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Clinical Problem Solving: Pathology
July 2005

Pathology Quiz Case 1: Diagnosis

Author Affiliations
 

FREDERIC B.ASKINMDWILLIAM H.WESTRAMD

Arch Otolaryngol Head Neck Surg. 2005;131(7):644. doi:10.1001/archotol.131.7.644-a

Diagnosis: Chondroid syringoma

Originally described as a mixed tumor of the skin by Billroth1 in 1859, this uncommon benign neoplasm was called chondroid syringoma by Hirsch and Helwig2 in 1961 to more accurately describe the lesion’s cellular characteristics. Hirsch and Helwig proposed the following defining histologic characteristics of the lesion: (1) nests of cuboidal or polygonal cells; (2) tubuloalveolar structures lined by 2 or more rows of cuboidal cells; (3) ductal structures composed of 1 or 2 rows of cuboidal cells; and (4) occasional keratin cysts. The tumor is thought to arise from apocrine and/or eccrine glands.3 Histologic analysis of a chondroid syringoma demonstrates nests or cords of epithelial cells set in a stromal matrix. The epithelial cells are usually cuboidal, but they can have a variable cytologic appearance (eg, eccrine, apocrine, sebaceous, mucinous, simple glandular, or squamous). They can be oriented in sheets and whorls, with glandular and ductal formations. The surrounding stroma characteristically demonstrates chondroid features. Other variants may also exhibit stroma with myxoid, fibrous, osseous, or adipocytic characteristics.4 Because of histologic variability, chondroid syringomas may be confused with salivary neoplasms because of their glandlike cellular configuration.5 Nomenclature for this type of tumor has been inconsistent in the past, including terms such as pleomorphic adenoma of the skin as well as mixed tumor of the skin.

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