Hosp Aeronáut Cent 2012; 7(2): 124-126 Siringoma Condroide Maligno: a Propósito de un Caso Malignant chondroid syringoma: Case Report Gustavo Wasielewsky*, My. (E. Med.) Rubén D. Algieri**, 1er Ten. (E. Med.) Benjamin Nowydwor***, 1er Ten. ”e.c.” (E. Med.) Felix Viglione****, 1er Ten. “e.c.” (E. Med.) Fabiana Franco Alanis****, 1er Ten. “e.c” (E. Med.) Cristian Flores**** Workplace: - General Surgery Service. Hospital Aeronáutico Central. 3697, Ventura de la Vega Street, City of Buenos Aires. * Surgeon, General Surgery Service, Hospital Aeronáutico Central ** Head of the General Surgery Service, Hospital Aeronáutico Central. *** General Surgery Chief Resident. Hospital Aeronáutico Central. **** General Surgery Resident. Hospital Aeronáutico Central. Resumen Abstract Introducción: El siringoma condroide maligno es un tumor Introduction: Although the malignant chondroid syringoma is a cutáneo muy infrecuente pero que debemos tener en cuenta en very rare skin tumor, it must be considered in the differential el diagnóstico diferencial de los tumores axilares. diagnosis of axillary tumors. Objetivos: Se realiza el análisis y la presentación del siguiente Objectives: The following clinical case is analyzed and presented caso clínico con el objetivo de considerar esta entidad como in order to consider this entity as differential diagnosis of axillary diagnostico diferencial de los tumores axilares. tumors. Presentación de Caso: Paciente de sexo femenino de 82 años Case Report: 82 year-old, female patient who presents with a que refiere la presencia de una tumoración cutánea en axila skin tumor of 3 years evolution in the right axilla. Biopsy (PUNCH) derecha de 3 años de evolución, con realización de biopsia reports infiltration due to moderately differentiated carcinoma. (PUNCH) que informa infiltración por carcinoma moderadamente Surgical extirpation is decided. diferenciado. Se decide su exéresis quirúrgica. Discussion: The malignant chondroid syringoma is a rare tumor, Discusión: El siringoma condroide maligno es un tumor but can metastasize, with extended survival times. It prefers limbs infrecuente, pero puede dar metástasis, pero con prolongados and trunk. tiempos de sobrevida. Prefiere las extremidades y el tronco. Its prognosis is good when the extirpation is complete, but Su pronóstico es bueno cuando la exéresis es completa, aunque patients must be followed-up anyway. es necesario realizar un seguimiento completo de los pacientes. Palabras clave: Siringoma Condroide Maligno. Tratamiento quirúrgico Received: October 9th, 2012. Accepted: November 11th, 2012 124 Keywords: Malignant chondroid syringoma. Surgical treatment. Wasielewsky et al, Hosp Aeronáut Cent 2012; 7(2): 124-126 thoracoabdominal Introduction tomography). Both the tomography and the ultrasound show images The usually called “chondroid syringoma” is compatible with adenopathies in the right under considered a rare pathological entity affecting arm area. mainly glandular processes 1,2,6 . It is extremely The surgical procedure is carried out (tumor malignant. As regards its location, it is most resection plus right axillary emptying). The results commonly found, in 80% of cases, on the head of the pathological anatomy showed skin mixed and neck (nose, cheek, upper lip, hairy skin and tumor (malignant forehead); this location is followed, in 10% of axillary nodal metastases (17/17). cases, by the trunk and limbs and, less frequently, It is submitted to the tumor committee where it can affect the feet, axillary region, abdomen, progress monitoring and a new assessment to penis, vulva and scrotum. It presents as a slow- start radiation therapy and chemotherapy are growing asymptomatic nodule which may develop decided. metastasis over time. chondroid syringoma) with 2,8,9 It is difficult to diagnose the chondroid syringoma before performing the biopsy, and its result may not be definitive since this is a tumor made up of two very different parts. The final diagnosis is provided by the immunohistochemical histopathological and examination the of complete tumor piece and differential diagnosis must be performed against similar entities such as mioepithelium, chondroid fibromyxoid tumor. 