181 Dermatol Sinica, June 2006

Poroid neoplasms (PN)

(hidroacanthoma simplex, HS)

(eccrine poroma, EP) (dermal

duct tumor, DDT) (poroid

hidradenoma, PH)

HS (Fig. 1) DDT

PH (Fig. 2)

EP(Fig. 3)

DDT

From the Department of Dermatology, Taipei-Veterans General HospitalReprint requests: Han-Nan Liu, M.D., Department of Dermatology, Taipei-Veterans General Hospital, 201, Section 2, Shih-PaiRoad, Taipei, Taiwan, R.O.C.TEL: 886-2-28757188 FAX: 886-2-28757666

The Many Faces of Poroid NeoplasmsHan-Nan Liu

PH DDT PH

(nodule) PH

AB Ackerman

PH AB Ackerman

PN

PN EP

EP

Fig. 1Hidroacanthoma simplex with discrete nests of poroid cells.

Fig. 2Wholly intradermal poroid hidradenoma with solid and cys-tic components.

Dermatol Sinica, Sep 2006 182

Fig. 3Eccrine poroma*

Fig. 4Poroid hidradenoma with some scattering sebocyte-likecells.

DDT14 DDT

PH

RK Winkelmann13-14 DDT the variously

shaped tumor islands were located in the mid-

dle and lower portions of the dermis and were

composed of small, uniform, cuboidal cells.

DDT poroid cells

PH cuticular cells

(cystic) AB

Ackerman PH 4

DDT

PN

AB Ackerman4.

PN

PN

AB Ackerman

PN (variants)

(1) poroid cells (Fig. 5); (2)

cuticular cells (Fig. 5); (3)

E P

(apocrine gland)1, 2

(sebaceous cells)

PH 3 (Fig.

4) (mixed

tumor of skin)

PH Abenoza AB

Ackerman 1990 4 PH

10 5-12

6

Clear cell hidradenoma

DDT 1966 Winkelmann

McLeod 13

1978 Winkelmann

183 Dermatol Sinica, Sep 2006

(intracytoplasmic or intercellular

vacuolization en route to formation of ducts)

(Fig. 6 ); (4) (necrosis en masse)

(Fig. 7); (5) poroid cells cuticular cells

(monomorphism)

poroid cells

(dermal eccrine duct)

(peripheral cells) cuticular cells

H&E

(cuticles) cuticular cells

luminal cells. 30 PN

HS poroid cells

PN

cuticular cells cuticu-

lar cells PH

PH

HS cuticular cells

單純汗腺棘皮瘤 (Hidroacanthoma simplex)

Fig. 5Large cuticular cells with abundant eosinophilic cytoplasmand small dark poroid cells with scant cytoplasm. Note thesmall ductal structures amid the tumor cells.

Fig. 6The cystic wall of poroid hidradneoma with several ductalstructures.

Fig. 7The necrosis en masse in a tumor island of eccrine poroma.

22,000 6 HS

(flat plaque)(Fig. 8)

(verrucous papule)(Fig. 9 )

HS HS

nests

(horizontal growth)

(superficial basal cell epithelioma)

(Bowen's disease)

Dermatol Sinica, Sep 2006 184

(superficial spreading malignant

melanoma) (seborrhic ker-

atosis)

HS

HS

Rahbar i 1983 15

HS15

4 50

HS

PN 16-17

HS

HS

HS18-19

20

1.

(poroid cells) (Fig. 1)

Fig. 8A 1.5x1.5 cm brownish plaque on the right side of buttocks.

Fig. 9A verrucoid papule on right dorsal foot

(acrosyringium) HS

HS

(dermal eccrine duct)

HS

HS cuticular cells

HS Horn cyst HS

2. : HS

HS porocarcinoma

HS poro-

carcinoma Zina 1982

HS porocarcinoma21

seborrheic keratosis 8

HS Ansai 1994

HS 1987

HS22 94

HS

irritated seborrheic keratosis23

HS

Lee 2003 HS

185 Dermatol Sinica, Sep 2006

porocarcinoma

HS 24 HS

Rahbari 1983 15 HS

HS

Zina21

23 seborrheic ker-

atosis porocarcinoma

seborrheic keratosis

汗腺汗孔瘤 (Eccrine poroma)

1. EP PN25-26

EP (65%)*

10%27 AB Ackerman 353 EP

15% 5%

30% 16 EP

3

(19%) 1 (6%)

(36%)

EP

(13/16) (Fig. 10)

EP

(stroma)

EP

EP

(clear

cell acanthoma) Spitz's nevus

2. (Fig.3)

EP

(

)

16 12 10

10

EP

28

3. : EP

porocarcinoma EP29 porocarcinoma

30-31

EP poro-

carcinoma

EP Abenoza and Ackerman

porocarcinomas 30

50% EP4 Robson

69 porocarcinoma 11Fig. 10An 6x4 mm erythematous papule on left sole

Dermatol Sinica, Sep 2006 186

(18%) 32

1983 Pylyser K 33

50% EP

Porocarcinoma EP AB

Ackerman 358 PN

5 porocarcinoma EP

porocarcinoma (Fig. 11, 12)

EP HS

EP

真皮汗管瘤 (Dermal duct tumor)

1.

