Reactive eccrine syringofibroadenoma in an elderly patient

Eccrine syringofibroadenoma (ESFA) is an uncommon benign adnexal tumor with eccrine differentiation, with fewer than 100 cases reported worldwide. Since its initial description, several clinical subtypes have been recognized, including a reactive form associated with chronic inflammatory or neoplastic conditions. We report the case of an 88-year-old man with extensive reactive ESFA developing in the setting of long-standing postthrombotic lymphedema and neglected ulceration. The patient presented with poor general health, bilateral pleural effusions, multiple verrucous nodules, severe stasis ulcers, and secondary polymicrobial and fungal infections. Histopathologic examination of a nodule demonstrated interconnecting cords of cuboidal epithelial cells with ductal structures within a fibrovascular stroma, consistent with eccrine differentiation and diagnostic of ESFA. Management focused on infection control, wound care, and supportive therapy, as surgical excision and amputation were not suitable options. Clinical improvement was achieved; however, ongoing monitoring was advised because of the potential for malignant transformation. This case highlights the role of chronic tissue injury in the pathogenesis of reactive ESFA and underscores the importance of histopathology for diagnosis, multidisciplinary collaboration in management, and individualized treatment planning in elderly patients with advanced comorbidities.