Chondroid syringoma (mixed tumor of skin) with hair matrix differentiation

This lesion caught my eye because at the edge it looks like a pilomatrixoma, with ghost cells and prominent foreign body giant cell response. The bulk of the lesion is a typical mixed tumor or chondroid syringoma.  A few cells along the ducts showed some sebaceous differentiation as well. These mixed tumors are appropriately named, as they present with a mixed bag of tricks.  It might lead to misdiagnosis in a small sample. These findings are reported in current textbooks, but a nice reference on this goes back to 1984 with an article by Dr. Ron Rapini.  His case was better because it showed some basaloid cells with transition to the ghost cells.  I noticed at the bottom of his paper it was sponsored by a grant from the Dermatology Foundation. This demonstrates the value of joining this foundation, as the foundation has supported some outstanding people early in their career.

Reference

Hair matrix differentiation in chondroid syringoma. Rapini RP, Kennedy LJ, Golitz LE. J Cutan Pathol. 1984 Aug;11(4):318-21.

Cutaneous mixed tumor containing ossification, hair matrix, and sebaceous ductal differentiation.  Akasaka T, Onodera H, Matsuta M.  J Dermatol. 1997 Feb;24(2):125-31. 

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2 responses to “Chondroid syringoma (mixed tumor of skin) with hair matrix differentiation

  1. As a clinician I had one of these recently on a man’s chin. They called it an Apocrine mixed tumour but put chondroid syringoma in brackets after it. They obviously can have varying histological patterns as shown by your ghost cells of pilomatrixoma. What are the clefts in your first image. They remind me of cholesterol or uric acid clefts.

  2. I agree, I would call those cholesterol clefts. There is also a lot of keratin debris associated with the foreign body giant cell response. Often the pilomatrixomas that we receive show just this type of picture, shelled out fragments of foreign body giant cell response, keratin, calcification, and ghost cells.

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