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Indian Journal of Dermatology, Venereology and Leprology
Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL)
ISSN: 0378-6323 EISSN: 0973-3922
Vol. 74, Num. 1, 2008, pp. 83-85

Indian Journal of Dermatology, Venereology and Leprology, Vol. 74, No. 1, January-February, 2008, pp. 83-85

Quiz

A bluish nodule on the arm

Ragunatha S , Inamadar Arun C, Annam Vamseedhar, Yelikar B R

Department of Dermatology, Venereology and Leprosy, BLDEA's SBMP Medical College, Hospital and Research Centre, Bijapur, Karnataka
Correspondence Address:Department of Dermatology, Venereology and Leprosy, BLDEA's SBMP Medical College, Hospital and Research Centre, Bijapur - 586 103, Karnataka, aruninamadar@rediffmail.com

Code Number: dv08036

A 21-year-old male presented with an asymptomatic, slow-growing swelling on the left arm of 4 years duration. He gave history of expression of black-colored fluid and, sometimes, blood when punctured. On examination, solitary, sessile, globular, well-circumscribed bluish nodule, measuring 2 cm in diameter, was present on the lower part of his left arm [Figure - 1]. The surface of the nodule was smooth, with visible superficial vessels. On palpation, the nodule was freely mobile, nontender and soft in consistency, with firm base. An excisional biopsy showed a single cyst (3 mm) containing black-colored material. Histopathological features are shown in [Figure - 2],[Figure - 3].

What is your Diagnosis ?

Diagnosis: Nodular hidradenoma

Histopathology showed well-circumscribed tumor with solid and cystic areas [Figure - 2], arranged in lobules separated by thin fibrovascular septae [Figure - 3]. Two types of tumor cells were seen. One was oval-to-polyhedral with round-to-oval basophilic nucleus and moderate amount of eosinophilic cytoplasm. The other was round-to-oval with small hyperchromatic nucleus, and moderate amount of pale cytoplasm was also seen within the tumor. There were cystic spaces of varying sizes containing mucinous material lined by single-to-multilayered cuboidal epithelium. At some areas, degenerating tumor cells secreting their contents into the cystic spaces were noted.

References

1.Smoller BR, Coldiron B. Neoplasms with eccrine or apocrine differentiation. In : Arndt KA, LeBoit PE, Robinson JK, Wintroub BU, editors. Cutaneous medicine and surgery. 1 st ed. W.B. Saunders Company: Philadelphia; 1996. p. 1476-91.  Back to cited text no. 1    
2.Kaddu S, Kerl H. Appendage tumors of the skin. In : Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, editors, Fitzpatrick's Dermatology in internal medicine. 6 th ed. McGraw-Hill: New York; 2003. p. 785-809.  Back to cited text no. 2    
3.Hampton MT, Sahn EE. Recurrent draining cyst on the shoulder: Clear cell hidradenoma (CCH) (nodular hidradenoma). Arch Dermatol 1992;128:1531,1533-4.  Back to cited text no. 3    
4.Warter A, Diolombi G. Sweat gland tumors in Nigeria: Anatomopathology. Ann Dermatol Venereol 1989;116:621-7.  Back to cited text no. 4    
5.Faulhaber D, Worle B, Trautner B, Sander CA. Clear cell hidradenoma in a young girl. J Am Acad Dermatol 2000;42:693-5.  Back to cited text no. 5    
6.Ozawa T, Fuziwora M, Nose K, Muraoka M. Clear cell hidradenoma of the forearm in a young boy. Pediatr Dermatol 2005;22:450-2.  Back to cited text no. 6    
7.Hernandez-Perez E, Cestoni-Parducci R. Nodular hidradenoma and hidradenocarcinoma: A 10 year review. J Am Acad Dermatol 1985;12:15-20.  Back to cited text no. 7    
8.Klein W, Chan E, Seykora JT. Tumors of the epidermal appendages. In : Elder DE, Elenitsas R, Johnson Jr BL, Murphy GF, editors, Lever's Histopathology of the skin. 9 th ed. Lippincott Williams and Wilkins: Philadelphia; 2005. p. 867-926.  Back to cited text no. 8    
9.Weedon D. Tumors of cutaneous appendages. In : Skin pathology. 2 nd ed. Churchill Livingstone: Edinburgh; 2002. p. 859-916.  Back to cited text no. 9    
10.Kumar N, Verma K. Clear cell hidradenoma simulating Breast carcinoma: A diagnostic pitfall in fine-needle aspiration of breast. Diagn Cytopathol 1996;15:70-2  Back to cited text no. 10    
11.Volmar KE, Cummings TJ, Wang WH, Creager AJ, Tyler DS, Xie HB. Clear cell hidradenoma: A mimic of metastatic clear cell tumors. Arch Pathol Lab Med 2005;129:e113-6.  Back to cited text no. 11    
12.Bonvalet D, Bassandon Y, Foix C, Civatte S. Benign adnexal tumors if late occurrence in verrucoid-sebaceous nevus (Jadassohn): Apropos of 7 cases. Ann Dermatol Venereol 1983;110:337-42.  Back to cited text no. 12    
13.Domoto H, Terahata S, Sato K, Tamai S. Nodular hidradenoma of the breast: Report of two cases with literature review. Pathol Int 1998;48:907-11.  Back to cited text no. 13    
14.House NS, Helm KF, Maloney ME. Management of a hidradenoma with Mohs microscopic surgery. J Dermatol Surg Oncol 1994;20:619-22.  Back to cited text no. 14    

Copyright 2008 - Indian Journal of Dermatology, Venereology and Leprology

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[dv08036f2.jpg] [dv08036f3.jpg] [dv08036f1.jpg]
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