Document Detail

Hidradenoma papilliferum occurring on the nasal skin.
Jump to Full Text
MedLine Citation:
PMID:  22148064     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Hidradenoma papilliferum is a rare benign neoplasm that usually occurs in the female anogenital area. We present a 43-year-old female with a non-anogenital (ectopic) hidradenoma papilliferum on her nose. The patient had had a skin-colored subcutaneous nodule on her nose for 7 years. The histopathological findings showed variously shaped cystic spaces in the tumor. And the lumina were surrounded by a single or double layer of cell which showed decapitation secretion. In the English dermatological literature, only one case of ectopic hidradenoma papilliferum arising in nasal skin has been reported. Hence we suggest hidradenoma papilliferum occurring on the nasal skin is a peculiar and interesting event.
Authors:
Hyun-Jae Lee; Deborah Lee; So Young Jung; Soon Kwon Hong; Jong Keun Seo; Ho Suck Sung
Related Documents :
17307494 - Septic arthritis of the manubriosternal joint.
19554134 - Orthognathic surgery for management of arthrogryposis multiplex congenita: case report ...
7880354 - Refixation of large chondral fragments on the weight-bearing area of the knee joint: a ...
16415284 - Synovial chondromatosis of the subtalar joint and tenosynovial chondromatosis of the po...
23119444 - Synovial sarcoma of the larynx.
3617244 - Retroperitoneal approach for transureteroureterostomy: a neglected and forgotten proced...
Publication Detail:
Type:  Journal Article     Date:  2011-10-31
Journal Detail:
Title:  Annals of dermatology     Volume:  23     ISSN:  2005-3894     ISO Abbreviation:  Ann Dermatol     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-12-07     Completed Date:  2012-10-02     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  8916577     Medline TA:  Ann Dermatol     Country:  Korea (South)    
Other Details:
Languages:  eng     Pagination:  S254-7     Citation Subset:  -    
Affiliation:
Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Ann Dermatol
Journal ID (publisher-id): AD
ISSN: 1013-9087
ISSN: 2005-3894
Publisher: Korean Dermatological Association; The Korean Society for Investigative Dermatology
Article Information
Download PDF
Copyright © 2011 Korean Dermatological Association; The Korean Society for Investigative Dermatology
open-access:
Received Day: 05 Month: 10 Year: 2009
Revision Received Day: 14 Month: 7 Year: 2011
Accepted Day: 14 Month: 7 Year: 2011
Print publication date: Month: 10 Year: 2011
Electronic publication date: Day: 31 Month: 10 Year: 2011
Volume: 23 Issue: Suppl 2
First Page: S254 Last Page: S257
ID: 3229079
PubMed Id: 22148064
DOI: 10.5021/ad.2011.23.S2.S254

Hidradenoma Papilliferum Occurring on the Nasal Skin
Hyun-Jae Lee, M.D.A1
Deborah Lee, M.D.A1
So Young Jung, M.D.A1
Soon Kwon Hong, M.D.A1
Jong Keun Seo, M.D.A1
Ho Suck Sung, M.D.A1
Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Correspondence: Corresponding author: Deborah Lee, M.D., Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, 633-165 Gaegeum-dong, Busanjin-gu, Busan 614-735, Korea. Tel: 82-51-890-6135, Fax: 82-51-890-6392, paikderma@hanmail.net

INTRODUCTION

Hidradenoma papilliferum is a benign, cystic, papillary tumor that originates from the apocrine gland or anogenital mammary gland; it occurs almost exclusively in the female anogenital area1-4. However, these tumors occasionally occur in a non-anogenital area and are referred to as "ectopic" hidradenoma papilliferum1,5-9. Ectopic hidradenoma papilliferum usually occurs in the head and neck region; most cases of ectopic hidradenoma papilliferum occur in the external ear or eyelid, where modified apocrine glands are found. Although ectopic apocrine glands are found normally in the nose, there has been only one case of ectopic hidradenoma papilliferum arising in nasal skin8. The tumor may show a variety of histopathological findings including cystic, tubular, papillary or solid pattern2-5. Herein we report a peculiar case of ectopic hidradenoma papilliferum on the nose.


