F 65, vulva, atrophic indurated lesion

Diagnosis: Lichen sclerosus with dermal syringoma.

Fig 1. Syringoma in the mid dermis with overlying epidermal and dermal changes showing lichen sclerosus (hyperkeratosis, epidermal atrophy, loss of rete ridges, clefting in upper dermis, papillary dermal edema and homogeneous sclerosis with linear chronic inflammatory cell infiltration deep to the dermal sclerosis).

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Fig 2. Epidermal and dermal changes showing lichen sclerosus (hyperkeratosis, epidermal atrophy, loss of rete ridges, clefting in upper dermis, papillary dermal edema and homogeneous sclerosis with linear chronic inflammatory cell infiltration deep to the dermal sclerosis).

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Fig 3. Dermal syringoma showing numerous small epithelial ducts embedded in sclerotic stroma. The walls of the ducts are lined by two layers of cuboidal or flat epithelial cells. Ductal lumen contains eosinophilic, amorphous debris. Some ducts have elongated tails of epithelial cells that produce a comma-shaped or tadpole appearance.

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Fig 4. Dermal syringoma showing numerous small epithelial ducts embedded in sclerotic stroma. The walls of the ducts are lined by two layers of cuboidal or flat epithelial cells. Ductal lumen contains eosinophilic, amorphous debris. Some ducts have elongated tails of epithelial cells that produce a comma-shaped or tadpole appearance.

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Comment:

 Syringoma is a benign adnexal neoplasm formed by well-differentiated ductal elements       of sweat gland.

 Four variants of syringoma : (1) localized form, (2) associated with Down syndrome, (3)         generalized multiple and eruptive syringomas, and (4) familial.

 Syringomas are common lesions, mostly in female, appearing at puberty as symmetrical     multiple 1-3 mm clustered lesions in the upper cheeks and lower eyelids.

 Other sites include axilla, chest, abdomen, genital skin.

 Eruptive syringomas are more common in African Americans and Asians.

Deba P Sarma, MD, Omaha

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