These individuals presented with lesions that began to show abnormal growth (82.6% of cases), pain (47.7% of cases), and/or ulcerations (38.7% of cases). In earlier studies, SAC tumors were reported to varied in size with 40% being larger than 5 cm and the majority not having metastasized; the sites to which these lesions metastasized were most commonly to lymph nodes near to the SAC or, rarely, distant tissues such as the lung, liver, brain, spinal cord, bone, skin, and breast. Pathology
As determined by the microscopic histopathological appearances of their hematoxylin and eosin-stained samples, spiradenomas are non-encapsulated nodular skin lesions that extend into the dermis. The lesions consist of a relatively disorganized and dense array of proliferating basophilic cells (i.e. cells appearing blue because of their abnormally large uptake of the hematoxylin stain). These cells are arranged as small cells with hyperchromatic nuclei and scant cytoplasm layered outside and larger cells with vesicular (i.e. vesicle-containing) nuclei layered inside of intertwining strips. Lymphocytes commonly populate these lesions. Some lesions may merge the histopathological features of spiroadenomas with those of cylindromas. Cylindromas are hair follicle tumors that consist of basal cells (i.e. small, round cells similar to those seen in the lowest layer of the skins epidermis) which are arranged in ("jigsaw-like" cylindrical patterns separated by thickened basement membranes. The cylindroma tissues may also contain disorganized, dense arrays of proliferating basophilic cells.Spiradenocarcinoma tumors almost always derive from SA tumors and have areas of SA architecture abruptly transitioning to areas of SAC architecture.
Each check-up should incorporate the examination of the patients regional lymph nodes and on a case-by-case basis annual chest X-rays and liver function tests. Spiradenomas
The currently preferred treatment for sporadic SA tumors (including giant vascular eccrine SA) in almost all cases is surgical excision. Many studies recommend wide local surgical excision of these tumors with surgical margins of ≥1 cm in order to ensure that all tumor cells are removed: local lymph node resections are usually reserved for those cases suspected of having lymph node metastases. Mohs micrographic surgery has been used as an alternative to surgical excision for the complete removal of these tumors. Since SA tumors may contain unidentified areas of malignancy and therefore have high recurrence rates, may metastasize to local lymph nodes and/or distant tissues, and can result in overall poor survival times, adjuvant radiation therapy has been used to minimize these aggressive events in SA tumors with equivocal signs of malignancy. However, the effectiveness of these adjuvant therapies has not been established. Adjuvant CO2 laser treatments have been used on occasion to remove these tumors in cases with multiple tumors. Some trials have using botulinum toxin A and triamcinolone injections directly into SA tumors but these trials have had limited success. Spiradenocarcinomas
With only 117 malignant cases reported in the literature as of 2022, there are no standard guidelines for the treatment of SAC tumors. Localized (i.e.