|ONLINE ONLY ARTICLES - CASE REPORT
|Year : 2022 | Volume
| Issue : 2 | Page : 152
Poroid hidradenoma over dorsum of the hand
A Savitha Somaiah1, R Raghunath Reddy1, H Apoorva1, L Eshwari2
1 Department of Dermatology, Roots Institute of Dermatological Sciences, Bengaluru, Karnataka, India
2 Department of Dermatology, Bangalore Medical College, Bengaluru, Karnataka, India
|Date of Submission||12-Dec-2020|
|Date of Decision||08-Apr-2021|
|Date of Acceptance||27-May-2021|
|Date of Web Publication||26-Aug-2022|
Roots Institute of Dermatological Sciences, No. 235, 1st Main Road, Banaswadi, Bengaluru - 560 043, Karnataka
Source of Support: None, Conflict of Interest: None
Poroid hidradenoma is a rare, benign cutaneous neoplasm which presents as a solitary swelling. It has eccrine differentiation with features of both hidradenoma and poroma. We hereby present a case of a 50-year-old female patient with a slowly growing asymptomatic lesion over the dorsum of the left hand for 1½ years. Histopathology was consistent with poroid hidradenoma. The hidradenoma component consists of solid and cystic areas and poroma by poroid and cuticular cells. There was no recurrence of the lesion after 1 year of follow-up. Very few cases of poroid hidradenoma have been reported in the literature.
Keywords: Eccrine duct tumor, hidradenoma, poroma
|How to cite this article:|
Somaiah A S, Reddy R R, Apoorva H, Eshwari L. Poroid hidradenoma over dorsum of the hand. Clin Dermatol Rev 2022;6:152
| Introduction|| |
Poroid hidradenoma is a benign neoplasm with eccrine differentiation, originally described by Abenoza and Ackerman in 1990. It is usually a solitary asymptomatic tumor that rarely becomes malignant. The onset ranges from 28 to 77 years, with a peak incidence in the seventh decade. The most frequent site of involvement is the head and neck. The tumor is typically well-circumscribed and slightly reddish or bluish. Poroid hidradenoma shows architectural features of hidradenoma and cytologic features of poroid neoplasms in histology. To prevent its recurrence total excision of the lesion is required. Very few cases of poroid hidradenoma have been reported in the literature. Here, we describe a patient with a poroid hidradenoma of the hand with characteristic histological features.
| Case Report|| |
A 50-year-old otherwise healthy woman presented with an asymptomatic swelling over the left dorsum of the hand for 1½ years. The lesion started as a tiny swelling and gradually increased to reach the current size [Figure 1]. There was no history of trauma before the onset of lesion, neither was there bleeding from the lesion at any point. Family history and past medical history were unremarkable. On cutaneous examination, a 1 cm × 0.5 cm nontender, solitary firm light color tumor with clinically distinct margins was seen. There was a bluish tinge on one end of the tumor. Systemic examination was not contributory. An excision biopsy was done under aseptic precautions. The excised biopsy tumor specimens were fixed in 10% buffered formalin and paraffin-embedded. Histological examination revealed an epithelial neoplasm that had no connection with surface epidermis and made-up of interconnecting tumor islands. The tumor had both solid and cystic portions [Figure 2]. The islands consisted of poroid cells that are smaller and darkly stained and cuticular cells that are pink and larger. Both types of cells were monomorphous with rounded nuclei. Cystic areas show mucinous degeneration and calcification [Figure 3] and [Figure 4]. In a few foci structures, resembling ducts were seen though typical apocrine secretions are not seen. The stroma showed fibroplasia and dilated capillaries. The histological picture described was suggestive of a poroid hidradenoma. The patient had no recurrence after 1 year of follow-up.
|Figure 1: Solitary pale tumor over the dorsum of the hand, with bluish tinge at one end|
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|Figure 2: Section showing solid and cystic areas- architecture of hidradenoma (H and E, ×100)|
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|Figure 3: (a) Solid areas showing polyhedral poroid cells with characteristic intercellular connections. (b) Cystic areas with mucinous degeneration and pigment deposition|
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|Figure 4: Poroid cells with rounded nucleus and basophilic cytoplasm (red arrows) and cuticular cells showing ductal differentiation (black arrows)|
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| Discussion|| |
Poroid hidradenoma is an uncommon variant of the eccrine poroma described by Abenoza and Ackerman in 1990. Hidradenomas are tumors arising from sweat glands, which are of two types. The first type originates from eccrine sweat glands and are characterized by dermal nodules which do not have any connection with the overlying epidermis, like in our case. The predominant cell types include cuticular and poroid and these are designated as “poroid hidradenomas.” The second type is characterized by tumors with apocrine differentiation, composed of mucinous, polygonal, and clear cells.
Four histopathologic variants are identified in poromas according to the architectural features of the neoplasm: hidradenoma simplex or intraepidermal poroma, eccrine poroma, dermal duct tumor, and poroid hidradenoma. Hidroacanthoma simplex is characterized by an ovoid collection of poroid cells within the normal epidermis. Eccrine poroma has a clear-cut margin between the lesion and the normal keratinocytes with small cuboidal cells which have darker nuclei protruding into the dermis. Dermal duct tumor shows the presence of poroid cells in the dermis.
Poroid hidradenoma is a tumor with solid and cystic components, in which neoplastic poroid cells are all located within the dermis and without connection to the epidermis. This neoplasm presents the architectural features of hidradenoma, with solid and cystic areas and cytological features of poroid neoplasm such as poroid and cuticular cells. The diagnosis of poroid hidradenoma is based on histological examination of tissue samples.
Poroid hidradenoma presents as a solitary, tender papule or nodule, well-circumscribed, with a diameter ranging from 1 to 2 cm. It appears slightly reddish, but the presence of cystic parts may confer a blue color on the lesion caused by the Tyndall phenomenon. The most common sites of involvement are the head and neck regions, and less frequently involves trunk and extremities as seen in our patient. The histology must be evaluated carefully because there are reports of coexistence of eccrine poroma and poroid hidradenoma within the same lesion.
The main clinical differential diagnoses of poroid hidradenoma are other members of sweat glands neoplasms such as hidroacanthoma simplex, dermal duct tumor, eccrine poroma, and apocrine hidradenomas. Some benign subcutaneous connective tissue neoplasms such as fibroma, fibrolipoma, dermatofibroma, hemangioma, pyogenic granuloma, epidermal inclusion cyst, basal cell epithelioma, and malignant eccrine poroma may also be challenging and may cause confusion with poroid hidradenoma. Poroid hidradenoma is treated by total excision of the lesion to prevent its recurrence [Table 1].
|Table 1: Differential diagnosis for poroid hidradenoma and important differentiating features|
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]