Hidradenoma Research Articles

Sweat gland tumor: A rare diagnosis of eyelid mass- A case report

Eccrine acrospiroma or Nodular hidradenomas are extremely rare sweat gland tumors of eyelid that arise as intradermal nodules from eccrine sweat glands. This case reports documents evaluation of a nodular mass of upper eyelid and its adequate management. Clinical examination followed by wide local excision and histopathologic evaluation of mass was done. Clinically, the mass was diagnosed as sebaceous cell carcinoma of eyelid. Post-operative histopathologic evaluation of the mass was suggestive of benign acrospiroma. Sweat gland tumors constitute of a very small proportion of eyelid tumors which often mimic other malignant tumors of eyelid.

MAML2 Positive Nodular Hidradenoma Presenting as a Subcutaneous Submental Mass – The Importance of Clinical Correlation

MAML2 Positive Nodular Hidradenoma Presenting as a Subcutaneous Submental Mass – The Importance of Clinical Correlation

Ancillary immunohistochemical and molecular testing in the classification of cutaneous sweat gland/duct neoplasms: A validation study with emphasis on histomorphologic correlation and pathological diagnosis

Sweat gland neoplasms represent a challenging area of dermatopathology, as they are relatively uncommon and often histopathologically complex. Recent studies have uncovered distinct immunohistochemical and molecular profiles in several sweat gland neoplasms, including digital papillary adenocarcinoma (DPA), papillary eccrine adenoma/tubular apocrine adenoma (PEA/TAA), poroid family tumors (PFT)/porocarcinoma, and clear cell hidradenoma (CCH)/clear cell hidradenocarcinoma (CCHCa). To further evaluate the diagnostic utility of ancillary studies in various sweat gland neoplasms, we performed an independent validation study in a cohort of patients with acral and non-acral tumors (9 DPA, 8 PEA/TAA, 13 PFT, 5 porocarcinoma, 23 CCH, 7 CCHCa, 6 sweat gland carcinoma not otherwise specified). p63 immunohistochemistry (IHC) demonstrated a myoepithelial pattern in 8/8 DPA and 4 of 4 tested PEA/TAA cases, and showed a ductal pattern in all tested PFT/porocarcinoma and CCH/CCHCa cases (42/42). All PEA/TAA (8/8) cases were positive for BRAF V600E IHC. 5 of 12 tested PFT and 5/5 porocarcinoma cases showed either positive staining with NUT IHC or harbored YAP1::NUTM1 fusion gene by RNA sequencing. MAML2 fluorescence in situ hybridization (FISH) was positive in all CCH and CCHCa cases (23/23 and 7/7, respectively). Our results further support the usefulness of appropriate ancillary studies in precise classification of sweat gland tumors, which may be routinely applied in diagnostic pathology practice when morphologic evaluation is in doubt.

Advancing precision medicine in cutaneous oncology through 3D high-frequency ultrasound imaging.

