Chondroid Syringoma

INTRODUCTION Chondroid syringoma is also known as pleomorphic adenoma or mixed tumor of the skin. These benign lesions are of possible eccrine gland or hair follicle origin, although several reports showed apocrine differentiation. They usually occur on the head and neck. They only occasionally involve the eyelid. Rarely, malignant variants have been reported.

CLINICAL PRESENTATION These lesions present as an asymptomatic solitary nodule 0.5 to 2.0 cm in diameter.

They generally show slow growth over 2 to 10 years or longer before coming to medical attention. When they occur on the eyelid they tend to be fixed to the underlying tarsus, but they do not cause changes in the overlying epidermis except occasionally for some pigmentation.

Lower Eyelid Pilomatrixoma
(Courtesy of J. Justin Older, M.D.)

HISTOPATHOLOGY Epithelial cells are distributed singly or form tubules or ducts that are usually lined by two or more rows of epithelial cells. The outer layer of epithelial cells lining the tubules tends to be more flattened than the inner layer of cells. The epithelial cells are within a stroma that varies in appearance from chondroid to myxoid to fibrous. The chondroid stroma is bubbly and blue in H&E stained sections and contains abundant glycosaminoglycans (mucopolysaccharides) that stain positively using alcian blue, colloidal iron, and mucicarmine techniques.

Neurfibroma Eyelid

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes epidermoid cyst, neurofibroma, and pilomatrixoma.

TREATMENT Treatment is not indicated except for cases of cosmesis or when the lesion interferes with vision. Surgical excision within its capsule is curative.


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