Objective: This study aimed to investigate the effectiveness of prophylactic photobiomodulation (PBM) in reducing postinflammatory hyperpigmentation (PIH) induced by carbon dioxide (CO2) laser resurfacing in a patient with periorbital syringomas. Background: PIH is a common condition characterized by abnormal skin pigmentation after an inflammatory process occurring in up to 20-30% of patients undergoing CO2 laser resurfacing. Methods: The patient was treated with PBM using a pulsed home-use device at 630 nm before and after CO2 laser treatment. The patient was asked to treat the right periorbital area before and after the CO2 laser treatment, which was continued once a day for 2 consecutive weeks. Results: At 12 weeks, PIH was significantly reduced on the treated side compared with the contralateral untreated side (leading to persistent erythema at 6 months). Conclusions: This is the first report of prophylactic treatment of CO2 laser-induced dyschromia using PBM.

Syringomas are benign tumors originating from the intraepidermal portion of eccrine sweat ducts. A six-year-old African American female presented with multiple 2-3 mm hyperpigmented papules over the neck, upper chest, and axillae bilaterally. The lesions were non-tender, non-pruritic, and did not bleed when lightly scraped. A café-au-lait macule was incidentally found in the mid-back of the patient. Histopathologically, multiple small ducts displaying a tadpole-shaped/paisley-tie pattern with fibrotic stroma were identified on hematoxylin and eosin staining. Epithelium showing nests of cells with basaloid appearance and dilated glands filled with eosinophilic material were also identified. These histopathologic findings were consistent with a diagnosis of eruptive syringoma. The patient was treated conservatively, and the lesions subsided without intervention. In most patients requesting treatment, isotretinoin is used; however, this may be an unnecessary measure in many patients. Overall, this case was significant due to the patient\'s young age, ethnicity, and clinical improvement in the absence of treatment.

Eccrine tumors are adnexal tumors with a varied clinical presentation and wide histological spectrum. This study aims to consolidate data on the clinical characteristics of eccrine tumors to help improve clinical acumen and management of such tumors. Histopathological records from January 2008 to December 2012 were retrieved. Clinical characteristics of the tumor including site, appearance, symptoms, color, duration prior to presentation, and clinical and histological diagnosis were recorded. Eighty-four patients with eccrine tumors were identified, with seven main types of tumors recognized-hidradenoma (33.3%), poroma (29.8%), mixed tumors (14.3%), spiradenoma (8.3%), porocarcinoma (6.7%), eccrine adenoma (3.6%), and syringoma (3.6%). A total of 50% of mixed tumors were misdiagnosed as epidermal cysts. Eccrine tumors have a wide array of clinical presentations and are often clinically misdiagnosed as cysts. Recognizing certain clinical features may aid in the diagnosis, but, if in doubt, a biopsy should be performed.

BACKGROUND: Syringomas are benign tumours of the sweat glands, the most familiar clinical presentation of which is the presence of multiple lesions on the eyelids. The aim of our study was to determine the clinical and histological characteristics of a large series of patients and to examine anatomoclinical correlations.
METHODS: This was a retrospective study conducted in all of the cases of syringoma analysed at the cutaneous histopathology laboratory in Strasbourg between 1970 and 2008. The clinical elements, patient history and diagnostic data were collated. All slides were re-read in order to determine the microscopic characteristics of the lesions.
RESULTS: Two hundred and forty-four lesions were included. The sex ratio was 0.27 and the mean age was 42 years (8 to 85 years). Multiple syringomas were noted in 76% of cases, of which 29.2% were eruptive, and one case occurred in a setting of metastatic melanoma. The sites of predilection were the face (56.7%, of which 36.3% on the eyelids), the chest (18.1%) and the neck (17.5%) for the multiple forms. The lesions were in the form of papules (67%), either brown (34.2%) or flesh-coloured (19.8%). Pruritus was reported in 14 cases, including 4 at vulvar sites (out of a total of 8). A diagnosis of syringoma was made by the clinician in only 30.2% of the multiple forms, with mastocytosis being proposed in 7.1% of cases. The clear-cell forms (18 cases) presented no special clinical features.
CONCLUSIONS: Syringomas are frequently multiple and are seen mainly in women. They are found predominantly on the face and trunk, and lesions are generally brown and pruritic, a little-known feature that accounts for the degree of diagnostic confusion with mastocytosis. The vulvar forms, which are often pruritic, are poorly known. The eruptive forms may include a hormonal component.

