Summary: A 38-year-old woman presented with a mass on her left hand that had
been gradually increasing in size over a 3-year period. Hand
radiography was obtained, followed by contrast-enhanced magnetic
resonance imaging (MRI).
Benign chondroid syringoma (mixed tumor)
Radiography of the hand showed no abnormalities (not shown). MRI
revealed an oval 1.3-cm mass in the volar subdermal tissue
immediately superﬁcial to the ﬂexor tendons of the
second digit (Figure 1).
At the time of excision, gross pathologic analysis revealed
well-encapsulated tan tissue (Figure 2). No areas of hemorrhage or
necrosiswere noted. Histologically, the lesion was nodular, and
there was differentiation toward the adnexal ductal epithelium with
chon dro myxoid and adipocytic differentiation in the stroma.
A chondroid syringoma is a rare mixed tumor of sweat-gland
origin that has both a benign and malignant form.1,2 The
term chondroid syringoma was introduced by Hirsch and
Helwig in 1961 because of the cartilaginous matrix (chondroid) and
sweat-gland elements (syringo-ma).2,3 They usually are
adherent to the skin and should have no attachments to the deep
structures.3 Up to 80% of benign lesions occur on the
head or neck and usually occur in adults >35 years of
age.1,3 These tumors have a reported male-to-female
predilection ranging from 2:1 to 5:1.
There have been few reported cases of malignant chondroid
syringoma. The majority of the reported malignant cases occur on
the extremities or trunk and there is a 2:1 female-to-male
predominance. The average age at diagnosis is 48.2
Common locations of metastases includeregional lymph nodes (48%),
lung and bone.2 The treatment of choice for chondroid
syringoma is a wide surgical excision.3 Incomplete
removal secondary to the lobulations and satellite lesions is
hypothesized to cause local recurrence.3
At the time of removal, the tumors are typically ﬁrm,
circumscribed whitish-yellow nodules. Histologically, the tumors
contain varying amounts of: nests of cuboidal/polygonal cells,
tubuloalveolar structures, ductal structures, keratinous cysts and
matrix (chondroid substanceis the most prevalent).2 On
samples from ﬁne-needle aspiration biopsy, there is a
usually mesenchymal tissue with a chondroid appearance and an
It has been argued that the distinction of malignant versus
benign can be made by malignant cytology features, but this is
somewhat in question, as there have been 4 reported cases of
metastases without malignant features.2 Ishimura
believed that the true malignant potential was better measured as a
function of the amount of matrix and chondroid
No reports providing the MRI characteristics of benign chondroid
syringoma were found in our search of literature, but the MRI
appearance of a malignant chondroid syringoma has been
described.4 This lesion was slightly higher in signal
intensity than muscle on the proton-density sequence, had
heterogeneously increased signal on the T2-weighted images, and had
high signal with focal regions of intermediate signal on the short
T1 inversion recovery (STIR) images. This benign lesion was
slightly hyperintense relative to muscle on the T1-weighted images,
had heterogeneously increased signal on the T2-weighted images, and
showed heterogeneous but diffuse enhancement.
Chondroid syringoma is a rare subcutaneous tumor composed of
mesenchymal and sweat gland elements that is usually found in the
head and neck. This tumor is most often benign and is usually seen
in men. When the malignant form occurs, it is seen more commonly in
women and is found on the extremities or trunk. When malignant, it
can invade locally as well as metastasize to lymph nodes, lung or
bone. The MRI characteristics of the lesion are nonspeciﬁc,
but could aid in identifying the extent of the tumor. Excision is
the treatment of choice,thereby making early identiﬁcation
advantageous. Importantly, the histology does not always predict
the clinical behavior of the tumor, and benign-appearing lesions
have been known to metastasize.
- Terrill RQ, Groves RJ, Cohen MB. Two cases of chondroid
syringoma of the hand. J Hand Surg [Am].
- Barnett MD, Wallack MK, Zuretti A, et al. Recurrent malignant
chondroid syringoma of the foot: A case report and review of the
literature. Am J Clin Oncol. 2000;23:227-232.
- Chen AH, Moreano EH, Houston B, Funk GF. Chondroid syringoma of
the head and neck: Clinical management and literature review.
Ear Nose Throat J. 1996;75:104-108.
- Nicolaou S, Dubec JJ, Munk PL, et al. Malignant chondroid
syringoma of the skin: Magnetic resonance imaging features.
Australas Radiol. 2001;45:240-243.