Hidrocistomas múltiplos apócrinos: um diagnóstico clínico confuso

Abstract

This is a case report followed by a short review of literature of apocrine hidrocystomas. A 67 year old lady came to this clinic with multiple translucent, asymptomatic papulocystic lesions on the face which got worse in summer. A biopsy showed a single cystic cavity lined by two layers of small cuboial epithelial cells was seen. Apocrine differentiation characterised by decapitation secretion was seen. A diagnosis of multiple apocrine hidrocystomas was made. Treatment can be attempted with individual excision of lesions or lasers. Topical atropine and scopolamine too have been tried with variable success. Our patient did not wish any treatment once the benign nature of the condition was confirmed. Keywords: Apocrine glands; Face; Hidrocystoma Resumo: Este é um relato de caso seguido por uma breve revisão da literatura sobre hidrocistomas apócrinos. Uma senhora de 67 anos de idade foi à clínica anteriormente citada apresentando lesões papulocísticas múltiplas, translúcidas e assintomáticas na face que pioravam durante o verão. Uma biopsia mostrou uma cavidade cística única contornada por duas camadas de pequenas células epiteliais cubóides. Diferenciação apócrina caracterizada por remoção de secreção foi observada. Foi feito um diagnóstico de hidrocistomas múltiplos apócrinos. Tratamento pode ser tentado com excisão individual de lesões ou laser. Atropina tópica e escopolamina também foram tentadas com sucesso variável. Nossa paciente não quis nenhum tratamento uma vez que a natureza benigna da condição foi confirmada. Palavras-chave: Face; Glândulas apócrinas; Hidrocistoma CLINICAL FINDINGSA 67 year old lady presented to this clinic with multiple small, 1-3 mm translucent, dome shaped, smooth surfaced, asymptomatic papules located on the face for the past 7 years which were more noticeable during summers. (Figure 1) She was bothered about them only from the cosmetic point of view. She had taken two consultations previously with a diagnosis of mollucscum contagiosum and acneform lesions due to some moisturizer that she was applying regularly. She had been applying tretinoin off and on for the past one year without any effect. She was otherwise healthy with no other problems. She had no past history of acne, any systemic illnesses; she was not on any drug except amlodipine for hypertension. Hematological and biochemical profile was normal. The patient was given various options for treatment which she refused after being assured of the benign nature of the disease. HISTOLOGICAL FINDINGSA biopsy was performed which showed two cystic cavities within the superficial and mid dermis. (Figure 2) One of them was lined by two layers of cuboidal secretory epithelial cells resembling cells of the apocrine secretory coil. (Figures 3, 4) The apocrine cells had rather abundant, finely granular pink

Diagnostic Workup and Treatment of a Rare Apocrine Hidrocystoma Affecting the Oral Mucosa: A Clinical and Histological Case Report

“…It appeared as a slow-growing dome-shaped, solitary, well-delimited nodule with a cystic consistency. Though the most common presentation is a solitary lesion, some cases of multiple apocrine hidrocystomas have been described often in association with Gorlin-Goltz and Schopf-Schulz-Passarge syndromes [4]. The lesion may assume various colours including light brown, red-brown, bluish, black, or skin colours; however in the oral cavity a yellowish colour was observed.…”

“…Total automation of this system allowed obtaining all the staining needed at the same time, avoiding preanalytical biases. In particular, PAS and SMA positivity has been associated with apocrine differentiation [2, 4, 5, 9]. …”

“…Other methods have been reported to treat intraoral lesions including marsupialization, CO 2 , and Er,Cr:YSGG laser ablation, whereas nonsurgical treatment modalities are still under development. Focusing on AHs management in other districts, several treatment options have been documented including simple needle puncture, application of anticholinergic creams, trichloroacetic acid, and botulinum toxin, electrodessication, carbon dioxide laser vaporization, cryotherapy, and laser treatment [2, 4]. …”

“…The typical localization of AHs is the periorbital area; however they may also occur on the lips, ears, neck, scalp, chest, shoulders, or feet. Very rarely AHs are documented to be on axilla, penis, and anus as well [4]. Histologically, AH is characterized by the presence of one to several layers of cuboidal or columnar cells showing decapitation secretion and expression of a keratin pattern of secretory type [5].…”