Despite of the fact that the vulva contains a high density of apocrine and anogenital mammary glands in addition to eccrine glands and folliculosebaceous units, the benign vulvar adnexal tumours are rare. Though the varied clinical presentation and diverse histopathological spectrum of vulvar neoplasms has amazed the pathologists, only few studies have been reported in literature. The present five year study consists of only five cases of benign vulvar neoplasms depicting their rarity. Hidradenoma papilliferum and syringoma were the most common entities followed by Chondroid syringoma. The aim of our study is to explore and highlight the histopathological diversity of benign vulvar adnexal tumours reflecting the relative frequency of these structures.

BACKGROUND: Syringoma is a benign adnexal tumor derived from intraepidermal eccrine duct.
OBJECTIVE: The aim of the study is to report the experience concerning syringoma by reviewing the clinical and histopathologic features of a series of 34 histologically diagnosed syringoma patients observed over a period of six years.
METHODS: Thirty-four patients were sorted into two groups, localized and generalized syringoma, according to the Friedman and Butler classification. Different histopathologic findings were recorded in specially designed questionnaires for further analysis.
RESULTS: Ninety-seven percent of the patients were females with the mean age of 27.6 years. The mean duration of the lesions before the presentations was six years. The diagnosis of syringoma was only considered in 23 patients (67.6%) and was the initial diagnosis in only 13 (38.2%) patients. All histological findings were seen more common in our cases. in comparison to the documented cases in the literature. Clear cell change of epithelial eccrine cells was 85.2% and there was no difference in the histopathological findings in the two groups. Our patients with generalized syringoma (GS) had a considerable lower age of onset than the ones with localized syringoma (LS) (P = 0.027).
CONCLUSIONS: Our patients with generalized syringoma were younger than the ones with localized syringoma. Distribution of the generalized syringoma was mainly in the chest and neck followed by the forearms whereas localized syringoma was mostly confined to the face, axilla and genitalia. There were also some conditions associated with our cases including sarcoidosis, calcinosis cutis and basal cell carcinoma.

BACKGROUND: Although much research has been conducted into the origin of syringoma, the histogenesis and differentiation of it remains controversial. The published studies examined various antibodies, and our study is an additional immunohistochemical work-up.
OBJECTIVE: We attempted to identify the cell that acts as the precise origin of a syringoma, based on a comparative analysis of carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), and cytokeratin (CK) 5 through immunohistochemical staining in the solid strand of basophilic epithelial cells of syringoma.
METHODS: A total of 31 patients with biopsy-confirmed syringoma were included in this study. Each sample was analyzed with antibodies to CEA, EMA, and CK5. These markers were indicating each part of the normal sweat gland structure: CEA stains the luminal surface of sweat ductal structures; EMA stains the peripheral cells of normal dermal ducts and the intraepidermal duct; CK5 stains the outer cells of the dermal duct and lower intraepidermal duct but does not stain the intraepidermal duct located in the upper epidermis.
RESULTS: We were able to confirm that the solid strands stained for EMA and CK5, as did the outer cells of the ductal structure. However, the solid strands did not stain with CEA.
CONCLUSIONS: The results indicated that solid strands observed in syringomas originate from the outer cells of the two layers of cells that compose the lower epidermal duct or the transitional portion between the intraepidermal duct and dermal duct in the normal eccrine or apocrine structure. Thus, we surmise that a syringoma is developed by the proliferation of these cells.

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OBJECTIVE: The Home Study Course is intended for the practicing colposcopist or practitioner who is seeking to develop or enhance his/her colposcopic skills. The goal of the course is to present colposcopic cases that are unusual or instructive in terms of appearance, presentation, or management or that demonstrate new and important knowledge in the area of colposcopy or pathology. Participants may benefit from reading and studying the material or from testing their knowledge by answering the questions.
BACKGROUND: The American Society for Colposcopy and Cervical Pathology (ASCCP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The ASCCP designates this education activity for a maximum of 1 AMA PRA Category I Credittrade mark. Physicians should only claim credit commensurate with the extent of their participation in the activity. The ASCCP also designates their educational activity for 1 Category 1 credit hour of the ASCCP\'s Program for Continuing Professional Development. Credit is available for those who choose to apply. The Home Study Course is planned and produced in accordance with the ACCME\'s Essential Areas and Elements.
BACKGROUND: The clinical history and images in the Home Study Course may represent an actual case, but not always. To improve educational quality, some gross, cytological, or histological images may come from photographic libraries. Good teaching cases are often difficult to obtain, and we encourage our readers to submit cases with high-quality images to the Home Study Course editor or executive editor to consider for publication. Lastly, faculty must disclose any significant financial interest or relationship with proprietary entities that may have a direct relationship to the subject matter. For this course, the authors had the following relationships to report: Gordon D. Davis, MD, FACOG: No such relationship to report Joseph A.D. Brooks, MD: No such relationship to report.

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