RK Winkelmann

DDT14

DDT

( AB Ackerman

25%) Rook DDT

Occasionally with verrucous change

overlying it, DDT

DDT EP HS

30 PN DDT

DDT 85

Eccrine

poroma_a case of report of a dermal variant,

DDT

DDT34

DDT

RK Winkelmann

DDT

AB Ackerman4: DDT

EP

DDT PH

(http://atlases.muni.cz/atl_en/main+nadory+ad

nextum.html#potzltum+poromy+dermal_duct

_tum; http://www.bweems.com/dermaldt.html

Fig. 11A large erythematous plaque with an uneven surface.

Fig. 12Porocarcinoma with tumor islands varying greatly in sizeand shape. Inset: pleomorphic poroid cells with severalmitoses.

187 Dermatol Sinica, Sep 2006

)

2. DDT

poroid cells

(tumor islands)

( c y s t i c

space) (keratins)

PH

3.

DDT

PN

汗孔樣汗腺瘤 (Poroid hidradenoma)

1.

12 5-

13 28 77

70

(Fig. 13)

PH

PN

1.6 0.83

PH17 DDT

RK Winkelmann DDT

1

2. Ackerman

PH

(cystic space) (Fig. 2)

solid and cystic

hidradenoma HS EP

DDT PH

PH

cuticular cells

(Fig. 5)

(sebaceous cells)

PH

PN

PH

EP

(HS PH DDT )

3.

Fig. 13A slightly painful black to red nodule on the scalp with cys-tic consistency.

Fig. 14Eccrine poroma with a discrete poroid hidradenoma in thedermis. Serial sections disclosed no connection in between.

Dermatol Sinica, Sep 2006 188

DDT

兩種甚至於三種PN可以合併發生

PN

(Fig. 14)

Ishikura DDT EP 35

Kakinuma HS DDT EP36 Noriyuki PH EP37

PH EP HS

PN

Pinkus

EP (acrosy-

ringium) poroma

Pinkus

(eccrine secretory regions)

Watanabe38

3

PN內的蘭格罕氏細胞 (Langerhans cells)

PN

PH

21.7 33.8

439.2 347.5

(P=0.045)3 (Fig. 15) HS16

(innate immunity)

LL-37 dermcidin39

REFERENCES1. Harvell JD, Kerschmann RL, Leboit PE: Eccrine

or apocrine poroma? Six poromas with divergentadnexal differentiation. Am J Dermatopathol 18:1-9, 1996.

2. Lee NH, Lee SH, Ahn SK: Apocrine poroma withsebaceous differentiation. Am J Dermatopathol22: 261-263, 2000.

3. Liu HN, Chang YT, Chen CC, et al.: Thehistopathological and immunohistochemical stud-ies of poroid hidradenoma. Arch Dermatol Res297: 319-323, 2006.

4. Abenoza P, Ackerman AB: Neoplasms witheccrine differentiation. Philadelphia, Lea &Febieger, 113-85, 311-350, 1990.

5. Cho S, Kim JS, Shin JH, et al.: Poroid hidradeno-ma. Int J Dermatol 40: 62-64, 2001.

6. Hoshida Y, Hanai J, Matsushita N, et al.: Poroidhidradenoma. Report of a case with cytologic find-ings on fine needle aspiration. Acta Cytol 43: 471-474, 1999.

7. Whitmore RM, Anderson CJ, Piper T: Poroidhidradenoma. A case presentation. J Am Pod MedAssoc 88: 510-513, 1998.

8. Layfield LJ, Mooney E: Fine needle aspirationcytology of poroid hidradenoma. Acta Cytol 42:1064-1066, 1998.

9. Misago N, Kohda H: A single lesion demonstrat-

Fig. 15Much fewer CD1a (+) Langerhans cells in the cystic wall ofporoid hidradenoma (right lower part) than those in the over-lying normal epidermis (left upper corner).

189 Dermatol Sinica, Sep 2006

ing features of eccrine poroma and poroid hidrade-noma. J Dermatol 22: 773-779, 1995.

10.Ansai S. Koseki S. Hozumi Y, et al.: Assessmentof cellular proliferation of eccrine acrospiromasand eccrine sweat gland carcinomas by AgNORcounting and immunohistochemical demonstrationof proliferating cell nuclear antigen (PCNA) andKi-67. Clin Exp Dermatol 20: 27-34, 1995.

11. Ichioka S, Yamada A: A case of cystic dermal ducttumor corresponding to poroid hidradenoma: JDermatol 20: 554-557, 1993.

