Skin nonmelanocytic tumor
Cysts
Hidrocystoma


Topic Completed: 1 January 2015

Minor changes: 14 October 2020

Copyright: 2002-2020, PathologyOutlines.com, 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. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skintumornonmelanocyticapocrinecystadenoma.html. Accessed October 21st, 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)
Sites
  • 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
Treatment
  • Complete excision recommended
Clinical images

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Eyelid, malar area, ear lobe

Eyelid, malar area, ear lobe

Dome shaped cystic mass

Dome shaped cystic mass

Lesion below lower lip

Lesion below lower lip

Capsule in subepidermis

Capsule in subepidermis

Skin colored nodules

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. and Dr. V. Zaitsev



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Decapitation secretion

Decapitation secretion

Cyst wall

Cyst wall

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

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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