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CASE REPORT
Year : 2012  |  Volume : 1  |  Issue : 3  |  Page : 172-173

Nodular hidradenoma of anterior abdominal wall


Department of General Surgery, Alluri Sita Ramaraju Academy of Medical Sciences, Eluru, West Godavari, Andhra Pradesh, India

Date of Web Publication15-Oct-2012

Correspondence Address:
Naveen B Goluguri
Department of General Surgery, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, West Godavari, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.102444

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  Abstract 

Nodular hidradenoma is a variant of benign cutaneous adnexal tumors which arises from eccrine sweat glands. They occur frequently on the scalp, face, abdomen, and extremities. The clinical appearance of this lesion is not specific and differential diagnosis can only be done after complete removal of the lesion. We report a case of nonhealing ulcer on anterior abdominal wall in a 35 year male. The ulcer occurred following excision of a recurrent anterior abdominal wall swelling of 4 year duration. Wedge biopsy was done in this institution and it was inconclusive. The ulcer was managed with antiseptic dressing, followed by skin grafting. Patient developed recurrent ulcero-proliferative lesion involving the same area in 3 months period. Wide excision of the ulcer revealed features of nodular hidradenoma. Nodular hidradenoma is reported rarely.

Keywords: Adnexal tumor, eccrine sweat gland, nodular hidradenoma


How to cite this article:
Rudraraju SR, Patnaik P, Goluguri NB. Nodular hidradenoma of anterior abdominal wall. J NTR Univ Health Sci 2012;1:172-3

How to cite this URL:
Rudraraju SR, Patnaik P, Goluguri NB. Nodular hidradenoma of anterior abdominal wall. J NTR Univ Health Sci [serial online] 2012 [cited 2019 Nov 15];1:172-3. Available from: http://www.jdrntruhs.org/text.asp?2012/1/3/172/102444


  Introduction Top


Nodular hidradenoma is referred as clear cell hidradenoma, clear cell acrospiroma, clear cell myoepithelioma, and eccrine sweat gland adenoma. Usually, these are diagnosed between the fourth and the eighth decade of life with a peak incidence in the sixth decade. [1] Women are affected more often than men. [2] Patients are clinically asymptomatic. Diagnosis is made based on histopathological examination. Growth is slow and malignant change is rare. [3] Complete surgical excision is the best curative method with regular follow-up.


  Case Report Top


A 35-year-old male presented to surgical outpatient department with an ulcerative growth over anterior abdominal wall of 6 months duration [Figure 1]. There was scanty serous discharge. Ulcer was not associated with pain and fever. Patient was a known diabetic and was receiving oral hypoglycemic agents with blood sugar levels within normal limits. No relevant family history. Patient gave history of small swelling over the anterior abdominal wall of 4 year duration for which he got operated twice, followed by which he developed persistent nonhealing ulcer after second surgery 6 months back. Thorough investigations were made and wedge biopsy revealed nonspecific ulcer. Split skin grafting was done. Graft uptake was 50 percent. Patient was discharged. Patient reported again with graft rejection and ulcero-proliferative growth in 3 months period. Clinical examination revealed a single ulcero-proliferative lesion measuring 3 × 2 cm size situated above the umbilicus. It is firm to hard in consistency, nontender, no bleeding on touch, and fixed to underlying subcutaneous tissue. Umbilicus was normal in position. Inguinal and axillary lymph nodes were not enlarged. All investigations were within the normal limits. Wide excision was done under spinal anesthesia. Ulcero-proliferative lesion was confined to skin and subcutaneous tissue, not involving the rectus sheath. Postoperative course was uneventful. Histopathological examination of the lesion demonstrated polyhedral tumor cells with clear cytoplasm and PAS stain positive, suggestive of Nodular hidradenoma of low malignant potential [Figure 2]. Patient was free from recurrence after 6 months of follow-up.
Figure 1: Nodular hidradenoma anterior abdomen

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Figure 2: PAS Stain nodular hidradenoma

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  Discussion Top


Nodular hidradenoma of the skin was first described by Liu in 1949. [4] Nodular hidradenoma is a benign dermal tumor that arises from the distal excretory duct of eccrine sweat glands. It presents as slowly enlarging, solitary nodule measuring 0.5-2 cm in diameter, but may reach 6.0 cm or more. Most of the tumors reported in the literature are small round red or skin colored nodules or sometimes subcutaneous lesions are misdiagnosed as epidermoid cysts. [5] Lesion can occur anywhere on the body, e.g., axilla, face, arms, thigh, trunk, scalp, and pubic region. They are usually covered by intact skin, but some tumors show superficial ulceration and discharge a serous material. It is composed of two cell types: the polygonal cells, whose glycogen content give the cytoplasm a clear appearance, and elongated, darker, and smaller cells, which may appear at the periphery. The tumor may be solid or cystic in varying proportions. [6] Ultrastructural and enzyme histochemical studies suggest that nodular hidradenoma is intermediate between eccrine poroma and eccrine spiradenoma. [7] Although surgical excision appears to be curative in these tumors, it should be kept in mind that close follow-up is essential because of the possibility of a recurrence and silent local malignant change. [8]

 
  References Top

1.Faulhaber D, Wörle B, Trautner B, Sander CA. Clear cell hidradenoma in a young girl. J Am Acad Dermatol 2000;42:693-5.  Back to cited text no. 1
    
2.Schweitzer WJ, Goldin HM, Bronson DM, Brody PE. Ulcerated tumor on the scalp. Clear-cell hidradenoma. Arch Dermatol 1989;125:985-6.  Back to cited text no. 2
[PUBMED]    
3.Mackie RM, Calonje E. Tumours of the skin appendages. In: Burns T, Breathnach S, Cox N, et al. Rook's textbook of dermatology. 7 th ed., vol. 2. Oxford: Blackwell Science; 2004. p. 3721-2.  Back to cited text no. 3
    
4.Liu Y. The histogenesis of clear cell papillary cell carcinoma of the skin. Am J Pathol 1949;25:93-103.  Back to cited text no. 4
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5.K Sakuma T, Ohashi H, Kawano. Nodular hidroadenoma maquerading an epidermal cyst. J Eur Acad Dermatol Venereol 2008;22:900-1.  Back to cited text no. 5
    
6.Weedon D. Skin Pathology. Edinburgh, New York: Churchill Livingstone; 1997. p. 713-55.  Back to cited text no. 6
    
7.Elder D, Elentisas R, Ragsdale BD. Tumors of the epidermal appendages. In: Elder D, Elentisas R, Jaworsky C, Johnson B Jr, editors. Histopathology of the Skin. Philadelphia: Lippincott-Raven; 1997. p. 747-803.  Back to cited text no. 7
    
8.Will R, Coldiron B. Recurrent clear cell hidradenoma of the foot. Dermatol Surg 2000;26:685-6.  Back to cited text no. 8
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    Figures

  [Figure 1], [Figure 2]



 

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