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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 3  |  Issue : 4  |  Page : 248-250

Nodular hidradenoma over the chin: A rare presentation


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 Publication16-Oct-2014

Correspondence Address:
Siddharth P Dubhashi
A-2/103, ShivranjanTowers, Someshwarwadi, Pashan, Pune - 411 008, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.143065

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  Abstract 

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 2019 Nov 22];3:248-50. Available from: http://www.ijhas.in/text.asp?2014/3/4/248/143065


  Introduction Top


Nodular hidradenoma is an uncommon benign adnexal tumor arising from the eccrine sweat glands. [1] It is also known as clear cell hidradenoma, acrospiroma, or solid cystic hidradenoma. [2] It occurs as a slow growing, nodular, solid or cystic, protruding cutaneous mass, which may exhibit serous discharge or ulceration. [3] The lesions are commonly seen on head, neck and limbs. [4] They are most frequently diagnosed from fourth to eighth decade of life and are common in women than in men. [5],[6]


  Case report Top


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 1: Nodular swelling over chin with evidence of ulceration

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Figure 2: X-ray mandible

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Figure 3: Cut section of specimen

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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 Top


The first case of nodular hiradenoma was described in the literature by Delacretaz and Leresche. [7] 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. [6] Some mention it as of the apocrine origin. [8] It is a slow growing tumor, and rapid growth may indicate trauma, hemorrhage or a malignant change. [9] 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. [1],[6] Clear cell hidradenoma shows positive staining with PAS, cytokeratin and p63. [6],[10] 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. [11] Malignant transformation is characterized by nuclear atypia, mitosis, and invasion into surrounding tissue. [10] 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. [9] Lesions appearing benign clinically may show focal nuclear polymorphism with increased mitotic activity and clinically aggressive looking tumors may exhibit a benign histology. [8] 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. [1],[9]


  Conclusion Top


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 Top

1.
Jagia R, Abdelaziz N. Nodular hidradenoma presenting as solitary scalp nodule. Gulf J Dermatol Venereol 2012;19:44-6.  Back to cited text no. 1
    
2.
Winkelmann RK, Wolff K. Solid-cystic hidradenoma of the skin. Clinical and histopathologic study. Arch Dermatol 1968;97:651-61.  Back to cited text no. 2
[PUBMED]    
3.
Dhingra KK, Mandal S, Khurana N. An unusual case of nodular hidradenoma of breast. Iran J Pathol 2007;2:80-2.  Back to cited text no. 3
    
4.
Orsaria M, Mariuzzi L. Recurrent eccrine hidradenoma of the breast in a male patient: Problems in differential diagnosis. Our Dermatol Online 2013;4:215-7.  Back to cited text no. 4
    
5.
Faulhaber D, Wörle B, Trautner B, Sander CA. Clear cell hidradenoma in a young girl. J Am Acad Dermatol 2000;42:693-5.  Back to cited text no. 5
    
6.
Yildiz B, Ozdemir F, Cobanoglu U, Kavgaci H, Fidan E, Aydin F. Clear cell hidradenoma of the gluteal region: A case report. Acta Dermatovenerol Croat 2009;17:144-6.  Back to cited text no. 6
    
7.
Delacretaz J, Leresche A. Hidradenoma of the clear cells. Rev Med Suisse Romande 1958;78:130-5.  Back to cited text no. 7
[PUBMED]    
8.
Gianotti R, Alessi E. Clear cell hidradenoma associated with the folliculo-sebaceous-apocrine unit. Histologic study of five cases. Am J Dermatopathol 1997;19:351-7.  Back to cited text no. 8
    
9.
Biddlestone LR, Mclaren KM, Tidman MJ. Malignant hidradenoma - A case report demonstrating insidious histological and clinical progression. Clin Exp Dermatol 1991;16:474-7.  Back to cited text no. 9
    
10.
Volmar KE, Cummings TJ, Wang WH, Creager AJ, Tyler DS, Xie HB. Clear cell hidradenoma: A mimic of metastatic clear cell tumors. Arch Pathol Lab Med 2005;129:e113-6.  Back to cited text no. 10
    
11.
Thami GP, Kaur S, Mohan H. Atypical clear cell hidradenoma. Indian J Dermatol Venereol Leprol 2003;69:43-5.  Back to cited text no. 11
  Medknow Journal  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


This article has been cited by
1 Nodular hidradenoma: a series of five cases in male subjects and review of literature
Sant Prakash Kataria
Advances in Cytology & Pathology. 2018; 3(2)
[Pubmed] | [DOI]



 

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