Malignant hidradenoma—a case report demonstrating insidious histological and clinical progression

Abstract

A histologically benign hidradenoma, occurring in a 15-year-old female inadequately excised at first procedure, recurred locally over the course of 11 years and exhibited first local and subsequently regional metastatic spread. The insidious progression was associated with increasing cytological atypia and alteration of epithelial antigenic expression. In view of the rarity of malignant sweat-gland tumours and consequent lack of a specific treatment protocol, this case serves to emphasize the importance of adequate primary local excision, with histological confirmation of clearance, in the management of sweat-gland tumours.

Hidradenoma: A Skin Adnexal Tumour, Case Report and Literature Review

“…It usually presents as a superficial dermal lesion and hence it is diagnosed early and often excised without much investigation. Malignant transformation has been described and there is a report of metastasis in the skeleton from a lesion in the foot [3][4][5]. As they are dermal in origin, they seldom grow to enormous sizes.…”

Clear Cell Hydradenoma of Eac. A Rare Case Report

“…[5] Clinically benign CCH with focal nuclear pleomorphism and increased mitotic activity have been reported, while tumors with aggressive clinical behavior and metastasis may have deceptively benign histological appearance. [1,3] In the reported case, potential for aggressive behavior was suggested by the clinical findings of a rapid growth and pigmentation. However there were no features of nuclear atypia or angiolymphatic invasion and thus the lesion was histologically benign.…”

“…[1] Biddlestone et al have described a young girl with progression of a histologically benign hidradenoma to a malignant sweat gland carcinoma with metastasis over a period of 11 years. [1] However, mitotic activity and cellular pleomorphism may not be accurate predictors of clinical behavior. [5] Clinically benign CCH with focal nuclear pleomorphism and increased mitotic activity have been reported, while tumors with aggressive clinical behavior and metastasis may have deceptively benign histological appearance.…”

“…[4,5] Presence of malignant change is suggested clinically by a rapid growth, pigmentation and cutaneous ulceration and histologically by an increased number of mitotic figures, nuclear atypia and angiolymphatic or perineural invasion. [1] Lesions having frequent mitoses or nuclear atypia but lacking clear evidence of asymmetric invasive growth are termed as atypical CCH and require an aggressive management in view of a risk of recurrence and malignant transformation. [4,5] We report a patient with large, pigmented CCH arising from EAC that clinically resembled a squamous cell carcinoma.…”

“…[1,5] In view of reported malignant transformation, how so ever rare, even the histologically benign lesions should be promptly diagnosed followed by surgical excision and histologic confirmation of clearance.…”