Submit Manuscript | http://medcraveonline.com Introduction Chondroid syringoma is an uncommon skin adnexal tumor which arises from both the secretory as well as the ductal elements of the sweat gland. Among all the primary tumors of the skin, the reported incidence of chondroid syringoma is low, ranging between 0.01% to 0.098% and it exists in two forms i.e. benign and malignant. 1,2 The benign type has a predilection for the head and neck region of the middle-aged men whereas, the malignant type is more commonly encountered at the extremities of the females and is characterized by rapid growth, local invasion, and distant metastasis. 3 We describe a rare case of a benign chondroid syringoma with an atypical location on the left foot of a 40-year-old female and also highlight the pivotal role of cytology in such an unusual setting. Case report A 40-year-old illiterate female from a rural background presented to the orthopaedic outpatient department with a swelling over the lateral border of the left foot in the midfoot area since last 15 years. She revealed that the swelling was initially pea sized but gradually over a period of last 6 months it has increased in its size. History of any trauma, pain, itching or infection of this area was non- contributory. Her personal, past, family and medical history was insignifcant. Local examination of the left foot revealed a non-tender, mobile, frm swelling that measured 1x0.8cm in size. The overlying skin was normal (Figure 1). Her hematological investigations revealed microcytic hypochromic anemia with hemoglobin level of 10.5gm/dl, total leucocyte count of 10,500/mm 3 with diferential being of 75% neutrophils and a platelet count of 2,00,000/mm 3 . The erythrocyte sedimentation rate was 18cumm/hr. Renal as well as liver function tests were normal. Urine and blood cultures were negative. X-ray of the left foot showed a well-defned soft tissue mass in the midfoot area without any bony involvement (Figure 2). Based on the history of the patient and the clinical fndings, a provisional diagnosis of a benign mesenchymal lesion was made. To arrive at a conclusive diagnosis, Fine Needle Aspiration Cytology (FNAC) was performed. Two passes at two diferent sites of the lesion were done. Thick mucoid material was aspirated in both the attempts. This material was pushed onto the clean glass slides and the smears were drawn. The smears prepared, were stained with May-Grunwald-Giemsa (MGG) stain followed by microscopic examination. FNAC smears were cellular on microscopy and revealed distinct epithelial and mesenchymal components. The epithelial cells were round and had moderate amount of cytoplasm with a central round to oval bland nucleus having fnely dispersed chromatin. The myoepithelial cells were larger and had moderate to abundant amount of pale blue cytoplasm and an eccentric round nucleus giving the cell a plasmacytoid appearance. Both these cell types were embedded within the chondromyxoid fbrillary stroma. There was no evidence of any nuclear atypia, prominent nucleoli or tumor diathesis (Figure 3). Based on these cytomorphological fndings, a diagnosis of a benign chondroid syringoma of the left foot was rendered and excision of the mass was advised. The mass was resected along with a margin of the normal surrounding tissue and the specimen was sent for histopathological examination. Grossly, the mass was partly skin covered, grey white to grey brown in color, well- circumscribed, frm in consistency and measured around 1x1x0.5cm in size. On cut section, it was greyish white and had focal cystic spaces which were flled with mucoid material. Formalin fxed parafn embedded routine Hematoxylin and Eosin stained microsections revealed a well-circumscribed tumor comprising of proliferating epithelial cells, interspersed in chondromyxoid and fbrocollagenous stroma. Numerous nests of polygonal cells and interconnecting tubuloalveolar structures lined by two layers of cuboidal epithelial cells were seen. Ductal structures lined by a single layer of epithelial cells were also apparent. Cellular pleomorphism was absent (Figure 4). These histopathological fndings pointed towards the fnal diagnosis of a benign chondroid syringoma (eccrine type) of the left foot. Immunohistochemistry (IHC) was also performed, which revealed a strong positivity of inner epithelial layer for cytokeratin (CK) 7 as well as epithelial membrane antigen (EMA) and the outer myoepithelial layer for vimentin, S100 and p63. A negative immunoexpression of tumor cells for p15, p16 and desmin was seen. The post-operative period of the patient was uneventful. There was no evidence of recurrence of the lesion during her 2 year follow-up period. J Cancer Prev Curr Res . 2020;11(2):27‒30. 27 ©2020 Sharma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Benign chondroid syringoma of foot: a clinical dilemma Volume 11 Issue 2 - 2020 Sonam Sharma, 1 Sansar Chand Sharma 2 1 Department of Pathology, Kalpana Chawla Government Medical College, Karnal, India 2 Department of Orthopaedics, Faculty of Medicine and Health Sciences, SGT University, Gurgaon, India Correspondence: Sonam Sharma, Department of Pathology, Kalpana Chawla Government Medical College, Karnal, Haryana, India, Tel 9999841393, Email Received: January 31, 2020 | Published: March 11, 2020 Abstract Chondroid syringoma is a rare skin appendageal tumor which is most commonly encountered in the head and neck region. We herein report an unusual case of a benign chondroid syringoma of the left foot in a 40-year-old female which posed as a diagnostic conundrum. The approach to such a case, diferential diagnosis and the management of this rare entity is also presented. Keywords: benign, chondroid syringoma, cytology, foot Journal of Cancer Prevention & Current Research Case Report Open Access