e13625 Background: Clinical assessment of tumor depth and shape often requires biopsy, especially when evaluating skin cancers. High Frequency Ultrasound (HFUS) is a non-invasive clinical tool that can quickly produce high resolution images ideally suited for evaluating topical tumors. In comparison to other imaging modalities, HFUS do not always provide the spatial data required to model 3-dimensional (3D) tumors. Currently, 3D-images are an amalgamation of many segmented image slices. However, in outpatient clinics it is unrealistic for HFUS devices and clinicians to gather large sets of image data. In our present original research, we aimed to overcome limited number of HFUS and dermatoscopic images by constructing a simple framework to process sparse and non-spatial data into working 3D skin tumor models. Methods: We analyzed two different skin tumors, the dermal duct tumor (DDT) and basal cell carcinoma (BCC), each with different number of HFUS images at 30Hz and 50Hz respectively. 1 set of 6 parallel images were obtained for the BCC, while 2 orthogonal sets of 6 parallel images were obtained for the DDT. For each tumor, a single dermatoscopic photo and sets of bitmap HFUS images with a resolution of 1024 x 512 were taken. Our study was IRB-approved. Mathematica and MATLAB, both with accessible documentation, were used to process images. Results: We developed a novel algorithmic approach to produce 3D tumor models with limited medical data. Both tumors appear corporally hypoechoic under HFUS. Mathematica was used to first reduce HFUS image noise and binarize the tumor region with a bilateral Gaussian filter. The user-friendly MATLAB Image Segmenter application manually filled the region of interest. Next, Mathematica was used to orient and plot tumor borders in 3D. Finally, we encompassed the borders with a 3D convex hull to conservatively predict tight margins around the tumor. Conclusions: Our simplified approach allows clinicians and scientists to produce 3D renderings of tumor margins. Margin control must always be balanced with a positive surgical outcome. By approaching our 3D-model with a convex hull around sampled border cross-sections, we chose a conservative approach that focuses skin tumor margin evaluation. Our results promote precision medicine and planning into the current standard of skin cancer treatment. Our findings can allow tracking tumor progression or treatment possible via non-invasive evaluation of tumor depth and contour. An aim of our present research is to lower the barrier of 3D construction in clinical settings. Simple algorithms, such as shown in our work, transform orthogonal and sparse data into usable data that can be implemented to train machine learning and artificial intelligent programs. Future research tailoring this approach may allow instant programming of HFUS images to non-invasively render cutaneous tumor borders and depth in real time during clinical examination.

Case Report: Thigh hidradenoma masquerading as lipoma

Background: Hidradenomas are benign adnexal neoplasms which were recently been subdivided into two groups: eccrine differentiation (poroid hidradenomas) or apocrine differentiation (clear cell hidradenomas) with the latter being rarer. These types of tumors have been associated with recurrence and malignant transformation, however; recurrence and malignancy are considered very rare. We present a case report of a 35-year-old male who presented with two lumps, clinically representing simple lipomas but one of them turned to be a hidradenoma.

Expression of Early Growth Response 3 in Skin Cancers.

To assess the expression of early growth response 3 (EGR3) in normal skin and different types of skin tumors: cutaneous squamous cell carcinoma (cSCC), basal cell carcinoma (BCC), melanoma (MM), and cutaneous adnexal tumors containing sebaceous carcinoma (SC), trichoepithelioma (TE) and clear cell hidradenoma (CCH). EGR3, expressed in multiple organs, including skin, plays an important role in cell differentiation and tumor growth. Previous studies have shown that EGR3 suppresses tumor growth and is downregulated in various malignancies. However, its distribution in normal skin and its expression especially in skin tumors have not been studied. Samples of normal cases (n = 4), cSCC (n = 12), BCC (n = 12), MM (n = 12), SC (n = 4), TE (n = 4), and CCH (n = 4) were collected from patients treated in our department between 2018 and 2023. Immunohistochemistry was used to investigate the expression of EGR3. The results were analyzed with the description of the staining pattern and the histochemical score. Immunohistochemical staining showed that EGR3 was uniquely expressed in normal skin in the granular layer and upper part of the stratum spinosum, as well as in sebaceous glands and hair follicles, but not in sweat glands. In skin cancers, BCC, SC, and TE showed positive EGR3 staining, whereas cSCC, MM, and CCH were negative. EGR3 has a specific expression pattern in normal skin and in skin tumors, which is important for the differential diagnosis of skin tumors, in particular for cSCC and sebaceous gland carcinoma.

