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Syringocystadenoma Papilliferum of the Eyelid: Reply
Vol. 118, No. 6
Correspondence
Reply EDITOR: We appreciate the comments of Drs. Johnson and Buerger regarding our case of syringocyst adenoma papilliferum of the eyelid and its possible origin from a nevus sebaceus of Jadassohn. 1 The nevus sebaceus of Jadassohn is a hamartomatous lesion, which manifests as a verrucous plaque at birth or during childhood with hyperplastic growth at puberty. 2 As dis cussed in their letter, secondary development of other neoplastic lesions is a common seque la. As we indicated in our case, syringocystad enoma papilliferum has been reported to origi nate from a preexisting nevus sebaceus. The clinical manifestation in our patient is consistent with the growth pattern of a nevus sebaceus. In particular, our patient had noted the presence of an upper eyelid mass since the age of 8 years, with rapid, painless growth during puberty. We do not believe, however, that the histo pathologic features of the excised mass can ei ther support or disprove this hypothesis. The characteristic histopathologic features of nevus sebaceus include papillomatous epidermal hyperplasia, sebaceous hyperplasia, and hamar tomatous apocrine gland formation. In our pa tient, the skin adjacent to the lesion did not exhibit these features. As indicated by Drs. Johnson and Buerger, apocrine-like glands were noted at the base of the lesion in our patient, but we believe this to be a nonspecific
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finding as it has also been reported in cases of syringocystadenoma papilliferum not believed to have originated from a pre-existing nevus sebaceus. 3 The clusters of sebaceous glands seen in our patient were a minor feature and not consistent with the large, hyperplastic, glandular proliferations typically associated with nevus sebaceus. Although we have no direct evidence that this case of syringocystadenoma papilliferum originated from a nevus sebaceus of Jadassohn, the suggestions of Drs. Johnson and Buerger are valid. JAY I. PERLMAN, M.D. ROBERT C. URBAN, JR., M.D. DEEPAK P. EDWARD, M.D. MARK O. M. TSO, M.D. Chicago, Illinois
References 1. Jadassohn J. Bemerkungen zur Histologie der systematisierten Naevi und ber "Talgdrsen-Naevi." Arch Dermatol Syphilol 1895;33:355-94. 2. Wilson Jones E, Heyl T. Naevus sebaceus. A report of 140 cases with special regard to the devel opment of secondary malignant tumours. Br J Derm 1970;82:99-117. 3. Jakobiec FA, Streeten BW, Iwamoto T, Harrison W, Smith B. Syringocystadenoma papilliferum of the eyelid. Ophthalmology 1981;88:1175-81.
Correspondence
Reply EDITOR: We appreciate the comments of Drs. Johnson and Buerger regarding our case of syringocyst adenoma papilliferum of the eyelid and its possible origin from a nevus sebaceus of Jadassohn. 1 The nevus sebaceus of Jadassohn is a hamartomatous lesion, which manifests as a verrucous plaque at birth or during childhood with hyperplastic growth at puberty. 2 As dis cussed in their letter, secondary development of other neoplastic lesions is a common seque la. As we indicated in our case, syringocystad enoma papilliferum has been reported to origi nate from a preexisting nevus sebaceus. The clinical manifestation in our patient is consistent with the growth pattern of a nevus sebaceus. In particular, our patient had noted the presence of an upper eyelid mass since the age of 8 years, with rapid, painless growth during puberty. We do not believe, however, that the histo pathologic features of the excised mass can ei ther support or disprove this hypothesis. The characteristic histopathologic features of nevus sebaceus include papillomatous epidermal hyperplasia, sebaceous hyperplasia, and hamar tomatous apocrine gland formation. In our pa tient, the skin adjacent to the lesion did not exhibit these features. As indicated by Drs. Johnson and Buerger, apocrine-like glands were noted at the base of the lesion in our patient, but we believe this to be a nonspecific
823
finding as it has also been reported in cases of syringocystadenoma papilliferum not believed to have originated from a pre-existing nevus sebaceus. 3 The clusters of sebaceous glands seen in our patient were a minor feature and not consistent with the large, hyperplastic, glandular proliferations typically associated with nevus sebaceus. Although we have no direct evidence that this case of syringocystadenoma papilliferum originated from a nevus sebaceus of Jadassohn, the suggestions of Drs. Johnson and Buerger are valid. JAY I. PERLMAN, M.D. ROBERT C. URBAN, JR., M.D. DEEPAK P. EDWARD, M.D. MARK O. M. TSO, M.D. Chicago, Illinois
References 1. Jadassohn J. Bemerkungen zur Histologie der systematisierten Naevi und ber "Talgdrsen-Naevi." Arch Dermatol Syphilol 1895;33:355-94. 2. Wilson Jones E, Heyl T. Naevus sebaceus. A report of 140 cases with special regard to the devel opment of secondary malignant tumours. Br J Derm 1970;82:99-117. 3. Jakobiec FA, Streeten BW, Iwamoto T, Harrison W, Smith B. Syringocystadenoma papilliferum of the eyelid. Ophthalmology 1981;88:1175-81.