Skin nonmelanocytic tumor

Topic Completed: 1 January 2015

Minor changes: 13 December 2019

Copyright: 2002-2019,, Inc.

PubMed Search: Apocrine cystadenoma [title] skin

Ghassan A. Tranesh, M.D.
Hong Qu, M.D.
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Cite this page: Tranesh GA, Qu H. Hidrocystoma. website. Accessed September 29th, 2020.
Definition / general
  • Uncommon benign adenomatous cystic proliferation derived from apocrine glands
  • Also called apocrine hidrocystoma, although apocrine cystadenoma may be preferable for lesions with true papillary projections and active epithelial secretions; these lesions are usually small (< 2 cm), on face of older adults (see also J Cutan Pathol 1997;24:249)
  • Despite its apocrine derivation, rare at sites rich in normal apocrine glands (groin, axilla, anogenital region, eyelids [Moll's glands], ears [ceruminous glands])
  • Usually solitary, but multiple lesions have been documented
  • Often occurs as cystic lesion of head and neck (commonly check), rarely in axilla
  • Similar lesion on eyelid known as Moll's gland cyst
Clinical features
  • Presents as intradermal, moderately firm, dome-shaped, translucent, blue, bluish-black or purple cystic nodule up to 1 cm
  • No gender preference
  • Lesions on face, also called Robinson variant, usually in middle aged women
  • Solitary lesions are not familial, but multiple apocrine hidrocystomas are a feature of ectodermal dysplasia (Acta Derm Venereol 2008;88:607) and focal dermal hypoplasia (Goltz syndrome)
  • Although solitary apocrine hidrocystomas lack seasonal variation, multiple lesions in some patients worsen in summer or with excessive heat and improve during winter
  • May be precursor to apocrine carcinoma
Case reports
  • Complete excision recommended
Clinical images

Images hosted on other servers:

Eyelid, malar area, ear lobe

Dome shaped cystic mass

Lesion below lower lip

Capsule in subepidermis

Skin-colored nodules

Gross description
  • Unilocular cystic lesion with clear to brown fluid
Microscopic (histologic) description
  • Large unilocular or multilocular cystic space within dermis
  • Fibrous pseudocapsule is often present
  • Typically, cystic spaces are lined by double layer of epithelial cells: an outer layer of flattened vacuolated myoepithelial cells and an inner layer of tall columnar cells with eosinophilic cytoplasm and basally located, round or oval vesicular nuclei
  • Decapitation secretion is usually present
  • Often adjacent to hyperplastic apocrine glands
Microscopic (histologic) images

Contributed by Angel Fernandez-Flores, M.D., Ph.D.

Images hosted on other servers:

Courtesy of Dr. V. Zaitsev

Decapitation secretion

Cyst wall

SMA, MIB1, GCDFP-15, CK7, CK18, CK19

Positive stains
Electron microscopy description
  • Two types of cells: secretory cells with granules resembling lipid droplets, and basal (myoepithelial) cells
  • Lumen filled with cytoplasmic fragments detached from apical portions of secretory cells (Arch Dermatol 1979;115:194)
Differential diagnosis
  • Eccrine cystadenoma
  • Eccrine hidrocystoma
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