Nodular Hidradenoma of the Scalp: A Rare Case Report

Nodular hidradenoma is a rare benign tumour originating from eccrine or apocrine sweat glands. While documented cases exist in the medical literature, nodular hidradenoma of the scalp is relatively uncommon. We present a rare case of nodular hidradenoma located on the scalp to contribute to the limited knowledge regarding its clinical presentation, diagnosis, management and outcomes in this specific anatomical site. We present a case of a 45-year-old female with a nodular hidradenoma of the scalp. The patient complained of a slow growing swelling, itchy, slightly tender scalp lump over 9 years period. Clinical examination revealed a well-defined, firm nodule measuring 3.5 x 3 cms in diameter with 2 cms wide stalk. The patient underwent complete surgical excision, resulting in a favourable outcome for regular follow up to one year

Cutaneous balloon-cell melanoma metastases to the axillary lymph node: Exploring cytomorphologic features and differential diagnoses on fine needle aspiration biopsy.

Balloon cell melanoma (BCM) is an exceptionally uncommon histological variant, making up <1% of all malignant melanomas. Diagnosing balloon cell melanoma on cytological specimens can be challenging due to its scarcity and its similarity to other medical conditions. A comprehensive clinical assessment and histological analysis, coupled with immunohistochemical staining, play a crucial role in distinguishing balloon cell melanoma from various benign and malignant skin conditions. The differential diagnoses encompass spitz nevus, balloon cell nevus, clear cell sarcoma of tendons and aponeuroses (melanoma of soft tissues), metastatic clear cell renal cell carcinoma, sebaceous carcinoma, and benign adnexal tumours like clear cell hidradenoma. Malignant melanoma encompasses a spectrum of histopathological subtypes, each with unique clinical and cytological characteristics. Notably, balloon-cell melanoma (BCM) emerges as an exceptionally rare and diagnostically challenging variant. Marked by the presence of distinct balloon-like, clear cytoplasmic vacuoles within melanoma cells, BCM stands apart from other melanoma subtypes. Despite its rarity, the distinctive cytological features of BCM make it a compelling subject of investigation, emphasizing the crucial role of Fine Needle Aspiration (FNA) cytology in ensuring accurate diagnosis and guiding subsequent management decisions.

Poroid Neoplasms: A Clinicopathological Study of 13 Cases.

Poroid neoplasms (PN) are a heterogeneous group of tumors deriving from sweat glands and folliculo-sebaceous units. Their histological classification and clinical features are challenging. Our aim was to report clinicopathological features of poroid neoplasms. It is a retrospective study including all cases of poroid neoplasms registered at our Pathology laboratory of Niamey National Hospital (February 2020-February 2024). We registered 13 cases of benign poroid neoplasms: 10 classic poromas (CP) (76.9%), 2 poroid hidradenomas (PH) (15.4%) and 1 dermal duct tumor (DDT) (7.7%). Nine cases (69.2%) had preoperative clinical diagnosis of malignancy. The mean age was 41.1 years (range of 12-70 years) with a slight female predominance. Only 4/13 cases (30.8%) had classical palmoplantar locations. The tumors mean size was 3.7 cm (range of 0.4-8 cm). Clear cells were present in 7 cases (53.8%), apocrine ductal differentiation (mixed or pure) in 6 cases (46.2%), keratin horns in 2 cases (15.4%), squamous eddies in 6 cases (46.2%), melanin pigments in 1 case (7.7%) and sebaceous differentiation in 2 cases (15.4%). Unlike what is classically reported, our study shows that apocrine ductal differentiation, younger age and non-palmoplantar locations are common in poroid neoplasms.

Role of Cytology for Diagnosis of Appendageal Tumours and Comparison with Histopathology: A Cross-sectional Study

