Abstract:

Eccrine squamous syringometaplasia (ESS) is defined as squamous metaplasia of eccrine ducts. It has been reported in a variety of conditions including chronic cutaneous ulcers or margins of healing ulcers, areas of ischemia, systemic or topical chemotherapeutic agents, anti-inflammatory drugs and cryotherapy. We present two cases of florid ESS with interesting clinical presentations. Case 1, a 73-year-old-female with history of diabetes mellitus, hypertension and coronary artery disease presented to emergency department with a 2-day history of rapidly developing right hand swelling with blister. She denied history of injury/ wound, numbness or tingling, or fever. She stated a possible history of spider bite. Upon admission, the lab investigations revealed leucocytosis. The culture from the blister fluid demonstrated Group A ?-hemolytic streptococci. Clinical presentation of erythematous, tender soft tissue swelling, culture positivity supported the diagnosis of cellulitis. The patient was managed with antibiotics and wound care. Case 2, an 84-year-old-male with a history of excision of a basal cell carcinoma of the left forearm following a shave biopsy 3 weeks before. The histological examination from both the cases showed surface ulceration with a florid dermal proliferation of irregular squamous epithelium with linear and lobular patterns. Interspersed eccrine ducts were noted. The squamous epithelium showed intercellular bridges with abundant eosinophilic cytoplasm and occasional neutrophilic infiltrates. Desmoplasia, atypical mitoses and dysplasia were absent. Case 2 showed no residual BCC. ESS can occur in a variety of clinical conditions and histologically may mimic squamous cell carcinoma. Diagnostic clues of dermal proliferation with occasional lumen and inner hyaline cuticle, lobular configuration, and absence of dysplasia favors ESS.

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Nupur Jadhav, MD