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UC Davis Dermatology Online Journal UC Davis Dermatology Online Journal Title Eccrine poromatosis following chemotherapy and radiation therapy Permalink https://escholarship.org/uc/item/9177r4fp Journal Dermatology Online Journal, 25(11) Authors Nguyen, Khoa Kim, Gene Chiu, Melvin Publication Date 2019 DOI 10.5070/D32511046146 License https://creativecommons.org/licenses/by-nc-nd/4.0/ 4.0 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Volume 25 Number 11| November 2019| Dermatology Online Journal || Photo Vignette 25(11):11 Eccrine poromatosis following chemotherapy and radiation therapy Khoa Nguyen1 BS, Gene Kim2 MD, Melvin Chiu2 MD MPH Affiliations: 1University of Central Florida College of Medicine, Orlando, Florida, USA, 2Department of Dermatology, University of Southern California Keck School of Medicine, Los Angeles, California, USA Corresponding Author: Melvin Chiu MD, MPH, University of Southern California, 1450 San Pablo Street, Los Angeles, CA 90033, Tel: 323-442-6206; Fax: 323-442-6299, Email: [email protected] tumors [1]. No predilection for race or sex have Abstract been identified. Eccrine poroma presents as a single, symptomless Clinically, an eccrine poroma presents as a single, erythematous papule in areas with a high density of eccrine sweat glands. Although rare, eccrine symptomless erythematous papule in areas with a poromas can present as multiple lesions, high density of eccrine sweat glands such as the otherwise known as eccrine poromatosis. The palms, soles, and fingers. Although rare, eccrine etiology of eccrine poromatosis is unclear. We poromas can present as multiple lesions, present two cases of eccrine poromatosis in otherwise known as eccrine poromatosis. A patients who had undergone chemotherapy, broader distribution that includes the neck, trunk, radiation therapy, and stem cell transplant. This and face may be observed. Newer reports suggest case report serves to raise awareness of this that eccrine poromatosis may occur in the setting condition and highlight its association with of concurrent or history of chemotherapy, but the malignancies and their treatment. relationship is unclear [2]. We present two cases of eccrine poromatosis in Keywords: eccrine poromatosis, eccrine poroma, patients who had undergone chemotherapy, poroma, chemotherapy, radiation therapy, radiation therapy, and stem cell transplant for malignancies lymphoma. Introduction Case Synopsis Eccrine poromas are benign, adnexal, slow- Case 1 growing neoplasms originating from the intra- A 58-year-old man presented to the clinic with epidermal eccrine duct and the acrosyringium. four pink, pedunculated, exophytic, 2-14mm sized These tumors belong to a group of benign eccrine papules on his dorsal left foot, right flank, and left ductal tumors that also include hidroacanthoma groin (Figure 1). The patient’s medical history simplex, dermal ductal tumor, and poroid included diffuse large B-cell lymphoma with hidradenoma. Eccrine poromas account for nearly several masses including one lesion near the 65% of poroid neoplasms and 10% of sweat gland hippocampus. He had extensive treatment 10 - 1 - Volume 25 Number 11| November 2019| Dermatology Online Journal || Photo Vignette 25(11):11 A B C D Figure 1. Eccrine poromas of the A, B) dorsal left foot and C, D) right flank. A B Figure 2. Eccrine poroma histopathologic findings of interanastamosing islands of cuboidal cells with occasional ductal differentiation. H&E, A) 40× and B) 200×. - 2 - Volume 25 Number 11| November 2019| Dermatology Online Journal || Photo Vignette 25(11):11 were also seen in the dermis. These findings were consistent with eccrine poromatosis. No further treatment was performed. The patient was then lost to follow up. Case 2 A 72-year-old man presented to the clinic with a pink eroded papule on the right anterior shoulder and a pink and yellow papule on the right upper back (Figure 3). The patient’s medical history included mantle cell lymphoma 10 years prior for Figure 3. Eccrine poromas on the right upper back (left) and which he received high-dose R-CHOP, stem cell right anterior shoulder (right). transplant; he remained on maintenance years prior that included 5 rounds of rituximab, rituximab and lenalidomide. He also had a history cyclop hosphamide, doxorubicin, vincristine, and of prostate cancer 6 years prior for which he prednisone (R-CHOP); 20 rounds of radiation; underwent radical prostatectomy and intrathecal liposomal cytarabine; stem cell radiotherapy. The patient denied any symptoms transplant; and 8 rounds of methotrexate, or trauma to the affected areas. Shave excisions of etoposide, and cyclophosphamide. Outside of his the two papules were performed. history of lymphoma, the patient’s past medical Histopathological