Clear cell hidradenoma (nodular hidradenoma)

Case contributed by Dr Mikkaela McCormack

Presentation

The patient presented with a slowly enlarging, solitary skin nodule on the scalp.

Patient Data

Age: 40
Gender: Male

H+E Sections

Modality: Pathology

The section shows skin with a dermally-based lesion composed of solid and cystic lobules / nodules of cells separated by thick bands of hyalinised fibrous tissue.  The cells form sheets and papillary like structures, where cells are arranged around delicate fibrovascular cores.  The cells are cytologically bland and show either clear or finely granular eosinophilic cytoplasm.

Case Discussion

Nodular hidradenoma may also be referred to as clear cell hidradenoma (when there is a prominent clear cell component) or eccrine acrospiroma. A lesion with numerous aliases, it has also been referred to as clear cell myoepithelioma, solid-cystic hidradenoma and eccrine sweat gland adenoma of clear cell type. 

Nodular hidradenoma is a benign dermal-based skin appendageal neoplasm most commonly seen around axillary and scalp regions. There is no connection with the overlying epidermis. 

Lesions display a nodular, lobulated, cystic and solid growth pattern and are composed of an admixture of both eosinophilic and clear cells.  Trichilemmal-like keratinisation is common, and focal sebaceous differentiation may also be seen. When clear cells predominate, lesions may be referred to as clear cell hidradenoma. 

Tumours usually behave in a benign fashion, but may rarely behave aggressively, and may recur if inadequately excised. 

When exhibiting striking clear cell differentiation, the possibility of a metastatic clear cell tumour may need to be considered. 

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Case Information

rID: 43940
Case created: 30th Mar 2016
Last edited: 30th Mar 2016
System: Head & Neck
Inclusion in quiz mode: Included

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