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|Year : 1999 | Volume
| Issue : 2 | Page : 56-7
Malignant hidradenoma: a rare sweat gland tumour.
P Vaideeswar, CV Madhiwale, JR Deshpande
Department of Pathology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India., India
Department of Pathology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India.
Source of Support: None, Conflict of Interest: None
Malignant hidradenoma is a rare sweat gland carcinoma, which can have an aggressive course with recurrence and/or metastasis. A case is reported, in an elderly male. The tumour had a histologic similarity to its benign counterpart, but exhibited additional features of infiltrative growth pattern and invasion of adjacent tissue.
Keywords: Adenoma, Sweat Gland, pathology,Case Report, Human, Male, Middle Age, Sweat Gland Neoplasms, pathology,
|How to cite this article:|
Vaideeswar P, Madhiwale C V, Deshpande J R. Malignant hidradenoma: a rare sweat gland tumour. J Postgrad Med 1999;45:56
Sweat gland carcinomas are rare neoplasms that possess an infiltrative and/or metastatic potential. They are generally classified into two groups. The first group comprises malignant tumours that closely mimic their benign counterparts while tumours in the second group do not have a benign counterpart. We report a case of malignant hidradenoma, a tumour belonging to the first group.
A 55-year-old male had a recurrent swelling on the volar aspect of the right wrist. The swelling had had been excised in 1995. The swelling (three years after excision) measured 3.5 cm. in diameter and was firm, non-mobile, non-fluctuant and adherent to the old scar. Per-operatively, a hard fibrous tumour was observed to infiltrate the extensor tendon sheath and the pisiform bone.
Multiple irregular firm yellow-white fibrous bits aggregating 4 cm. were received. Few of the bits had a gelatinous surface while one of them was adherent to bone. None were covered by skin. Microscopically, the tumour was composed of solid nests of polygonal to small basaloid cells. Cribriform and adenoidal patterns were also seen. Clear cell change was also present [Figure - 1].
The tumour lobules were surrounded by a characteristic condensed stroma, which also extended into the tumour nests. There was no nuclear atypia or mitotic activity. However, the tumour exhibited an infiltrative growth pattern and had invaded the bone [Figure - 2]. A diagnosis of malignant hidradenoma was made.
Sweat gland carcinomas are rare and among these, carcinomas included under the broad category of eccrine carcinomas are the commonest. In a span of 77 years, Wick et al found a mere 14 such cases. Malignant hidradenoma belongs to this group, and these are also infrequent. Among 35 cases of eccrine adenocarcinoma studied by Mehregan and associates, only two had the histologic features malignant hidradenoma. It mostly occurs in elderly males and is seen as a slowly growing swelling in the extremities for a prolonged duration. Grossly, they appear as nodular dermal masses with or without skin changes with a firm, fibrous appearance simulating a connective tissue tumour. In the report, the tumour was present in an elderly male with a peroperative diagnosis of a fibrous tumour.
The histology of malignant hidradenoma resembles that of its benign counterpart. The criteria for malignancy include poor circumscription, presence of nuclear atypia and mitotic activity, predominantly solid cell islands, infiltrative growth pattern and angio-lymphatic permeation,,. In the present case, there was a striking resemblance to benign nodular hidradenoma, because there was no nuclear changes or involvement of blood vessels. It was designated as malignant based on its recurrence, poor circumscription and an infiltrative pattern with invasion of the tendon sheath and bone. Such features are also sufficient to designate these tumours as malignant.
Malignant hidradenomas are most often malignant from their inception as seen in this case where the tumour was present for two years. Few others, however, develop from their benign counterpart. Half the tumours recur after initial local excision while other metastasise to lymph nodes and to distant sites, in due course of time. The tumour in this case recurred, following the second excision, the patient does not have tumour in a follow-up of one year.
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|2.||Cooper PH. Carcinomas of sweat glands. Pathol Annu 1987; 22:83-124. |
|3.||Wick MR, Goellner JR, Wolfe JT, Su WPD. Adnexal carcinomas of the skin Eccrine carcinomas. Cancer 1985; 56:1147-1162. |
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[Figure - 1], [Figure - 2]
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