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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. 75, Num. 3, 2009, pp. 327-328

Indian Journal of Dermatology, Venereology and Leprology, Vol. 75, No. 3, May-June, 2009, pp. 327-328

Quiz

Solitary nodule over the labia majora

Veeranna S, Vijaya

Department of Skin and STD, J.S.S Hospital, Mysore, Karnataka
Correspondence Address:Dr. S. Veeranna, Departments of Skin and STD, JSS Hospital, Ramanuja Road, Mysore - 570 004, Karnataka
veerannashastry@yahoo.com

Code Number: dv09104

PMID: 19439903
DOI: 10.4103/0378-6323.51257

A 35-year-old woman presented with an asymptomatic solitary lesion on the labia majora for the past 6 months. The lesion started as a small swelling and gradually increased in size. There was no history of pain, itching, bleeding or discharge. On examination, there was a solitary nodule measuring 1 x 1 cm situated on the inner aspect of the right labia majora [Figure - 1]. The surface was eroded. There was no tenderness or induration. There was no regional lymphadenopathy. Hemogram and urin-analysis was normal. Blood Venereal Disease Research Laboratory (VDRL) and HIV test results were negative. Excision biopsy was done. Histopathology findings are shown in [Figure - 2],[Figure - 3],[Figure - 4].

What is your diagnosis ?

Diagnosis: Hidradenoma papilliferum
Histopathology showed tubular and cystic structures in the dermis [Figure - 2]. The tubules and glands were lined by tall columnar cells with decapitation secretion [Figure - 3]. The cystic structures were lined by apocrine cells with abundant eosinophilic cytoplasm [Figure - 4]. The features were suggestive of hidradenoma papilliferum.

Discussion

Hidradenoma papilliferum is a rare, benign, cystic, papillary apocrine gland tumor that occurs almost exclusively in the skin of the anogenital region in women. [1] It occurs between the ages of 25 and 40 years. [2] It usually presents as an asymptomatic nodule measuring 1 to 40 mm in size. The most common site is the labia majora, but it may occur elsewhere on the vulva or perianal area. Other ectopic sites include eyebrow, eyelid, nose, chest and external auditory canal. [3] Ectopic hidradenoma papilliferum occurs more frequently in the head and neck region. It is rarely associated with Paget′s disease and invasive squamous cell carcinoma. [4]

The tumor represents an adenoma with apocrine differentiation. Hidradenoma papilliferum can also originate from recently described anogenital mammary-like glands. [5] Located in the dermis, it is well circumscribed and surrounded by a fibrous capsule. The tumor is usually partly cystic and comprises of both papillary and glandular areas. The lumina are lined by single or double layer of cells consisting of a luminal layer of secretory cells, which show active decapitation secretion, and an outer layer of small cuboidal cells. [6]

The tumor is usually mistaken for a cyst, polyp or an angioma. The histopathological differential diagnosis includes tubular apocrine adenoma, syringocystadenoma papilliferum, apocrine hydrocystoma and apocrine fibroadenoma. [6] Simple excision is curative.

References

1.Daniel F, Mahmoudi A, de Parades V, Flιjou JF, Atienza P. An uncommon perianal nodule: Hidradenoma papilliferum. Gastroenterol Clin Biol 2007;31:166-8.  Back to cited text no. 1    
2.MacKie RM, Calonje E.Tumours of the skin appendages. In : Burns T, Breathnach S, Cox N, Griffith C, editors. Rook's Textbook of dermatology. 7 th ed. Oxford: Blackwell Science; 2004. p. 37.16-37.17.  Back to cited text no. 2    
3.Minami S, Sadanobu N, Ito T, Natsuaki M, Yamanishi K. Non-anogenital (ectopic) hidradenoma papilliferum with sebaceous differentiation: A case report and review of reported cases. none J Dermatol 2006;33:256-9.  Back to cited text no. 3    
4.Barrι C, Lorenzato M, Bourdat B, Quιreux C, Durlach A. Vulvar invasive squamous cell carcinoma and hidradenoma papilliferum. Gynecol Obstet Fertil 2007;35:776-9.  Back to cited text no. 4    
5.Sartaj A, Campbell RM, Li JH, Wang LJ. Adenoma of anogenital mammary like glands. J Am Acad Dermatol 2007;57:896-8.  Back to cited text no. 5    
6.Elder D, Elenitsas R, Ragsdale BD. Tumours of the epidermal appendages. In : Elder D editor. Lever's histopathology of the skin. 8 th ed. Philadelphia: Lippincot-Raven; 1997. p. 770-1.  Back to cited text no. 6    

Copyright 2009 - Indian Journal of Dermatology, Venereology and Leprology

The following images related to this document are available:

Photo images

[dv09104f4.jpg] [dv09104f3.jpg] [dv09104f1.jpg] [dv09104f2.jpg]
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