Introduction: Skin adnexal neoplasms are quite rare in routine pathology practice, yet the domain of Fine Needle Aspiration Cytology (FNAC) remains relatively unexplored. This current study explored different Adnexal Tumours (ATs) through FNAC, emphasising the efficacy of cytological diagnosis as a safe, simple, quick, and cost-effective tool with high sensitivity and specificity for diagnosing skin ATs. Aim: To diagnose various appendageal tumours through cytological examination, confirm and categorise them (benign/ malignant) via histopathological examination, and identify any cytohistological discrepancies. Materials and Methods: This retrospective cross-sectional study was conducted over a five-year period (January 2016- December 2021) at the Department of Pathology, Nil Ratan Sircar Medical College and Hospital (NRSMCH) in Kolkata, West Bengal, India, following ethical approval. Patients underwent history and physical examination followed by FNAC. ATs were diagnosed cytologically in 78 out of 23,852 FNAC cases. The results were compared with histopathological diagnosis to assess concordance or discordance based on predefined criteria. Leishman-Giemsa (L&amp;G) stain was used for cytological examination, and Haematoxylin and Eosin (H&amp;E) stain for histopathology. Results: Cytologically, ATs were diagnosed in 78 cases (0.33%), with the majority being benign 69 (88.46%). There was a female preponderance (49, 62.82%) with a male-to-female ratio of 1:1.7. Nodular Hidradenoma (NH) was the most common diagnosis (16/48=33.33%). Out of 59 biopsy-confirmed lesions, 55 showed cytohistological concordance (93.22%), with only four discordant cases (6.78%). The sensitivity, specificity, positive predictive value, and negative predictive value for detecting malignancy in this series were 70%, 97.90%, 87.50%, and 94.10%, respectively. Conclusion: FNAC should be the primary choice for detecting skin ATs due to its safety, reliability, high predictive value, and low chance of discordance. Although occasional cytohistological discrepancies may occur, proper clinical correlation, aspiration from multiple sites, expert cytopathologists, and high-quality staining are essential to avoid misdiagnosis.

Nodular hidradenoma of eyelid – A rare case with cyto-histo corelation

Nodular hidradenomas is an uncommon benign adnexal tumor that arises as nodules from eccrine sweat glands. Although it can appear at various sites, its occurrence in eyelids is extremely rare. The diagnosis is usually confirmed on histopathology, and the lesion poses a diagnostic challenge for cytopathologist and is rarely diagnosed on fine aspiration needle cytology (FNAC), which prompted us to report. Here we report a rare case of Nodular Hidradenoma in a 50-year male, that was initially diagnosed on FNAC and later confirmed on histopathology and IHC. Thus, our study emphasizes that FNAC can be used as a first line diagnostic modality for nodular lesions of skin.

Clear Cell Hidradenoma with Extensive Mucinous Change in the Axillary Tail of Breast as Mimicker: A Rare Case Report

Introduction: Clear cell hidradenoma (CCH) is a rare benign tumor of sweat gland. It can mimic other diseases clinically, radiologically and histologically when found in axilla. Methods: A 62-year-old female presented with a solitary lump in the axillary tail of her breast. Differentials in clinical examination and imaging were breast neoplasm and lymph nodal mass. Results: The patient underwent preoperative diagnostic workup, and the lesion was suspicious of hidradenoma. She underwent wide excision of the lesion. The final histopathological examination was suggestive of CCH with extensive mucinous change. Conclusion: Even though rare, hidradenoma should always be kept as a differential when presented as a solitary painless swelling. The present case represents diagnostic challenges involved during the course of her management and accurate use of preoperative tools, which helped in the diagnosis of the case before the definitive treatment.

Transcriptional repressor GATA binding 1 (TRPS1) immunoexpression in normal skin tissues and various cutaneous tumors.

