Skin nonmelanocytic tumor

Adnexal tumors

Sweat gland derived (apocrine & eccrine glands)

Hidradenoma



Topic Completed: 30 November 2021

Minor changes: 30 November 2021

Copyright: 2002-2021, PathologyOutlines.com, Inc.

PubMed Search: Eccrine acrospiroma [title]

Jasmine Saleh, M.D., M.P.H.
Jodi Speiser, M.D.
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Cite this page: Saleh J, Speiser J. Hidradenoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skintumornonmelanocyticeccrineacrospiroma.html. Accessed December 3rd, 2021.
Definition / general
Essential features
  • Presents as a slow growing, nodular, solid or cystic cutaneous mass usually measuring up to 3 cm in diameter (Dermatology 2016;232:78)
  • Characterized by variably sized nests and nodules of epithelial cells within the upper or mid dermis, typically with no overlying connection to the epidermis (J Clin Pathol 2007;60:145)
Terminology
  • Also known as nodular hidradenoma, eccrine acrospiroma, clear cell hidradenoma, eccrine sweat gland adenoma and solid cystic hidradenoma
Epidemiology
Sites
Clinical features
  • Presents as a slow growing, nodular, solid or cystic cutaneous mass usually measuring up to 3 cm in diameter (Dermatology 2016;232:78)
  • Overlying skin can be skin colored, erythematous or blue and may exhibit superficial ulceration or serous discharge (Indian Dermatol Online J 2016;7:410)
Case reports
Treatment
Gross description
Microscopic (histologic) description
  • Well circumscribed but unencapsulated, lobulated / cystic mass with variably sized nests and nodules of epithelial cells within the upper or mid dermis, typically with no overlying connection to the epidermis (J Clin Pathol 2007;60:145)
  • Shows both solid and cystic components (Arch Pathol Lab Med 2005;129:e113)
    • Solid portion composed of 2 types of cells: polyhedral cells with basophilic cytoplasm and glycogen containing clear cells with eccentric round nucleus
    • Cystic areas secondary to degeneration of tumor cells
  • Tubular lumina are lined by cuboidal or columnar secretory cells (J Oral Maxillofac Pathol 2013;17:136)
  • Fibrovascular, collagenous or hyalinized stroma (J Cutan Pathol 2007;34:497, Arch Pathol Lab Med 2005;129:e113)
  • Focal apocrine decapitation secretion, squamous differentiation, squamous eddy formation, keratinization, mucinous change or sebaceous differentiation can be seen (Am J Dermatopathol 2012;34:461, J Cutan Pathol 2007;34:801, J Cutan Pathol 2007;34:497)
  • Malignant hidradenocarcinoma presents with infiltrative growth pattern, nuclear atypia and pleomorphism, predominantly solid cell islands, angiolymphatic invasion, necrosis and ≥ 4 mitoses per 10 high power fields (Middle East Afr J Ophthalmol 2010;17:374, Mod Pathol 2009;22:600)
  • Variants:
    • Clear cell hidradenoma (Cutis 2014;94:268)
      • Has a biphasic cellular population: (1) round, fusiform, or polygonal cells with vesicular nuclei and eosinophilic cytoplasm and (2) cells with clear cytoplasm and often eccentrically located nuclei
    • Solid cystic hidradenoma (Arch Pathol Lab Med 2005;129:e113)
      • Shows both solid and cystic components
      • Cysts probably represent cystic degeneration
    • Mucinous hidradenoma (J Cutan Pathol 2007;34:497)
      • Demonstrates diffuse and prominent mucinous cell proliferation
    • Poroid hidradenoma (Ann Dermatol 2021;33:289)
      • Has architectural features of the apocrine hidradenoma and cytological features of poroid and cuticular cells
      • Poroid cells are uniform, small cuboidal cells with an oval to round nuclei
      • Cuticular cells have an abundant eosinophilic cytoplasm with a larger nucleus that shows occasional multinucleation
    • Pigmented nodular hidradenoma (Arch Dermatol 1971;104:117)
      • Shows melanin pigmentation
Microscopic (histologic) images

Contributed by Jasmine Saleh, M.D., M.P.H. and Jodi Speiser, M.D.

Intradermal nodule

Polyhedral basophilic cells

Clear cells

CK8/18

CEA

Positive stains
Negative stains
Molecular / cytogenetics description
Sample pathology report
  • Skin, neck, excision:
    • Hidradenoma, extending to the deep margin
Differential diagnosis
  • Metastatic renal cell carcinoma
    • Absence of ductal differentiation/sweat production
    • Positive for PAX8 and CD10
    • Negative for p63
  • Basal cell carcinoma with eccrine differentiation:
    • Peripheral palisading and no cystic areas
    • Stromal epithelial retraction
    • Epidermal connection
  • Hidradenocarcinoma:
    • Greater cytologic atypia, mitoses and infiltrative
  • Squamous cell carcinoma:
    • Epidermal connection, keratin pearls and infiltrative
    • Absence of secretory differentiation
  • Trichilemmoma:
    • Broad connection with the epidermis
    • CD34, thickened hyalinized basement membrane and peripheral cell palisading
  • Poroma:
    • Epidermal connection and broad, anastomosing cords
    • Cells are more basaloid while cells of hidradenoma are more eosinophilic
    • Recurrent YAP1-MAML2 and YAP1-NUTM1 fusions identified in a subset
  • Cylindroma:
    • Jigsaw puzzle pattern
    • Hyaline globules and thickened basement membranes
Board review style question #1

    Which of the following is true about this identity?

  1. Always expresses CD10
  2. Has no connection to the epidermis
  3. Is typically encapsulated
  4. Presents as a fast growing mass
Board review style answer #1
B. Has no connection to the epidermis

Reference: Hidradenoma

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