12.Requena L, Sanchez M. Poroid hidradenoma: alight microscopic and immunohistochemicalstudy. Cutis 50: 43-46, 1992.

13.Winkelmann RK, McLeod WA: The dermal ducttumor. Arch Dermatol 94: 50-55, 1966

14.Hu CH, Marques AS, Winkelmann RK: Dermalduct tumor: a histochemical and electron micro-scopic study. Arch Dermatol 114: 1659-1664,1978.

15.Rahbari H: Hidroacanthoma simplex--a review of15 cases: Br J Dermatol 109: 219-225, 1983.

16.Liu HN, Chang YT, Chen CC: Differentiation ofhidroacanthoma simplex from clonal seborrheickeratosis An immunohistochemical study. Am JDermatopathol 26: 188-193, 2004.

17.Chen CC, Chang YT, Liu HN: Poroid neoplasms:a study of 25 cases in Taiwan. Int J Dermatol 2006(In press).

18. Perniciaro C, Muller SA, Zelickson BD, et al.:Hidroacanthoma simplex: An ultrastructural andimmunohistochemical study. J Cutan Pathol 21:274-279, 1994.

19. Warner TFCS, Goell WS, Cripps DJJ:Hidroacanthoma simplex: an ultrastructural study.J Cutan Pathol 9: 189-195, 1982.

20.Nakagawa T, Inai M, Yamamoto S, et al.:Hidroacanthoma simplex showing variation in theappearance of tumor cells in different nests. JCutan Pathol 15: 238-244, 1988.

21.Zina AM, Bundino S, Pippione MG: Pigmentedhidroacanthoma simplex with porocarcinoma. JCutan Pathol 9: 104-112, 1982.

22.Ansai S, Koseki S, Hozumi Y, et al.: Malignanttransformation of benign hidroacanthoma simplex.Dermatology 188: 57-61, 1994.

23. : . 31

10024. Lee JB, Oh CK, Jang HS, et al.: A case of poro-

carcinoma from pre-existing hidroacanthoma sim-plex: need of early excision for hidroacanthoma

simplex? Dermatol Surg 29: 772-774, 2003.25.Wilkinson RD, Schopflocher P, Rozenfeld M:

Hidrotic ectodermal dysplasia with diffuse eccrineporomatosis. Arch Dermatol 113: 472-476, 1977.

26.Goldner R. Eccrine poromatosis. Arch Dermatol101:606-608, 1970.

27. Hyman AB, Brownstein MH: Eccrine poroma: Ananalysis of forty-five new cases. Dermatologica138: 29-38, 1969.

28.Elder D, Elenitsas R, Ragsdale D: Tumor of theepidermal appendages. In: Elder D, Elenitsas R,Johnson BL, et al., eds. Lever s Histopathology ofthe Skin. 9th ed. Philadelphia: Lippincott-Raven,900, 2005.

29.Nagore E, Diaz F, Sanchez-Motilla JM, et al.: Aporoid neoplasia arising close to a seborrheic ker-atosis and a trichoepithelioma. J Dermatol 26:253-257, 1999.

30.Akiyoshi E, Nogita T, Yamaguchi R, et al.:Eccrine porocarcinoma. Dermatologica 182: 239-242, 1991.

31.Shaw M, McKee PH, Lowe D, et al.: Malignanteccrine poroma: a study of twenty-seven cases. BrJ Dermatol 107: 675-680, 1982.

32.Robson A, Greene J, Ansari N, et al.: Eccrineporocarcinoma (Malignant eccrine poroma): Aclinicopathologic study of 69 cases. Am J SurgPathol 25: 710-720, 2001.

33.Pylyser K, De Wolf-Peeters C, Marien K: The his-tology of eccrine poromas: astudy of 14 cases.Dermatologica 167: 243-249, 1983.

34. : 14: 272-276, 1996

35.Ishikura T: Dermal duct tumor with eccrine poro-ma. Jpn Clin Dermatol 24: 459, 1982.

36.Kakinuma H, Miyamoto R, Iwasawa U, et al.:Three subtypes of poroid neoplasia in a singlelesion: Eccrine poroma, hidroacanthoma simplex,and dermal duct tumor. Am J Dermatopathol 16:66-72, 1994.

37.Nariyuki M, Hiromu K: A single lesion demon-strating features of eccrine poroma and poroidhidradenoma. J Dermatol 22: 773-779, 1995.

38.Watanabe S, Mogi S, Ichikawa E, et al.:Immunohistochemical analysis of keratin distribu-tion on eccrine poroma. Am J Pathol 142: 231-239, 1993.

39.Murakami M, Ohtake T, Dorschner RA, et al.:Cathelicidin anti-microbial peptide expression insweat, an innate defense system for the skin. JInvest Dermatol 119: 1090-1095, 2002.