Eccrine Spiradenoma

First described in 1956, spiradenomas are benign tumors that arise from the bulge of the hair follicle rather than the sweat gland. Epidemiologically, spiradenomas are rare, malignant ones are even rarer, with only around 120 documented cases worldwide. No racial association or sexual predilection for spiradenomas has been reported. Most spiradenomas occur between the ages of 15 and 35. As for malignant spiradenomas, they tend to develop after the age of 50, with a median age of 60 years. Clinically, they are generally skin-colored nodules approximately 1 cm in diameter with a soft consistency, located on the scalp, neck, upper part of the trunk, breasts and rarely the armpits and vulva. While malignant spiradenomas tend to have slightly different characteristics from benign spiradenomas which can metastasize with an estimated rate of 19%. We report the case of a 45-year-old primiparous patient who had been postmenopausal for 5 years and had a maternal aunt who died of breast cancer who consulted for the discovery on self-palpation of a subcutaneous nodule near the left axillary area. The breast examination is unremarkable on D cup breasts with palpation of a subcutaneous nodule measuring 2.5 x 1.5 cm near the left axillary area. Echo mammography finds tissue and cystic lesions of the left breast classified ACR3 and a left axillary subcutaneous lesion measuring 24x13mm that is difficult to characterize. After biopsy of this lesion, the histological and immunohistochemical appearance returned in favor of a cutaneous adnexal tumor compatible with an ECCRINE SPIRADENOMA The extension assessment made by Thoracal abdomino pelvic CT had revealed non-specific pulmonary micronodules to be monitored The patient was sent to multidisciplinary team discussion with the decision to perform a left lumpectomy of the axillary lesion. The management of malignant spiradenomas is multidisciplinary with a surgeon, an oncologist and possibly a radiation oncologist.