Clear cell hidradenoma of the breast: a case report with review of the literature

Abstract

Clear cell hidradenoma of the breast is rare. A 55-year-old woman demonstrated a left breast tumor during follow-up examination of the right breast. Focal asymmetric density was shown on mammogram, and ultrasonography showed an intracystic tumor. Since the diagnosis was not clear on aspiration cytology, excisional biopsy was performed. The lesion was an intracystic tumor macroscopically. Histological examination demonstrated characteristic histological features of clear cell hidradenoma, such as proliferation of uniform epithelial cells, clear or slightly eosinophilic cytoplasm, and cuboidal cell-lined ductal structures. Immunohistochemically, these proliferating epithelial cells were negative for myoepithelial markers, such as alpha-smooth muscle actin, CD10 and anti-muscle actin, but positive for p63. These features were consistent with clear cell hidradenoma.

Recurrent eccrine hidradenoma of the breast in a male patient: problems in differential diagnosis

“…The tumor showed only positivity for CK5/6, p63, PAS and negativity for PAS-D; even if these markers are quite nonspecific they were not in contrast with a diagnosis of eccrine hidradenoma; the morphology of the tumor along with the negativity for androgen receptor excluded a sebocytic differentiation; moreover, the tumor had no connection with the above skin, excluding a tumor with follicular differentiation. The clinical and radiological suspicious in this case was of a primitive breast carcinoma; the difficulty in the diagnosis of this tumor was to differentiate if the neoplasia was a skin primary or a breast one, in particular a clear cell hidradenoma, a very rare breast tumor that share the histological features of sweat gland tumors with only 18 cases reported in the literature [5], but the lacking of normal breast ductules around the tumor lobules let us to think that this case originated from the skin. Eccrine hidradenoma is an usually benign, slowly growing, asymptomatic, solid or cystic sweat gland tumour that occurs on the head, neck and limbs; the breast location is unusual, even if cases located in the trunk and in the breast were reported [5,7], and the male gender is less common [8].…”

“…The clinical and radiological suspicious in this case was of a primitive breast carcinoma; the difficulty in the diagnosis of this tumor was to differentiate if the neoplasia was a skin primary or a breast one, in particular a clear cell hidradenoma, a very rare breast tumor that share the histological features of sweat gland tumors with only 18 cases reported in the literature [5], but the lacking of normal breast ductules around the tumor lobules let us to think that this case originated from the skin. Eccrine hidradenoma is an usually benign, slowly growing, asymptomatic, solid or cystic sweat gland tumour that occurs on the head, neck and limbs; the breast location is unusual, even if cases located in the trunk and in the breast were reported [5,7], and the male gender is less common [8]. When a tumor with features as ours occurs in the breast it is worthwhile to keep in mind in the differential diagnosis a skin eccrine hidradenoma, the diagnostic clue is the lobulated architecture with the two-cell pattern of proliferation, composed of polygonal cells with distinct cell border and clear cytoplasm, and dark cuboidal cells lining the duct structure [5].…”

“…The breast location of this tumor and its particular histological findings include in the differential diagnosis a primary breast ductal carcinoma [3], a metastatic clear cell carcinoma [4], an adenomyoepithelioma [5] and primary skin tumors with follicular differentiation, sebaceous differentiation, or sweat gland differentiation [6]. Against a diagnosis of a primary breast ductal carcinoma, there weren't ductular structures around the tumor, cytological atypia was lacking and the neoplastic proliferation had a biphasic cellular population [3]; moreover, mammaglobin, GCDFP15, ER and PR immunohistochemical staining were negative, whereas in a well differentiated breast ductal carcinoma they would expect to be positive.…”

“…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][4][5][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].…”

Nodular hidradenoma of the breast: A case report with literature review

“…Commonest sites of origin of NH are face, upper extremity, axilla, trunk, thigh, scalp and pubic region [1,5]. NH of breast is very rare and few cases have been reported in English literature [1][2][3][6][7][8][9][10][11]. It occurs in the nipple and subareolar region in more than fi fty percent of cases [1,2].…”