Transcriptional repressor GATA binding 1 (TRPS1) is a transcription factor recently shown to play a role in the development of breast and liver cancer. Here, we evaluate TRPS1 immunoexpression in normal skin tissues and various cutaneous tumors. TRPS1 immunohistochemistry was performed in 109 cases of primary cutaneous tumors and 19 cases of metastatic carcinomas. TRPS1 expression was also evaluated in the normal skin tissues. The normal epidermis was TRPS1-. In contrast, the eccrine apparatus, epithelial compartment of the hair follicles, hair papilla, sebaceous glands, and anogenital mammary-like glands were TRPS1+. In primary cutaneous tumors, TRPS1 positivity varied in poroma (2/3), nodular hidradenoma (4/5), spiradenoma (4/4), cutaneous mixed tumor (5/5), trichilemmal cyst (7/8), proliferating trichilemmal tumor (1/3), pilomatricoma (9/9), sebaceoma (2/5), extramammary Paget disease (13/13), sebaceous carcinoma (2/2), actinic keratosis (3/10), Bowen disease (7/12), and squamous cell carcinoma (1/5) cases. All cases of seborrheic keratosis, basal cell carcinoma, Merkel cell carcinoma, and malignant melanoma were TRPS1-. All metastatic breast carcinoma cases (8/8) were highly positive for TRPS1, while all but one of the other metastatic tumor cases were TRPS1-. TRPS1 immunoexpression was observed in several skin appendages and cutaneous tumors.

Remote Possibility of Post Aural Swelling as Nodular Hidradenoma: A Case Report.

A 30-year-old female patient presented with swelling over the left post aural region of 6 months duration which gradually increased in size. Cutaneous examination: A solitary, non-tender, mobile swelling of variable consistency over the post aural region. Dermoscopic examination: Revealed white and red areas. Diagnosis of nodular hidradenoma was made by histopathological examination.

Genetic and Immunohistochemical Profiling of Mammary Hidradenoma and Comparison to Mucoepidermoid Carcinoma

Mucoepidermoid carcinoma (MEC) is exceedingly rare in the breast, with <45 cases reported in the literature. Although estrogen receptor/progesterone receptor/human epidermal growth factor 2 triple-negative, MEC is characterized as a special subtype of breast carcinoma with significantly better prognosis than conventional basal-type tumors. Cutaneous hidradenoma (HA) is considered a benign adnexal neoplasm showing histomorphologic overlap with MEC. Rare cases of HA have also been reported in the breast, but these are relatively uncharacterized. In this study, we examined the clinicopathologic, immunohistochemical (IHC), and genetic features of 8 breast HAs, in comparison to 3 mammary MECs. All cases were positive for MAML2 break-apart fluorescence in situ hybridization. Eight cases demonstrated a CRTC1::MAML2 fusion, and one MEC harbored a CRTC3::MAML2 fusion; the latter is a novel finding in the breast. Mutational burden was very low, with only one HA exhibiting a MAP3K1 pathogenic alteration. By IHC, both MEC and HA demonstrated cell type–dependent expression of high- and low-molecular-weight keratins and p63, as well as negative to low-positive estrogen receptor and androgen receptor. Smooth muscle myosin and calponin highlighted an in situ component in the 3 cases of MEC; expression of these myoepithelial markers was negative in HAs. Additional distinguishing characteristics included the growth pattern and tumor architecture, the presence of glandular/luminal cells in HA, and overall higher IHC expression of SOX10, S100 protein, MUC4, and mammaglobin in MEC. Morphologic findings were also compared to a series of 27 cutaneous nonmammary HAs. Mucinous and glandular/luminal cells were identified in significantly more mammary HAs than nonmammary lesions. The findings provide insight into the pathogenesis of MAML2-rearranged neoplasms of the breast, underscore the overlapping genetic features of MEC and HA, and highlight similarities to their extramammary counterparts.

Clear Cell Hidroacanthoma Simplex: A Case Report

Introduction: Hidroacanthoma simplex (HAS) is a benign eccrine adnexal neoplasm without characteristic clinical manifestations. Histopathologically, basaloid and poroid cell nests with ductal structure constitute the gold standard for diagnose. We herein report a extremely rare subtype of HAS with clear cell infiltration under hematoxylin-eosin staining. Case presentation: A 70-year-old woman gradually developed an asymptomatic proliferative lesion for 4 years. The tumor was surgically removed without recurrence. Histopathologic results showed intraepidermal poroid cell nests with lumina-like structures. While, cells in the center of the tumor showed obvious abnormal transparency of the cytoplasm, forming clear cells. PAS glycogen staining showed diffusely positive. Discussion: Hidroacanthoma simplex is an intraepidermal epithelioma, forming by acanthotic epidermis and cystic or ductal structure. Theoretically, HAS tumor cells lack of the ability to secrete cellular glycogen and lipid, and thus cannot further form clear cells. Thus, the initiating factor of its generation and its meaning of existence need to be further discussed. Besides, diseases requiring identification are also listed in detail. Conclusion: Clear cell hidroacanthoma simplex is a rare pathological subtype of HAS. Raising awareness of its various differential diagnoses, minimizing the possibility of misdiagnosis become important for dermatologists.

