To remove the growths, the patient underwent may surgical procedures where the nodules were effectively excised. The growth was described as a:“ten centimetre, firm, lobulated mass with skin ulceration and muscle involvement was removed. Microscopic examination revealed infiltrating nests of medium to large epithelial cells embedded in a chondromyxoid matrix with few scattered plasmacytoid myoepithelial cells. There was brisk mitosis as well as large areas of tumour necrosis. All auxiliary lymph nodes were negative for tumour.” (Garcia, Atun, and Fernando, 2016)From this information, Garcia, Atun, and Fernando diagnosed the patient with malignant chondroid syringoma. After the surgery, the patient developed further growths on the scalp, face, body, upper right arm, and right foot. He was recommended chemotherapy however died before treatment began. Lymph node metastasis after excision
This journal, written by Watarai, Amoh, Aki, Takasu, and Katsuoka discusses a case of malignant chondroid syringoma on a forty-six-year-old man and the state his diagnosis 12 years after excision. Originally in 1996, the man observed an “asymptomatic, enlarging nodule” (Watarai, Amoh, Aki, Takasu, and Katsuoka, 2011) on the sole of his right foot and proceeded to undergo an initial biopsy where he was not diagnosed. Physically, the nodule was “solitary, dome-shaped, skin coloured, and firm,” (Watarai, Amoh, Aki, Takasu, and Katsuoka, 2011) and was 30 mm x 30 mm. The tumour underwent excision utilising a three-millimetre margin. The nodule was then replaced with grafting of the transplanted skin.
The rare neoplasms generally do not follow a determinate development path and are often difficult to diagnose.Histologically, these malignant mixed tumours have epithelial and mesenchymal components and are very large, nodular, circumscribed, and nonulcerated. They are morphologically identical to pleomorphic adenoma and have a female predilection. They range from developing deep dermal to subcutaneous nodules and metastasise at a very high rate. Malignant mixed tumours can emerge "de nova or more rarely develop from a cartilaginous syringoma. "(IADVL, 2004)

Causes
Currently malignant mixed tumours do not have a definitive predisposing factor; however, prior physical injury has been proposed as a potential risk for the emergence of these tumours. Chondroid syringoma less than three centimetres are shown to have a heightened risk of malignancy. Other critical indicators include excessive mucoid matrix, – a connective tissue tumour with a myxoid background that is composed of "clear, mucoid substance – numerous mitoses, and poorly differentiated chondroid components." (Metzler, Schaumburg-Lever, Hornstein, and Rassner, 1996)

Diagnosis
Diagnosing malignant mixed tumours is difficult as there many types of tumours and their variants. Malignant chondroid syringoma is particularly challenging to distinguish from other skin tumours as it is prone to the absence of definitive symptoms and an ambiguous clinical presentation. Some signs that help determine diagnosis of malignancy include: "mitosis, nuclear atypia, pleomorphism, lymphatic invasion, and local recurrence" (IADVL, 2004). Though it is usually found within women in the forties, the youngest-recorded case was fourteen years old and the oldest was eighty-six.