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Case Report DOI: 10.7241/ourd.20132.52 RECURRENT ECCRINE HIDRADENOMA OF THE BREAST IN A MALE PATIENT: PROBLEMS IN DIFFERENTIAL DIAGNOSIS Maria Orsaria, Laura Mariuzzi Source of Support: Nil Competing Interests: None Department of Pathology, University Hospital of Udine, 33100 Udine, Italy Corresponding author: Dr Maria Orsaria mariaorsaria@yahoo.it Our Dermatol Online. 2013; 4(2): 215-217 Date of submission: 10.01.2013 / acceptance: 13.02.2013 Abstract Introduction: Hidradenoma is an uncommon usually benign tumor of the skin that grows slowly. Case report: We describe a case of a 39 patient with a breast mass. Physical examination revealed a solitary, well-circumscribed tumor, measuring 1 cm by 0.7 cm. No other skin abnormalities were found. A total surgical excision was performed and histologic examination concluded to an eccrine hidradenoma with clear cells. Conclusion: Here we discuss problems in the differentiate this tumor, mainly in this not common location, from a breast primary (ductal carcinoma or adenomyoepitelioma), from a metastatic clear cell carcinoma and from other types of skin tumors. Moreover, this patient presented with a recurrence of the tumor in the same location, suggesting a locally aggressive form of this neoplasia; few reports in the literature are described as at low malignant potential, but definite criteria for this diagnosis are not well defined. Key words: eccrine hidradenoma; breast; clear cell; recurrence Cite this article: Maria Orsaria, Laura Mariuzzi: Recurrent eccrine hidradenoma of the breast in a male patient: problems in differential diagnosis. Our Dermatol Online. 2013; 4(2): 215-217. Introduction Hidradenoma is a benign adnexal neoplasm, mostly dermal located, historically considered eccrine, but with evidences suggesting also an apocrine differentiation [1]. This neoplasia presents most often in young adults, and appears to be slightly more common in women than in men. Common locations are head, neck and limbs [2]. The histologic appearance put in the differential diagnosis other skin neoplasms and other tumors depending on the location [3-6]. These tumors are usually benign but they can have rarely low malignant potential, and they should be surgically removed with safety margins, because they have a high local recurrence rate and a potential of malignant transformation [7]. Case Report A 39-year-old man presented with a recurrent nodule of the left outer upper left breast quadrant, superficially located. The lesion was asymptomatic. He reported a previous history of a excised breast mass in the same location. No clinical-pathological report of the prior resection was available. Physical examination revealed a solitary, wellcircumscribed tumor, measuring 1 cm by 0.7 cm. No other skin abnormalities were found. The tumor was excised and submitted for histological examination. Tissues were fixed in buffered formalin, paraffin embedded and routinely processed for histological diagnosis. For immunohistochemistry, the Dako REAL EnVision Detection System, Peroxidase/DAB+, Rabbit/Mouse Code K5007 method was used. The antisera employed are listed in Table I, together with their source, dilution and antigen retrieval method. Results The histopathological result of a needle core biopsy showed a tumor composed of solid sheets of clear cells with an abundant vascularization; the subsequent excisional biopsy (Fig. 1) revealed a lobulated masses in the dermis with focal extension into the subcutaneous fat, without connection with the above skin, composed of two cell types (Fig. 2 a, b): a population of cuboidal cells with eosinophilic cytoplasm and round to oval nucleus with conspicuous nucleolus; elsewhere it consisted of cells with clear cytoplasm containing large glycogen deposits and with a small eccentrically located nucleus. No mitosis were found. Focally, duct-like structures were present, lined by cuboidal cells resulting in perivascular pseudorosettes. The tumor lobules were surrounded by a desmoplastic stroma. No breast ductules were found in proximity of the tumor lobules. www.odermatol.com © Our Dermatol Online 2.2013 215