3,4,6 choristoma or PHOTO 1: Growing and palpable axillary tumor Objectives To highlight the finding of this rare tumor including it within the differential diagnoses of axillary tumors. Case Report 82-year-old female patient who makes reference to the presence of a cutaneous tumor of 3 years evolution in her right axilla. Biopsie (PUNCH) reports infiltration due to moderately differentiated PHOTO 2: Resection of surgical piece carcinoma. Surgical extirpation is decided. Several complementary studies are carried out (breast ultrasound, Revista del Hospital Aeronáutico Central mammography, 125 Siringoma Condroide Maligno: a Propósito de un Caso Discussion References The names “chondroid syringoma” and “mixed 1. Burgesser MV, Metrebian MF, Kuurpis M, Diller A, tumor” have been used as synonyms; whenever it Neoplasias de la piel. Revisión Histopatológica de 8 años is located in the salivary gland it is called pleomorphic adenoma.1,2,5,7 de experiencia, Rev. Argentina Dermatología 2009; 90: 152164. 2. Carlos Álvarez Mora, Héctor Ricardo Lara Torres, Antonio This type of tumor is rarely found outside the Ysita Morales, Siringoma condriode: a propósito de dos salivary glans, but that may sometimes happen3,4. casos y revisión de la bibliografía. patología Revista Although the benign mixed tumor of the skin is latinoamericana Volumen 48, núm. 2, abril-junio, 2010:100104. relatively frequent, the chondroid syringoma is 3. Casteleiro Roca, P., Vázquez Barro, A., Comellas Franco, extremely rare. It is more common in women M, Pombo Otero, J., Martelo Villar, F, Siringoma condroide (women: men 3:2); it is more frequently found in maligno: a propósito de un caso, Cir.plást. iberolatinoam. - trunk and limbs than in head and neck. Often, it is Vol. 35 - Nº 1 Enero - Febrero - Marzo 2009 / Pag. 73-78. 4. Jiménez HF y cols. Siringoma condroide, Rev Cent bigger than the benign form and presents as a Dermatol Pascua, Vol. 18, Núm. 2, May-Ago 2009: 62-63. firm, unique, subcutaneous, slow-growing, simple 5. Ogawa R, Mitsuhashi K, Oki K, et al. A rare case of or multiple asymptomatic nodule. It may develop metastasis but has extended survival times. Unlike the benign variety, it prefers limbs and chondroid syringoma arising from the lower eyelid with ectropion. Plast Reconstr Surg 2006;118(6):137-140 6. Ollague-Torres JM, Vera ME, Neoplasias de las glándulas sudoríparas, Dermatología Perú. 2005;15(2):211-221. trunk. It is difficult to diagnose the chondroid 7. Torres S, Gutiérrez T, Navarrete G, et al. Siringoma syringoma before performing the biopsy, and its condroide. Presentación de dos casos. Rev Cent Dermatol result may not be definitive since this is a tumor made up of two very different parts. The final diagnosis histopathological and is provided by the immunohistochemical examination of the complete tumor piece and it is performed through exclusion against other entities such as mioepithelium, chondroid choristoma, fibromyxoid tumor, sebaceous cyst, implantation dermoid, neurofibroma, dermatofibroma, basal cell carcinoma, squamous cell carcinoma, pilomatrixoma or histiocytoma. The malignant chondroid syringoma is a very unfrequent cutaneous tumor with a very low incidence; however, it must be considered in the differential diagnosis of axillary tumors since it has a good prognosis when the “complete excision” is performed. In spite of that, the patient must be strictly followed 126 1,2,6,7,8 . Pascua 2007;16(1):30-33