Papillary hydradenoma of the skin: causes, symptoms, diagnosis, treatment

Papillary hydradenoma is a rare benign multi-lobed tumor of apocrine sweat glands localized in the dermis.

P. Abenoza, AB Ackerman (1990) from 1979 to 1987, among 750,000 biopsies, only 219 hydradenomas were detected - in 5% of cases they were eccridic (poroidal) hydratenomas, in 95% - apocrine (light cell) hydradenomas. 99% of tumors are solitary. The ratio of men and women is 1: 1. 80% of patients were older than 40 years. In 50% of the cases, the hydradenoma was localized on the skin of the face and scalp, in 21% - on the skin of the extremities, in 20% - on the trunk. Contrary to popular belief, only in 6 cases the tumor was localized in the skin of the breast and no cases of tumor localization on the vulva and in the perianal region were recorded.

The causes and pathogenesis of papillary skin hydradenoma are unknown.

Symptoms of papillary skin hydradenoma. Clinically, the hydradenoma is a cystose-like, clearly delineated cutaneous and / or intradermal nodule, a grayish-bluish hue, sometimes with a clear or saccharine fluid, with an average diameter of 1-3 cm.

The disease is diagnosed easily. Typically, the formation of tumorous formations in women in the area of large labia, perineum, less often in other areas of the skin, where there are apocrine sweat glands.

The tumor is spherical, of soft consistency, mobile, painless, the diameter varies from 1-2 to 4-5 cm. Large tumors protrude above the surface of the skin.

Histopathology. In the deep layers of the dermis, there is a tumor surrounded by a capsule that is not bound to the epidermis. Tumor of a glandular structure, consists of tubules and cystic formations lined with prismatic cells.

Pathomorphology. The authors distinguish two main forms of hydradenum - poroidal (with eccrine differentiation) and light cell (apocrine). The first variant with a small magnification is multi-lobed with a different ratio of solid and cystic components. The tumor is more often cystic, localized in the deep sections of the dermis, surrounded by a fibrous capsule, with its epidermis covering it is not connected. The walls of the cyst are lined with keratinized epithelium, in the lumen there are tubular structures, papillary outgrowths. Cytologically, poroidal (such as an eccrine powder) and cuticular cells, foci of necrosis, nuclear polymorphism, and sometimes multinucleated macrophages are cytologically determined. Porodnye cells are small, dark, with scant cytoplasm, cuticular cells larger, with light cytoplasm and intercellular bridges, resemble cuticular cells of the normal duct of the eccrine sweat gland. The hemidenoma variant must be differentiated from a simple hydra-canthoma, an ecrine powder - in both cases, the hydradenoma is not associated with the epidermis.

In the light-celled hydra-denomina, solid, cystic and solid-cystic variants are isolated. On the cellular composition, they can contain light, squamoid (eosinophilic, granular, polygonal), mucinous cells and apocrine cells lining the tubular structures. The latter are present in almost any form of hydradenoma. The tumor is usually located in the dermis, but sometimes there is a continuous connection with the hyperplastic epidermis and the funnel of the follicle. In the cytoplasm of bright cells, a high content of glycogen, which is removed during treatment with diastase. Squamoid cells have a round or oval nucleus, barely noticeable nucleoli and finely dispersed chromatin. In the cytoplasm there are many tonofilamentes. Mucinous cells are difficult to identify in the hydra-venom, they usually lining the cystic cavity and are characterized by balloon-like cytoplasm, rich in mucin. Cells lining the tubula can be of two types - prismatic and cylindrical. The first lining the protocol-like structures (a sign of duct differentiation), the second lining the glandular structures and to some extent reflect differentiation towards the secretory part of the apocrine gland.

Histogenesis. Histochemical and: Electron microscopic methods revealed signs of secretion of the type of apocrine glands: a positive response to lysosomal enzymes and a negative phosphorylase reaction. The histogenetic relationship of this tumor with the apocrine glands was confirmed by ultrastructural studies. The glandular cellular elements had a pronounced Golgi complex and electronically dense formations with a "lacing" of the apical part of the cells (secretory granules) into the duct lumen.

The clear-cell variant of hydradenoma is differentiated from the metastasis of clear-celled kidney cell cancer. The latter is characterized by the absence of lobular structure, abundant vascularization with massive extravasates of erythrocytes and the presence of abundant fatty inclusions in the cytoplasm of cells.

With a superficially taken biopsy, there may be difficulties in differential diagnosis with a clear cell variant of squamous cell carcinoma, malignant neoplasm and tricholemal differentiation in reactive hyperplasia of the follicular epithelium of viral genesis.

Treatment of papillary skin hydradenoma. Surgical excision of the tumor is performed.

[1], [2], [3], [4], [5], [6], [7]