CASE REPORT

A 43-year-old female complained of an asymptomatic tumor on her nose that had been slowly growing for 7 years. On physical examination, a 10-mm sized, pink-brown, elevated, firm nodule with a smooth surface was seen (Fig. 1).

The clinician's differential diagnosis included intradermal nevus, trichoepithelioma, and basal cell carcinoma. The tumor was excised and subjected to histopathological examination.

Microscopic examination showed a subcutaneous tumor that was well-circumscribed by connective tissue. Variously shaped cystic and tubular structures were seen. The lumina of those cystic structures were lined with a double or single layer of inner columnar and outer cuboidal cells. The cells of the lumina showed decapitation secretion similar to apocrine gland (Fig. 2). The epithelial cells of the lesion were strongly positive for gross cystic disease fluid protein (Fig. 3) and epithelial membrane antigen (EMA) (Fig. 4) but weakly positive for carcinoembryonic antigen (CEA) (Fig. 5) on immunoperoxidase examination. The lesion was excised, and the patient had no evidence of recurrence at 6-month follow-up.


DISCUSSION

Hidradenoma papilliferum is a benign adnexal tumor that mainly affects middle-aged women between the ages of 30 to 49 years (range, 25~66 years)10. It usually appears as a solitary, well-circumscribed, firm, flesh- to red-colored nodule of approximately 0.4 cm in diameter (range 0.1~1.0 cm)10. The nodule can also be umbilicated or cystic, and may be asymptomatic; however, bleeding, pain or pruritus can be associated1-4. Because these tumors occur almost exclusively in the vulva or perianal region, extragenital hidradenoma papilliferum are referred to as "ectopic hidradenoma papilliferum"9. Ectopic hidradenoma papilliferum has been reported in 19 people in the English dermatological literature5,6.

The clinical manifestations of ectopic hidradenoma papilliferum are similar to those of anogenital hidradenoma papilliferum. Lesions range in size from 0.5 to 6.0 cm; more than 85% of the lesions are about 1.5 cm in size9. The most common site of ectopic hidradenoma papilliferum is the head and neck region6-9. Lesions have occurred on the eyelid (3 lesions), forehead (2 lesions), face (site unspecified, 2 lesions), external auditory canal (1 lesion), postauricular area (1 lesion), scalp (1 lesion), and nose (1 lesion). Other lesion sites include the axilla, arm, thigh and back. Although the reason that most cases of hidradenoma papilliferum occur in the head and neck region has not been clarified, their location may be related to the distribution of apocrine glands. Apocrine glands are heavily concentrated in the anogenital area and axillae, most cases of hidradenoma papilliferum are located in the anogenital area. Modified apocrine glands are normally found in the external auditory ear canal, eyelid and breast. Thus the location of ectopic hidradenoma papilliferum corresponds to these common sites of apocrine glands and modified apocrine glands5-7. In our patient, it is possible that the heterotrophic apocrine gland normally found in the nasal skin may be related to the development of tumor. Therefore, the heterotrophic apocrine gland in the resection specimen may be heterotrophic apocrine glands adjacent to the tumor in the nasal skin8.

Histopathologic examination showed solitary, well-circumscribed, cystic spaces in the dermis surrounded by tissue with no connection to the overlying epidermis. Within the cystic spaces, multiple papillary projections into the cavity were seen. The lumen is usually lined with double or multiple rows of columnal cells or simple cuboidal cells with active "decapitation" secretion like that found in the apocrine gland. Although these invaginations that extend downward from epidermis and papillary projections can be found in syringocystadenoma papilliferum, the absence of connection in the papillary structure distinguishes hidradenoma papilliferum from syringocystadenoma papilliferum. Immunohistochemically, the hidradenoma papilliferum expresses EMA, CEA, gross cystic disease fluid protein (GCDFP)-15 and human milk fat globule membrane antigen (HMFG) and are usually positive for the markers of apocrine differentiation. Syringocystadenoma papilliferum usually express AE1/AE3, EMA and CEA, but the results of markers of apocrine differentiation including GCDFP-15 and HMFG are variable.

