|Year : 2014 | Volume
| Issue : 4 | Page : 248-250
Nodular hidradenoma over the chin: A rare presentation
Siddharth P Dubhashi1, Rajat D Sindwani1, Harsh Kumar2, Aparna Dharwadkar2
1 Department of Surgery, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
2 Department of Pathology, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
|Date of Web Publication||16-Oct-2014|
Siddharth P Dubhashi
A-2/103, ShivranjanTowers, Someshwarwadi, Pashan, Pune - 411 008, Maharashtra
Source of Support: None, Conflict of Interest: None
Nodular hidradenoma is an uncommon benign adnexal tumor arising from the eccrine sweat glands. It occurs as a slow growing, nodular, solid or cystic, protruding cutaneous mass, which may exhibit serous discharge or ulceration. The lesions are commonly seen in women on head, neck, and limbs. This is a case report of an 85-year-old lady who presented with a slowly progressive nodular protruding mass over the chin. Nodular hidradenoma is an uncommon benign tumor of sweat glands. The clinician and the pathologist should have a strong index of suspicion to detect the lesion. Complete surgical excision is warranted with a close follow-up.
Keywords: Apocrine, clear, eccrine, hidradenoma, polyhedral, surgical excision
|How to cite this article:|
Dubhashi SP, Sindwani RD, Kumar H, Dharwadkar A. Nodular hidradenoma over the chin: A rare presentation. Int J Health Allied Sci 2014;3:248-50
|How to cite this URL:|
Dubhashi SP, Sindwani RD, Kumar H, Dharwadkar A. Nodular hidradenoma over the chin: A rare presentation. Int J Health Allied Sci [serial online] 2014 [cited 2020 Apr 5];3:248-50. Available from: http://www.ijhas.in/text.asp?2014/3/4/248/143065
| Introduction|| |
Nodular hidradenoma is an uncommon benign adnexal tumor arising from the eccrine sweat glands.  It is also known as clear cell hidradenoma, acrospiroma, or solid cystic hidradenoma.  It occurs as a slow growing, nodular, solid or cystic, protruding cutaneous mass, which may exhibit serous discharge or ulceration.  The lesions are commonly seen on head, neck and limbs.  They are most frequently diagnosed from fourth to eighth decade of life and are common in women than in men. ,
| Case report|| |
An 85-year-old female presented with a 6 years history of an asymptomatic swelling over the chin which was insidious in onset and gradually progressive in size. The nodular swelling measured approximately 6 cm × 5 cm in size, was nontender, mobile, and variegated inconsistency. The overlying skin was ulcerated at one point with evidence of serous discharge [Figure 1]. There was no cervical lymphadenopathy. There was no evidence of bony involvement on radiological imaging [Figure 2]. The general condition of the patient was normal. Clinical diagnosis of multiple sebaceous cysts was made. A wide local excision of the lesion was performed. The cut section of the well-encapsulated mass showed lobules separated by fibrous septae [Figure 3]. Histopathological examination revealed a well-circumscribed neoplasm in the dermis, extending up to subcutaneous tissue. It showed tubular lumina of various sizes, some of which appeared cystic, containing an eosinophilic homogenous material. There were solid nests of tumor cells of two types: Polyhedral with basophilic cytoplasm and other with clear cytoplasm. Some cells also showed epidermoid differentiation, with keratinization and formation of horn pearls. Mitosis was absent. Periodic acid-Schiff (PAS) staining revealed positive results. The findings were consistent with the diagnosis of nodular hidradenoma [Figure 4],[Figure 5] and [Figure 6]. The sections reported tumor-free margins. The patient has been asymptomatic over a follow-up of 8 months.
|Figure 4: Well-circumscribed tumor in the dermis composed of cystic spaces of varying sizes (H and E, ×4)|
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|Figure 5: Solid portion of the tumor with fusiform cells and elongated nuclei. Some cells also show clear cell change (H and E, ×40)|
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|Figure 6: Epidermoid differentiation with keratinized cells and the formation of horn pearls (H and E, ×10)|
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| Discussion|| |
The first case of nodular hiradenoma was described in the literature by Delacretaz and Leresche.  It is also called as clear cell myoepithelioma, eccrine sweat gland adenoma of clear cell type. The origin of the lesion is reported as eccrine based on the number of mitochondria, glycogen granules, and enzyme histochemistry.  Some mention it as of the apocrine origin.  It is a slow growing tumor, and rapid growth may indicate trauma, hemorrhage or a malignant change.  Histopathology shows both solid and cystic components. The solid portion contains two types of cells: Polyhedral with basophilic cytoplasm and glycogen containing clear cells with clear cytoplasm and round nucleus. Cystic areas probably result from degeneration of tumor cells. , Clear cell hidradenoma shows positive staining with PAS, cytokeratin and p63. , Our case showed a positive reaction with PAS. The exact frequency of atypical clear cell hidradenoma and their risk of transformation into malignant tumors is not known. Malignant hidradenomas usually arise de novo.  Malignant transformation is characterized by nuclear atypia, mitosis, and invasion into surrounding tissue.  Biddlestone et al. have reported a case of young female with a malignant change in a nodular hidradenoma with metastasis over a period of 11 years.  Lesions appearing benign clinically may show focal nuclear polymorphism with increased mitotic activity and clinically aggressive looking tumors may exhibit a benign histology.  Our case appeared aggressive clinically with evidence of ulceration and discharge, but had no features of nuclear atypia or invasion. The treatment of nodular hidradenoma is wide surgical excision to minimize the risk of recurrence, with histological confirmation of the same. ,
| Conclusion|| |
Nodular hidradenoma is an uncommon benign tumor of sweat glands. The clinician and the pathologist should have a strong index of suspicion to detect the lesion. Complete surgical excision is warranted with a close follow-up.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]