|Year : 2021 | Volume
| Issue : 4 | Page : 714-716
Chondroid syringoma of the upper eyelid – A rare case
Jyoti Nigam, Anant Prakash Tripathi, Manoj Kumar Yadav
Department of Ophthalmology, Dr RML Hospital, New Delhi, India
|Date of Submission||10-Dec-2020|
|Date of Acceptance||20-May-2021|
|Date of Web Publication||09-Oct-2021|
Dr. Jyoti Nigam
Flat 209, Upper Ground Floor, Sudarshan Park, Motinagar, New Delhi - 110 015
Source of Support: None, Conflict of Interest: None
Chondroid syringoma is a benign mixed tumor characterized by sweat gland elements in a cartilaginous stroma. A 34-year-old male patient presented with a slow growing mass since 2 yrs. A complete surgical excision was done for the same under local anesthesia which showed a significant improvement. Our report aims to raise awareness about this rare benign tumour of the eyelids and to study the histopathological aspects of it.
Keywords: Benign, eyelid mass, mixed tumor, orbital tumour, sweat gland element.
|How to cite this article:|
Nigam J, Tripathi AP, Yadav MK. Chondroid syringoma of the upper eyelid – A rare case. Indian J Ophthalmol Case Rep 2021;1:714-6
Chondroid syringoma is a benign mixed tumour characterized by sweat gland elements in a cartilaginous stroma. This rare tumour accounts for only 0.01% of all primary skin tumours and occurs only rarely in the periorbital region. Usually between 0.5 cm and 3.0 cm, risk of malignancy increases in chondroid syringomas greater than 3.0 cm in size. Frequently known as mixed tumour of the skin, since its appearance is similar to the pleomorphic adenoma of the lacrimal and major salivary glands, in 1961 Hirsch and Hellwig substituted this term with chondroid syringoma on account of the constant presence of sweat gland elements and the cartilaginous appearance of the stroma.,
Here we report a rare case of chondroid syringoma of upper eye lid.
| Case Report|| |
A 34-year-old male patient presented with a slow growing mass since 2 years. The patient also complained of bleeding from the mass since 2 days. Rest of the ocular examination was normal and systemic examination was normal.
The mass was situated on the right upper eye lid, measuring 2.5 × 2 × 1.5 cm firm, non-tender, not fixed to underlying tissue [Figure 1]a. The mass was black in color, painless and of firm consistency and smooth surface, arising from the anterior lamella of the eyelid. The cut surface was white and homogenous.
|Figure 1: Composite picture of all four pics. (a) the right upper eye lid mass, measuring 2.5 × 2 × 1.5 cm firm, non-tender, not fixed to underlying tissue. (b) Shows tumour cells that are round to polygonal with moderate amount of eosinophilic cytoplasm. Also seen is chondromyxoid background. (H and E, 200×). (c) Shows tumour cells arranged in tubules, cords, nests and few of them diffusely in a chondromyxoid background. (H and E, 200×). (d) Shows tumour cells arranged diffusely in a chondromyxoid stroma and few areas of haemorrhage. (H and E, 200×)|
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Complete excision of mass was done under local anesthesia and sent for histopathological examination. HPE showed tumour cells that are round to polygonal with moderate amount of eosinophilic cytoplasm, with tumour cells arranged diffusely in a chondromyxoid stroma along with few areas of haemorrhage *[Figure 1]b, [Figure 1]c, [Figure 1]d. The mucoid stroma was stained positively with Alcian blue. Tumour also shows cells arranged in tubules, cords and few of them containing eosinophilic material diffusely in a chondromyxoid background.
| Discussion|| |
Chondroid syringoma is a benign neoplasia named because it is a proliferation of tubular and ductular eccrine or apocrine epithelium similar to that of a syringoma, mixed with a characteristic chondroid stromal matrix. These combined features account for the alternative designation of mixed tumour of the skin. Chondroid syringoma is a rare mixed tumour of sweat gland origin first described in 1859 by Bilroth as a tumor type similar to benign mixed tumor of salivary glands. Hirsch and Hellwig later classified this tumour type as chondroid syringoma in 1961 due to the presence of sweat gland elements in a cartilaginous stroma.,
The tumour is composed of tubular structures lined by a double layer of epithelial cells embedded in a mucoid stroma, often with areas of chondroid metaplasia.
The inner cells lining the ducts are secretory and produce a mucopolysaccharide; the outer cells are myoepithelial., It is believed that the stroma is derived from the outer myoepithelial cells which are capable of undergoing fibrous, myxoid, or chondroid metaplasia.
Headington has described 2 types of chondroid syringomas depending upon the morphological picture. The present case was chondroid syringoma with tubular, branching lumina. In general, the tubular structures are highly suggestive of eccrine differentiation. The other variety is chondroid syringoma with small, tubular lumina in which glands are lined by single layer of flat epithelial cells. The tumour can differentiate either to eccrine or apocrine elements and very rarely it can undergo malignant change with widespread metastases., The malignant transformation is more common in young females and have predilection for occurring in trunk and extremities. Tyagi et al. in their study of 207 eyelid tumours had one case of Chondroid syringoma with an incidence of 0.48% in their series.
The differential diagnosis of chondroid syringoma may include neurofibroma, dermoid cysts, sebaceous cysts, dermatofibroma, salivary gland pleomorphic adenoma, or basal cell carcinoma. Diagnosis is confirmed with biopsy of the mass demonstrating nests of cells and ducts surrounded by chondromyxoid stroma.,
They are commonly described in the upper lid. When the mass is located in the temporal aspect of the upper lid, it may be difficult to distinguish a pleomorphic adenoma arising from the sweat glands of the eyelid from one arising within the palpebral lobe of the lacrimal gland.
The treatment is by local surgical excision of the tumour and its capsule in their entirety. It has been suggested that incisional biopsy or fine-needle aspiration may disrupt the tumour and seed local tissue, increasing the risk of recurrence. In our observation, the tumour was completely excised without recurrence within a 1-year follow-up.
| Conclusion|| |
These tumours are benign but, if the capsule is ruptured, they may become locally invasive and, although rare, malignant transformation is also possible.
This case is being reported for its rarity, its occurrence in young patients and the need to keep this rare entity as a differential diagnosis of eye lid tumours.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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