Although the exact pathogenesis of hidradenoma papilliferum is unclear, the fact that these tumors have only been reported after puberty suggests that estrogen receptor expression may be involved9. Regardless of the site and size, the treatment of choice is local excision and recurrence is unusual. Recently, some authors found similarities between hidradenoma papilliferum arising from extra-genital area and apocrine papillary cystadenoma11,12. The similarity of histopathology and apocrine differentiation in both tumors suggest that they may be identical tumors, but further study is needed.

The differential diagnosis includes syringocystadenoma papilliferum, tubular apocrine adenoma, and clear cell (apocrine) hidradenoma. Syringocystadenoma shows some cystic invaginations extending downward from the epidermis as well as plasma cell infiltration. In tubular apocrine adenoma, some dilated tubules with papillary projections extend into the lumen. In clear cell hidradenoma, the lesions are constructed with apocrine-like tubular structures and clear cells can be seen6.

The prognosis for hidradenoma papilliferum is good1-4. Malignant transformation of these tumors is rare and there are only 2 reports of carcinoma arising in a pre-existing hidradenoma papilliferum11.

In conclusion, we suggest hidradenoma papilliferum occurring on the nasal skin is a peculiar and interesting event.


References
1. Scurry J,van der Putte SC,Pyman J,Chetty N,Szabo R. Mammary-like gland adenoma of the vulva: review of 46 casesPathologyYear: 20094137237819404851
2. Vazmitel M,Spagnolo DV,Nemcova J,Michal M,Kazakov DV. Hidradenoma papilliferum with a ductal carcinoma in situ component: case report and review of the literatureAm J DermatopatholYear: 20083039239418645314
3. Kazakov DV,Mikyskova I,Kutzner H,Simpson RH,Hes O,Mukensnabl P,et al. Hidradenoma papilliferum with oxyphilic metaplasia: a clinicopathological study of 18 cases, including detection of human papillomavirusAm J DermatopatholYear: 20052710211015798433
4. Nishie W,Sawamura D,Mayuzumi M,Takahashi S,Shimizu H. Hidradenoma papilliferum with mixed histopathologic features of syringocystadenoma papilliferum and anogenital mammary-like glandsJ Cutan PatholYear: 20043156156415268713
5. Fernández-Aceñero MJ,Sánchez TA,Sánchez MC,Requena L. Ectopic hidradenoma papilliferum: a case report and literature reviewAm J DermatopatholYear: 20032517617812652207
6. Minami S,Sadanobu N,Ito T,Natsuaki M,Yamanishi K. Non-anogenital (ectopic) hidradenoma papilliferum with sebaceous differentiation: a case report and review of reported casesJ DermatolYear: 20063325625916674789
7. Daniel F,Mahmoudi A,de Parades V,Fléjou JF,Atienza P. An uncommon perianal nodule: hidradenoma papilliferumGastroenterol Clin BiolYear: 20073116616817347625
8. Smith FB,Shemen LJ,Guerrieri C,Ismail SS. Hidradenoma papilliferum of nasal skinArch Pathol Lab MedYear: 2003127E86E8812562260
9. Vang R,Cohen PR. Ectopic hidradenoma papilliferum: a case report and review of the literatureJ Am Acad DermatolYear: 19994111511810411423
10. Meeker JH,Neubecker RD,Helwig EB. Hidradenoma papilliferumAm J Clin PatholYear: 19623718219514472046
11. Pelosi G,Martignoni G,Bonetti F. Intraductal carcinoma of mammary-type apocrine epithelium arising within a papillary hydradenomaof the vulva. Report of a case and review of the literatureArch Pathol Lab MedYear: 1991115124912541662944
12. Halbritter SA,Altermatt HJ,Caversaccio M,Bornstein MM. Apocrine papillary cystadenoma of a minor salivary gland on the lower lip: case presentationQuintessence IntYear: 20094016716919169449

Article Categories:
  • Case Report

Keywords: Ectopic, Hidradenoma papilliferum, Nose.

Previous Document:  A case of sinusoidal hemangioma with lipoma.
Next Document:  Steatocystoma multiplex confined to the scalp with concurrent alopecia.