Malignant Clear Cell Hidradenoma of the Breast

Abstract

A 58-year-old female had a mass in the right breast palpable beneath the areola. A mammogram revealed a 1.5-centimeter soft tissue density that was confirmed with a subsequent ultrasound. The patient underwent a core needle biopsy which was initially reported as a moderately differentiated invasive ductal carcinoma. Immunohistochemical analysis revealed negative staining for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor (HER2), mammaglobin, and gross cystic disease fluid protein 15 (GCDFP-15). A wide local excision of the mass was performed. The pathology report stated the tumor had an infiltrative growth pattern with a desmoplastic stromal response with enhanced epithelial atypia consistent with malignant transformation of a nodular clear cell hidradenoma. Clear cell hidradenoma is a very rare tumor originating from the sweat gland and has a propensity for the face and extremities. The malignant variant of this tumor is extremely rare and has been reported to originate from the breast in few cases. This case represents the difficulty in diagnosing this tumor along with the radiographic and histologic features that can distinguish this malignancy from other entities.

Perianal malignant nodular hidradenoma in HIV infected pregnant patient

“…Malignant nodular hidradenoma (MNH), first described as clear cell eccrine carcinoma by Keasbey and Hadley in 1954 [1][2][3] is an uncommon, highly malignant, primary skin tumor derived from eccrine sweat glands [1][2][3][4][5][6] accounting for approximately 6% of malignant eccrine tumors. 1,4 MNH has been described in the literature using various nomenclature, including clear cell hidradenocarcinoma, malignant clear cell myoepithelioma, malignant clear cell hidradenoma, clear cell eccrine carcinoma, and malignant clear cell acrospiroma.…”

“…1,4 MNH has been described in the literature using various nomenclature, including clear cell hidradenocarcinoma, malignant clear cell myoepithelioma, malignant clear cell hidradenoma, clear cell eccrine carcinoma, and malignant clear cell acrospiroma. 1,2,4,5 MNH is usually found on the face, scalp, or anterior surface of the trunk, [3][4][5][6] typically arising de novo, but on occasion transforming from the benign variant. [1][2][3][4][5][6] Local recurrence after excision has been described in up to 50% of cases, and metastases in up to 60% of cases.…”

“…1,2,4,5 MNH is usually found on the face, scalp, or anterior surface of the trunk, [3][4][5][6] typically arising de novo, but on occasion transforming from the benign variant. [1][2][3][4][5][6] Local recurrence after excision has been described in up to 50% of cases, and metastases in up to 60% of cases. [1][2][3][4][5][6] These metastases tend to affect the regional lymph nodes but can also involve the lung, bone, brain, liver, viscera, and skin.…”

“…[1][2][3][4][5][6] Local recurrence after excision has been described in up to 50% of cases, and metastases in up to 60% of cases. [1][2][3][4][5][6] These metastases tend to affect the regional lymph nodes but can also involve the lung, bone, brain, liver, viscera, and skin. 3,5,6 Most tumors occur in elderly individuals, 1,4 with no obvious gender predominance.…”

“…[1][2][3][4][5][6] These metastases tend to affect the regional lymph nodes but can also involve the lung, bone, brain, liver, viscera, and skin. 3,5,6 Most tumors occur in elderly individuals, 1,4 with no obvious gender predominance. 1,[3][4][5][6] Only one author specifically addressed the issue of HIV infection: Souvatzidis et al reported that none of their seven patients were HIV positive.…”