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Forum Name: Dermatology Topics

Question: Spreading Eccrine hamartoma with swelling ?


 tomleg - Tue Jun 22, 2010 9:24 am

Hi,

I have suffered for the last ten years from blotches on my legs which sweat profusely. It began with one red spot which sweated profusely on my calf a short while after a jungle hike in South America, and has now spread to the whole of my lower leg from my knee to my foot. It causes pain any time I put weight on it, especially when I am static, and my whole left leg is visibly larger than my right leg due to the swelling, and the sweating is visible.

Image

A couple of years after the problem appeared I visited an orthopedic doctor who x-rayed my leg and did not find anything. Four years ago I visited a dermatologist who took a biopsy of the growth and diagnosed it as being an Eccrine harmatoma with localized hyperdrosis, but up until now they have all just told me that I will just have to live with it. They said that it is extremely rare and that it would not spread, but with every passing month more of my leg becomes inflamed and new blotches and sweaty patches appear.

Image

I have done some research on the internet and it looks like in many cases it neither hurts nor spreads, hence their prognosis, but in my case it is both painful and spreading.

Image

I am at my wits end and the situation is getting worse as time goes on. I am yet to meet a doctor who is even familiar with my condition. Surely there must be something that can be done? Maybe a surgical procedure, maybe some other treatment. There is no knowing where it will end.

Here is an MRI scan showing the excessive amount of blood vessel growth in the area.

Image

Any help appreciated,

Full version with larger images http://pzx3.com/tomleg/

Tom
 Dr.M.Aroon kamath - Wed Jun 23, 2010 11:28 am

User avatar Hi,
Eccrine angiomatous hamartoma is a rare, benign entity. The histologic features include proliferation of eccrine sweat glands and angiomatous capillary channels. Neural or lipomatous involvement may be seen.

Most lesions are solitary.Many different presentations have been reported (variants):
- multiple asymmetrical,
- multiple symmetrical,
- mucin- rich,
- superficial,
- deep,
- ones associated with A-V malformations,
- painful,
- painless,
- infancy/childhood-onset(common), &
- adult-onset.

Presenting features may be variable.Commonly presents as painless, flesh coloured, reddish brown, violaceous or bluish subcutaneous nodules especially on the extremities(can occur anywhere in the body).

Sweating is a characteristic feature, but not always present.Sweating can be
- spontaneous,
- exertional or
- emotional
Sweating also can be lesional or involve a larger skin area.

Immunohistochemical studies show that these eccrine glands stain positively for S-100 and carcinoembryonic antigen (CEA). CD34, CD44, human nerve growth factor receptor have been reported in some cases.

From your description of your illness and the attached photographs, i will venture to make the following comments:
- The problem is more obvious in your left ankle(inner aspect or the so-called 'gaiter area').
- it appears to be like a the venous flare that one sees in cases of chronic deep venous insufficiency.
- some of these veins seem to be very superficial and forming sort of 'venous lakes'.
- there seems to be noticeable leg length discrepancy (left lower limb longer than the right).
- the girth of the left lower limb is significantly more than the right.

Their natural history indicates that they are benign and typically slow-growing and therefore,aggressive treatment is generally
unwarranted. Simple excision is usually curative and
is best reserved for painful or cosmetically disfiguring
lesions.

It is probable that in your case, Eccrine angiomatous hamartoma may be associated with an A-V malformation.Decisions regarding management of your case may be ideally done in consultation with a vascular surgeon and an interventional radiologist.
Best wishes!
 Dr.M.jagesh kamath - Wed Jun 23, 2010 8:41 pm

User avatar Hello,Clearly and succintly put, I agree with Dr.Kamath that there could be an AV Malformation with the limb hypertrophy associated with the hamartoma.
I would only add a reference which could be useful in therapy.
Very recently Botulinum injections have been used in the treatment of eccrine hamartoma.
Do consult your surgeon or dermatologist for further information and feasiblity.
My good wishes.

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