A rare case of malignant chondroid syringoma of scalp
A 61-year-old female presented with a large, fungating, and ulcerated growth over the occipital region of scalp []. The history was that of a painless, slow growing mass over a 9-month time period. Clinically the patient was suspected to have a squamous cell malignancy of scalp (which was the most confusing differential diagnosis). Initial biopsy of the lesion favored a benign mixed eccrine tumor of the scalp, that is, a benign CS. The patient was then referred for contrast enhanced computerized tomography (CECT) scan of head. The scout image was suggestive of a soft tissue lesion in the occipital region with erosion of the adjacent occipital bone []. CECT revealed a moderately and heterogeneously enhancing soft tissue density mass lesion of size approx. 8.0 1.4 cm, arising from the occipital scalp, causing lytic destruction of the adjacent occipital bone. Also, the underlying dura appeared focally thin, with white matter edema in the occipital region, suggesting dural invasion []. Wide local excision with primary closure was done. Histopathology revealed small groups as well as scattered pleomorphic epithelial cells having hyperchromatic nuclei and scanty cytoplasm with one to two mitotic figures per high power field, surrounded by abundant basophilic chondromyxoid stroma, diagnostic of malignant CS []. The patient developed high-grade fever and altered sensorium, and died on the 2nd postoperative day, possibly due to meningitis. This infection could have spread to the meninges from operative site, as there was certain evidence of meningeal invasion on CECT.