a 58-year - old male presented with a lesion on the medial aspect of left lower eyelid near the punctum .
he had a small elevated nodular swelling at the margin of the eyelid for the past two decades .
there was a gradual increase in the size of the swelling for past 4 years , however , during past 6 months it became more visible associated with discomfort , itching , and a noticeable mass .
physical examination revealed a solitary 2 cm  2 cm size brownish firm fleshy growth with hyperkeratotic surface covered with crusts in some areas , involving the skin of the left lower eyelid [ fig . 1 ] .
it did not involve the underlying deeper tissues also and there was no regional lymphadenopathy .
fleshy growth with hyperkeratotic surface covered with crusts in some areas , involving the skin of the left lower eyelid the mass was excised along with a 3 mm margin of healthy skin , and the resultant skin defect was repaired with a median frontoglabellar pedicle skin flap .
the final pathologic diagnosis of excision biopsy specimen confirmed syringocystadenoma papilliferum . on gross examination , skin covered tissue measuring 1.3 cm  1.1 cm  1 cm .
this showed a nodular lesion 0.7 cm in its greatest axis 0.3 cm away from the nearest peripheral surgical cut margins . on microscopic examination
, section showed a nodular lesion lined by epidermis with varying degree of papillomatosis [ fig . 2 ] .
these were lined by two rows of cells . the luminal row consisted of columnar cells with evidence of active  decapitation  secretion and outer row of cells composed of small cuboidal cells .
on gross examination , skin covered tissue measuring 1.3 cm  1.1 cm  1 cm .
this showed a nodular lesion 0.7 cm in its greatest axis 0.3 cm away from the nearest peripheral surgical cut margins . on microscopic examination
, section showed a nodular lesion lined by epidermis with varying degree of papillomatosis [ fig . 2 ] .
these were lined by two rows of cells . the luminal row consisted of columnar cells with evidence of active  decapitation  secretion and outer row of cells composed of small cuboidal cells .
syringocystadenoma papilliferum is a rare benign tumor that is believed to be derived from the apocrine or the eccrine sweat glands . in a recent report
, immunohistochemistry proved the apocrine nature of the benign , noncystic lesion by virtue of its nuclear androgen receptor and cytoplasmic gross - cystic disease fluid protein-15 positivity , along with its smooth muscle actin - positive myoepithelial layer .
this is predominantly a childhood tumor ; however presentation at a later stage like our case has been described in literature . in half of those who are affected , it is present at birth , and in a further 1530% , the tumor develops before puberty .
the lesion is frequently misdiagnosed as basal cell carcinoma or cyst or squamous cell carcinoma . in a series of 14 patients ,
this is unlike other benign eyelid lesions , where histopathological diagnosis confirms clinical diagnosis in 95.9% cases .
tumor is usually described as a skin colored to pink , hairless , firm plaque of grouped nodules or as a solitary nodule .
cauliflower like , verrucous , papillary , hyperkeratotic , or sometimes moist fleshy excrescences have also been described .
most of the lesions develop and enlarge slowly , although a few can increase to significantly within a short period .
the plaque type that presents a hairless area of the scalp is commonly associated with a sebaceous nevus of jadassohn . in about one - third of the case ,
appearance of the lesion in the face and neck region is seen in the linear type ; however , a solitary nodular type shows predilection for the trunk .
syringocystadenocarcinoma papilliferum is a malignant counterpart of syringocystadenoma papilliferum . the diagnosis is clinically suspected and histologically confirmed .
ulceration or a rapid enlargement of an existing tumor is indicative of a malignant transformation .
we were suspicious in the index case because of the recent increase of size . in about one - tenth of cases of syringocystadenoma papilliferum
squmaous cell carcinoma may also develop , but much less frequently . because of this , surgical excision is the treatment of choice . in our case ,
excision of the tumor was done followed by repair of skin defect with median frontoglabellar pedicle skin flap .
 syringocystadenoma papilliferum can rarely affect eyelid skin . 
 the lesion is frequently misdiagnosed as basal cell carcinoma or cyst or squamous cell carcinoma . we are presenting a case that was clinically diagnosed as basal cell carcinoma of eyelid but was later histologically diagnosed as syringocystadenoma papilliferum . 
Case Report
Pathologic findings
Discussion
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