A Case of Syringocystadenoma Papilliferum on Lower Leg: A Rare Location
An 18 years old male reported to skin outpatient department with complaints of slowly progressive multiple raised nodular lesions on the medial side of his left leg since birth. At birth the lesions were slightly raised and reddish in color. The lesions were asymptomatic and gradually increased in size and thickness. The growth of lesion was relatively faster after the onset of puberty.\nOn examination, there were 4 skin colored papulonodular lesions measuring from 0.6 × 0.6 cm to 1.2 × 1.2 cm in size on medial side of middle 1/3 of left leg. The lesions were firm and non-tender. Thick crusting noted on 2 of the 4 lesion []. Hairs were sparse on the lesions and surrounding skin. There was some atrophic scarring of skin near the larger nodule because of some trauma sustained during childhood. There was history of occasional serous discharge from the lesion since 8 years of age. There was no other finding noted on local examination. On systemic examination, the patient was clinically normal. The routine laboratory investigation including hemogram, Monteux test and X-ray chest was found to be normal. A provisional diagnosis of appendageal tumor was kept in mind. Excision biopsy of one of the nodule was done for histopathological examination (HPE).\nOn HPE the epidermis showed papillomatosis. There were cystic invaginations extending downwards from the epidermis. There were multiple papillomatous projections projecting into cystic invaginations []. The papillary projections and lower part of invaginations were lined by two rows of glandular epithelium []. The outer row consisted of small cuboidal cells and inner row displaying columner cells. Some columner cells were also showing decapitation secretion. The papillary projections and dermis had dense infiltration of plasma cells []. A final diagnosis of SCAP was considered.