Nodular Hidradenoma Breast—a Rare Case Report with Review of Literature

Nodular Hidradenoma Breast—a Rare Case Report with Review of Literature

Clinicopathological Profile of Nodular Hidradenoma: A ten year Study in a Tertiary Care Center.

Nodular hidradenoma is a rare skin adnexal tumor of eccrine differentiation with predominant site being scalp and axillae. Due to its variable locations and unusual clinical presentation and no definite radiological criteria, histopathology seems to be the mainstay in diagnosing these tumors. Most of the lesions present as a cystic swelling and was clinically thought to be a sebaceous cyst/metastasis/carcinoma/sarcoma. In our study, we have included 37 cases and compared its varied clinical and radiological presentation.

Histomorphological Spectrum of Adnexal Tumours of the Skin: A Descriptive Study from a Tertiary Care Centre in Karnataka, India

Introduction: Skin Adnexal Tumours (SAT) are a category of rare and most uncommon tumours. They could display multiple lines of differentiation such as follicular, eccrine, apocrine, sebaceous, and sometimes mixed differentiation, generating a mistaken diagnosis that might lead to unwarranted and unnecessary interventions. Aim: To describe the types and microscopic features of adnexal tumours. Materials and Methods: The present study was a retrospective study on SAT received for histopathology at the Department of Pathology, Mandya Institute of Medical Sciences, Mandya, Karnataka, India, from January 2018 to June 2022 during the study period of September 2022 to March 2023. The records of patients including age, gender and site were retrieved from the registers maintained at the department and Haematoxylin and Eosin (H&amp;E) stained slides were examined and the data was analysed by descriptive statistics. Results: A total of 62 cases were included in the study out of which, 59 (95.2%) cases were found to be benign and 3 (4.8%) cases were malignant. The mean age was found to be 43.87 years. A total of 28 (45.1%) cases were seen in the age group of 21 to 40 years. Females outnumbered the males with 32 cases (51.6%). A maximum number of cases belonged to the group of sweat gland tumours (29/62, 46.8%) followed by hair follicle tumours (21/62, 33.9%) and sebaceous gland tumours (12/62, 19.3%). Nodular hidradenoma was the commonest sweat gland tumour (12/29, 41.4%), pilomatricoma was the commonest hair follicle tumour (10/21, 47.6%) and sebaceous adenoma was the commonest sebaceous gland tumour (10/12, 83.3%). The most common malignancy was sebaceous carcinoma (2/3, 66.67%). The male-to-female ratio was found to be 1:1.06. Conclusion: The incidence of SAT was low with the majority being benign tumours. Malignant tumours are even rarer and are often mistaken for cutaneous epithelial malignancies. These lesions may prompt the clinician towards unwanted surgery or treatment for the patient. They exhibit a wide variety of morphological patterns which may be confused for primary from other sites. In such cases, histopathological examination becomes necessary. Hence, a combination of good clinical expertise and histopathological confirmation by the pathologist helps appropriately manage the patient.

Hidradenocarcinoma Treated with Mohs Surgery

Hidradenocarcinoma (HAC) is an exceedingly rare and aggressive malignant tumor of the adnexal eccrine and apocrine sweat gland. Due to its low incidence rate, nonspecific clinical presentation, and similar histopathological features to benign hidradenoma (HA), HAC is often misdiagnosed as its benign counterpart.