ADENOMA OF THE SWEAT-GLAND¹

Synonyms.—Spiradenoma; Spiroma; Adenoma sudoriparum.

Most of the cases which have been described under this or an equiv­
alent title are now known to have had no connection with the sweat-
glands, but represented what is at present recognized as multiple benign
cystic epithelioma (q. v.). It is not improbable, however, that the
conclusions on this point have been entirely too sweeping, and that
in a few of the examples these structures may have played an important
pathologic part. It is in some instances, doubtless, however, a secondary
development, as in the cases of linear nævus recorded by Peterson² and
Elliot,³ although the former was of the opinion that his cases represented
a primary adenoma of the sweat-gland. According to Buxton, who has
carefully gone over the subject, the true adenoma must be distinguished
from mere hypertrophy; as an example of this latter he considers Elliot's
case just referred to. Gland hypertrophy is not infrequent in tubercu­
losis cutis and in the neighborhood of malignant tumors; and he himself

¹ In the herewith brief presentation I am indebted to the papers of Unna, Histo-
pathology, p. 803 (with bibliography); Buxton (Benign Tumors of the Skin), Jour.
Cutan. Dis., 1901, p. 161 (with admirable cuts and bibliography); Fordyce, Morrow‘s
System, vol. iii (Dermatology), p. 618.

² Peterson, Archiv, 1892, vol. xxiv, p. 919, and “Beiträge zur Kenntniss der Schweiss-
drüsen-Erkrankungen,” ibid., 1893, vol. xxv, p. 441 (review of subject and references).

³ Elliot, Jour. Cutan. Dis. 1893, p. 168. These 2 cases are also referred to under
Linear nævus.

66o

NEW GROWTHS

gives a histologic example of its occurrence near the site of a carcinoma
of the breast. Unna asserts, however, that these cases, which may be
considered as secondary adenoma, and which are relatively numerous,
may also, in addition to the actual hypertrophy, show adenomatous
development. Genuine cases, excluding the secondary cases and those
which are rather to be looked upon as examples of hypertrophy, are rare;
and, according to Unna, are represented by those reported by Thier-
felder,¹ Lotzbeck,² Hoggan,³ Chandeleux,⁴ and Audry.⁵ Unna also
quotes one by Krauss, and gives brief notes of one under his own observa­
tion.

The clinical appearances are simply those of a subcutaneous tumor,
varying in size from a pea to an egg or larger, usually slow in develop­
ment. In Lotzbeck‘s case it had a pseudo-angiomatous aspect. In
the cases of Chandeleux and Hoggan the nodules were tender and liable
to spontaneous attacks of pain. In both instances the nodule was en­
capsulated by firm connective tissue and the nerves distributed outside.
The overlying skin shows but little departure from the normal. The
growth is usually single, and may occur on any region—by Lotzbeck,
on the cheek; by Thierfelder, at the hairy margin of the forehead; by
Krauss, at the outer border of the foot; by Chandeleux, near the elbow;
by the Hoggans, on arm; in Unna‘s case the position is not stated. It
may appear at any age and in either sex.

Unna would distinguish the, growth arising from the coil-duct, to
which he gives the name of syringadenoma, from that arising from and
involving the glandular structure proper, as an example of the former
citing Peterson‘s case, already referred to. The origin and, in fact,
the diagnosis from other clinically similar tumors in these various cases
and histologic varieties are possible only through careful microscopic
examination. In fact, their individuality, true position, and relation­
ship to other growths are still undetermined. There is scarcely a doubt
that occasionally such a formation constitutes the starting-point of car-
cinomatous or other malignant change,⁶ and it is fairly questionable also
whether, in some of the instances in which the adenomatous develop­
ment of the coil-glands was thought to be secondary to malignant growths,
it may not have been the primary affection and the starting-point of the
malignancy.

The treatment of sweat-gland adenomata is that of other tumor
formation—complete excision.

¹ Thierfelder, Archiv f. Heilknnde, 1870, p. 401 (with 3 histologic cuts and some
references).

² Lotzbeck, Virchow‘s Archiv, 1859, vol. xvi, p. 160

³ Hoggan (G. and F. E.), ibid., 1881, vol. lxxxiii, p. 233.

⁴ Chandeleux, Arch, de physiolog., 1882, vol. ix, p. 639.

⁵ Audry and Nové-Josserand, Lyon Médicate, 1892, vol. lxix, p. 315.

⁶ See papers by Darier, “Contribution a l‘étude de l‘epithéliome des glands sudori-
pares,” Arch, de méd. exper., 1889, p. 115 (with 10 histologic cuts); Fordyce, “Adeno-
carcinomata of the Skin Originating in the Coil-glands,” Jour. Cutan. Dis., 1895, p. 41
(with 7 excellent photomicrographs).

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