiradenoma that showed low signal intensity on T1WIs, and high signal intensity on short tau inversion recovery images. They reported the signal intensities of the lesions were not characteristic. Among the tumors that are differentiated from eccrine tumor, some have relatively characteristic features on MR imaging (for example, hemangioma)1,8,13). These features are helpful for diagnosis and follow-up but not for confirmation of the tumor. Because the literature lacked MR imaging findings of eccrine poroma on other body parts, we were unable to diagnose and differentiate eccrine poroma from other diseases by using MR imaging findings.

CONCLUSION

To our knowledge, this is the first report of eccrine poroma is demonstrated on MR imaging. Further case studies and analysis are necessary to clarify the radiological characteristics of this rare tumor.

Fig. 1
Cranial magnetic resonance (MR) imaging showing a inhomogeneous round mass in the parietal area with low signal intensity relative to gray matter on the T1-weighted image (T1WI) (A), and a homogenous mass with iso signal intensity relative to gray matter on the T2WI (B). After contrast injection, a partial heterogeneous contrast enhancement is observed (C).
nv-1-1-53f1.gif
Fig. 2
Histopathological examination of the surgical specimen, showing a tumor composed of proliferating uniform basaloid, cuboidal cells punctuated by focal ducts and occasional cysts (A). These ducts are lined by eosinophilic cuticular material (B, arrows).
nv-1-1-53f2.gif

REFERENCES

1. Beaman FD, Kransdorf MJ, Andrews TR, Murphey MD, Arcara LK, Keeling JH: Superficial soft-tissue masses: analysis, diagnosis, and differential considerations. Radiographics 27:509-523, 2007
crossref pmid
2. Cherif F, Dhaoui A, Kort R, Haouet S, El Euch D, Ben Osman Dhahri A: Eccrine poroma of the scalp: A study of three cases. Tunis Med 84:391-393, 2006
pmid
3. Chung BY, Cho SI, Ahn IS, Kim HO, Park CW, Lee CH: Two cases of eccrine poroma on the scalp. Korea J Dermatol 49:768-771, 2011

4. Han YD, Huan Y, Deng JL, Zhang YG, Zhang CH: MRI appearance of multiple eccrine spiradenoma. Br J Radiol 80:e27-9, 2007
crossref
5. Hyman AB, Brownstein MH: Eccrine poroma. An analysis of forty-five new cases. Dermatologica 138:29-38, 1969
crossref pmid
6. Jin KM, Nogita T, Toyoda H, Kawashima M, Hidano A: Pedunculated pigmented eccrine poroma of the scalp with increased urinary excretion of 5-S-cysteinyldopa. J Dermatol 17:555-558, 1990
crossref pmid
7. Kakinuma H, Kobayashi M: Eccrine poroma: another cause of a pigmented scalp nodule. Br J Dermatol 146:5232002
crossref pmid
8. Kamishima T, Hasegawa A, Kubota KC, Oizumi N, Iwasaki N, Minami A, et al: Intravenous pyogenic granuloma of the finger. Jpn J Radiol 27:328-332, 2009
crossref pmid
9. Kim HR, Na CH, Shin BS, Choi KC, Kim MS: A case of pigmented eccrine poroma on the scalp. Korea J Dermatol 50:79-81, 2012

10. Kose R, Coban YK, Ciralik H: Eccrine porocarcinoma arising from preexisting eccrine poroma of the scalp after radiotherapy for cervical cancer. Dermatol Online J 12:182006

11. Ohata U, Hara H, Suzuki H: Pigmented eccrine poroma occurring on the scalp: Derivation of melanocytes in the tumor. Am J Dermatopathol 28:138-141, 2006
crossref pmid
12. Reier AR, Farooki S, Ashman CJ, Miles L: MR imaging appearance of plantar eccrine acrospiroma (sweat gland tumor). AJR Am J Roentgenol 179:1079-80, 2002
crossref pmid
13. Takahashi M, Kohda H: Diagnostic utility of magnetic resonance imaging in malignant melanoma. J Am Acad Dermatol 27:51-54, 1992
crossref pmid
14. Watanabe T, Murakami T, Okochi H, Kikuchi K, Furue M: Eccrine poroma associated with Bowen’s disease. Int J Dermatol 43:472-473, 2004
crossref pmid
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