Antibody Clone, source Dilution ER 1D5, DAKO 1:100 PR 636, DAKO 1:100 GCDFP-15 23A3, DAKO 1:40 Mammaglobin 304-1A5, DAKO 1:100 CK19 RCK108, DAKO 1:50 High molecular weight Cytokeratin 34βE12, DAKO 1:50 CK5/6 D5/16B4, DAKO 1:50 Cytokeratin 7 OV-TL 12/30, DAKO 1:100 Vimentin V9, DAKO 1:300 RCC SPM314, DAKO 1:50 Calponin CALP-1, DAKO 1:50 CD10 56C6, DAKO 1:50 P63 4A4, DAKO 1:100 AR AR441, DAKO 1:100 S100 Polyclonal, DAKO 1:1000 Table I. Antibodies employed for immunohistochemistry ER Estrogen receptor; PR Progesterone receptor; GCDFP15 Gross cystic disease fluid protein-15; RCC Renal cell carcinoma marker; AR Androgen receptor. DAKO, Glostrup, Denmark Figure 1. Excisional biopsy showing a lobulated tumor in the dermis with focal extension into the subcutaneous fat, without connection with the above skin (haematoxylin- -eosin; original magnification x 20) Figure 2 A. The tumor is composed of two cell types: a population of cuboidal cells with eosinophilic cytoplasm and round to oval nucleus with conspicuous nucleolus; elsewhere it consisted of cells with clear cytoplasm containing large glycogen deposits and with a small eccentrically located nucleus (haematoxylin-eosin; original magnification x 200) Figure 2 B. Focally, duct-like structures were present, lined by cuboidal cells resulting in perivascular pseudorosettes (haematoxylin-eosin; original magnification x 200) 216 © Our Dermatol Online 2.2013
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Volume 4, Number 2, April 2013 ISSN
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Editorial Board: Abdel-Naser Mohame
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CONTENTS E d i t o r i a l O r i g
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Original Article DOI: 10.7241/ourd.
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Figure 1. Survival time of HIV/TB-
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Figure 3. A. melanocytic naevus on
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82% of the children belonged to the
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Comment to the article DOI: 10.7241
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The skin around body openings such
Page 24 and 25: Figure 1. Finger nail dystrophy in
Page 26 and 27: Comment to the article DOI: 10.7241
Page 28 and 29: Similar type of rash was also prese
Page 30 and 31: 13. Mastaglia FL, Ojeda VJ: Inflamm
Page 32 and 33: Figure 1. Atrophic areas on left up
Page 34 and 35: 5. Brocard A, Quereux G, Moyse D, D
Page 36 and 37: Figure 1. Macroglossia Figure 2. Ma
Page 38 and 39: Case Report DOI: 10.7241/ourd.20132
Page 40 and 41: Figure 4a, b. Skin biopsy shows hyp
Page 46 and 47: Discussion Poikiloderma of Civatte
Page 50 and 51: Comment to the article DOI: 10.7241
Page 52 and 53: Case Report A 56 year old Caucasian
Page 54 and 55: Using a battery of neurotoxic agent
Page 56 and 57: Figure 1. Multiple lesions on the u
Page 60 and 61: Figure 1. a PAS positive accentuati
Page 62 and 63: The patient was put on melanocyl 0.
Page 66 and 67: The type of treatment prescribed by
Page 68 and 69: On the basis of these clinical find
Page 70 and 71: Surgery has been reported to be the
Page 72 and 73: Figure 1. Histological section show
Page 76 and 77: Discussion The breast location of t
Page 78 and 79: Figure 2. The epithelial nests show
Page 82 and 83: Discussion SCACP is one of the cuta
Page 84 and 85: Figure 1. Tumor of the nasal colume
Page 86 and 87: Figure 2. Vesicles and crusts aroun
Page 88 and 89: Outbreaks have occurred recently in
Page 90 and 91: Clasificación En base al epitelio
Page 92 and 93: - Microcefalia, hipoplasia mediofac
Page 94 and 95: Caso Nº 3: · Niña, edad desconoc
Page 96 and 97: Clinical Images DOI: 10.7241/ourd.2
Page 98 and 99: Figure 7. Fixed cutaneous sporotric
Page 100 and 101: Letter to the Editor DOI: 10.7241/o
Page 102 and 103: Historical Article DOI: 10.7241/our
Page 104 and 105: Figure 6. Henri Mondor (1885-1962).
Page 108 and 109: Figure 5. Alfred Guido Miescher (18
Page 112 and 113: Names of ''Lines'', in dermatology
Page 114 and 115: Figure 1. Erik Adolf von Willebrand
Page 116 and 117: THOMAS INMAN English physician, 182
Page 118 and 119: There are three type of tinea capit
Page 120: Our Dermatology Online www.odermato
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