Nodular hidradenocarcinoma over the parotid gland: A pathologic presentation

Abstract

Background. Nodular hidradenocarcinoma (NHAC), an eccrine carcinoma, has been reported in the dermatology and pathology literature, but few references have been made in the otolaryngology literature even though the head and neck is a common site of occurrence.Methods. A case report of a 37-year-old Hispanic man with a right-sided neck mass diagnosed preoperatively as a parotid mass by imaging and fine-needle aspiration is presented. After presentation at our multidisciplinary tumor board, excision of the mass was undertaken.Results. Final pathology reveled a NHAC, which is presented in our report.Conclusion. NHAC is an aggressive malignant tumor that is often misdiagnosed preoperatively and that must be treated with aggressive multimodality therapy for increased survival. Head Neck 29: 193-197, 2007 Keywords: nodular hidradenocarcinoma; eccrine tumor; malignant skin tumor; skin cancer Nodular hidradenocarcinoma (NHAC) is a malignant cell eccrine tumor, often with clear cell morphology, which has been reported less than 60 times in the literature. It has been rarely reported in the otolaryngology literature, though the head and neck is a common site of occurrence. The tumor has been identified in the literature under many names including clear-cell hidradenocarcinoma, malignant clear-cell hidradenoma, solidcystic adenocarcinoma, malignant acrospiroma, malignant clear-cell myoepithelioma, and clearcell eccrine carcinoma. 1 NHAC tumors usually develop as malignant tumors, though there have been reports of malignant degeneration of the benign counterpart, hidradenomas. 2 We present the case of a patient with what was believed to be a parotid neoplasm by preoperative clinical examination that turned out to be a hidradenocarcinoma. CASE REPORTA 37-year-old otherwise healthy Hispanic man presented to our tertiary care hospital complaining of a painless right neck mass that the patient said had been present for approximately 3 months. On physical examination the patient had a 4 cm 3 2 cm right parotid mass that appeared to be connected to the skin though there were no skin changes. Facial nerve function was House Brackmann I/VI bilaterally. The patient was sent for fine-needle aspiration of the neck mass, which showed cellular clusters and sheets of monomorphous epithelial cells with low nuclear:cytoplasm

Apocrine Hidradenocarcinoma of the Scalp: A Classification Conundrum

“…Reflecting its rarity, hidradenocarcinomas have been described in the literature fewer than 60 times since then [5]. It usually presents on the face or limbs as an ulcerated reddish nodule in elderly patients [6].…”

“…Both cytonuclear atypia and increased mitotic activity, in addition to infiltrative borders, vascular and neural invasion, and lymph node metastases, may help distinguish it from hidradenoma. Macroscopically, compared to its benign counterpart, hidradenocarcinoma appears to be larger, less well demarcated, and more asymmetrical [2, 5, 7]. …”

“…These include clear cell eccrine carcinoma and porocarcinoma, sebaceous carcinoma, tricholemmal carcinoma, clear cell squamous cell carcinoma, balloon cell melanoma, and clear cell basal cell carcinoma [5, 8]. Clear cell carcinomas metastatic to the skin such as metastatic renal cell clear cell carcinoma should also be considered [5]. …”

“…However, partly due to the rare nature of the tumor, the role of lymph node dissection, sentinel lymph node biopsy, and lymphadenectomy on survival remains to be determined, as does the role of adjuvant chemotherapy. Reports on the effectiveness of radiotherapy have been conflicting, with some reports showing radiotherapy to be an effective treatment and other reports demonstrating radio-resistance [5, 7]. …”

Hidradenocarcinoma presenting as soft tissue mass: Case report with cytomorphologic description, histologic correlation, and differential diagnosis

“…[1][2][3][4][5][6] It usually presents as an ulcerated reddish nodule in older patients, but has been reported in a wide age range including children and newborns. [1][2][3][4][5][6] It usually presents as an ulcerated reddish nodule in older patients, but has been reported in a wide age range including children and newborns.…”