examination demonstrated an history was unremarkable. Review of systems was epidermis with superficial islands of monotonous- also unremarkable. Four shave biopsies were appearing cuboidal cells with epidermal performed. Histopathological examination interconnection and prominent ductal demonstrated an epidermis with inter- differentiation (Figure 4). These findings were anastamosing islands of monotonous appearing consistent with eccrine poromatosis. No further bland cuboidal cells with occasional ductal treatment was performed. Four years later, there differentiation (Figure 2). Similar epithelial islands is no evidence of recurrence to date. A B Figure 4. Eccrine poroma histopathologic findings of an epidermis with superficial islands of monotonous appearing cuboidal cells with epidermal interconnection and prominent ductal differentiation. H&E, A) 40× and B) 100×. - 3 - Volume 25 Number 11| November 2019| Dermatology Online Journal || Photo Vignette 25(11):11 Case Discussion cyclophosphamide and mizoribine but no Multiple eccrine poromas are an uncommon radiation therapy [18]. presentation of a rare disease. This case report Chemotherapy is also implicated in the serves to raise awareness of this condition and development of other eccrine conditions highlight its association with malignancies and including neutrophilic eccrine hidradenitis and their treatment. syringosquamous metaplasia. Previous reports Although no definitive etiology for eccrine suggested that the chemotherapeutic metabolites poromatosis has yet been described, possible accumulate in the sweat apparatus and are either etiologies for the development of multiple eccrine directly cytotoxic to, or induce remodeling in, the poromas include chemotherapy, radiation, actinic eccrine sweat glands [2, 19]. Because eccrine damage, and human papillomavirus [3]. Indeed, in poromatosis occurs years, sometimes even both of our patients, the identified potential decades, following chemotherapy exposure, it is etiologies among those previously reported were likely that there is a combination of remodeling a history of high-dose chemotherapy and and regeneration that triggers tumor radiation therapy 10 years prior to eccrine development [8]. poromatosis appearance. A recent case of Treatment of eccrine poromas is typically done by eruptive poromatosis in a pregnant woman in her simple excision. Other successful treatment third trimester indicates that there could be a modalities have included electrosurgical hormonal association [4]. Others have suspected desiccation, cryotherapy, and imiquimod [4, 9]. a tumor suppressor gene defect in eccrine cells Eccrine poromas can rarely transform into eccrine [5]. porocarcinomas. Therefore, careful monitoring or Chemotherapy or radiation therapy may be the treatment by a dermatologist is recommended. most likely etiology for eccrine poromatosis. That is, a history of chemotherapy and/or radiation Conclusion therapy is often noted in eccrine poromatosis Eccrine poromatosis is a condition characterized cases (Table 1), [2, 3, 5-17]. Although it is by an eruption of multiple eccrine poromas. common for patients to receive both Various etiologies have been discussed in the chemotherapy and radiation therapy throughout literature. We present two cases of eccrine the course of their neoplastic treatment, eccrine poromatosis in patients who had undergone poromatosis most commonly occurs on non- chemotherapy, radiation therapy, and stem cell irradiated skin in patients who received transplant. This case report raises awareness of polychemotherapy [2]. Additionally, eccrine this condition and highlights its association with poromatosis developed in patients who received malignancies and their treatment. chemotherapy without radiation therapy as well. Specifically, Yoshii et al. described a case of eccrine poromatosis in a patient with systemic Potential conflicts of interest lupus erythematosus who received The authors declare no conflicts of interests. - 4 - Volume 25 Number 11| November 2019| Dermatology Online Journal || Photo Vignette 25(11):11 References 1. Chen CC, Chang YT, Liu HN. Clinical and histological Dermatol. 2001;145:830-3. [PMID: 11736912]. characteristics of poroid neoplasms: a study of 25 cases in 11. Miura T, Yamamoto T. Eruptive poromatosis following Taiwan. Int J Dermatol. 2006;45:722-7. [PMID: 16796636]. radiotherapy. Am J Dermatopathol. 2013;35:615-7. [PMID: 2. Fujii K, Aochi S, Takeshima C, et al. Eccrine poromatosis 23676317]. associated with polychemotherapy. Acta Derm Venereol. 12. Nguyen BT, Lortscher DN, Lee RA. Multiple poromas in a bone 2012;92:687-90. [PMID: 22294042]. marrow transplant recipient: A case report. Dermatol Online J. 3. Deckelbaum S, Touloei K, Shitabata PK, Sire DJ, Horowitz
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