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CORRESPONDENCE
Year : 2020  |  Volume : 65  |  Issue : 4  |  Page : 318-319
Cricumscribed and multiple hidroacanthoma simplex


1 Department of Dermatologic Surgery, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
2 Department of STD, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
3 Department of Pathology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
4 Department of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China

Date of Web Publication11-Jun-2020

Correspondence Address:
Yichen Tang
Department of Dermatologic Surgery, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_4_19

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How to cite this article:
Luo H, Zhao W, Wu F, Jiang L, Yan J, Chen Y, Chen X, Li L, Liu X, Tang Y, Liu Y. Cricumscribed and multiple hidroacanthoma simplex. Indian J Dermatol 2020;65:318-9

How to cite this URL:
Luo H, Zhao W, Wu F, Jiang L, Yan J, Chen Y, Chen X, Li L, Liu X, Tang Y, Liu Y. Cricumscribed and multiple hidroacanthoma simplex. Indian J Dermatol [serial online] 2020 [cited 2020 Jul 3];65:318-9. Available from: http://www.e-ijd.org/text.asp?2020/65/4/318/286396




Sir,

A 60-year-old female presented with brown-colored tumor on her right hip for last 10 years. The problem started with an indolent but slightly pruritic, brown-colored papule that had appeared on her right hip 10 years ago and gradually increased in size. The patient had been to the hospital several times and was diagnosed with verruca vulgaris. Being given tretinoin cream application, the tumor did not show significant improvement. The number of lesions gradually increased. No previous history of trauma on the area could be elicited. Her medical and family histories were noncontributory. Physical examination revealed more than a dozen hyperkeratotic papules and plaques of sizes 3–15 mm, well-circumscribed, brown-colored, sessile on the right hip [Figure 1]. The surface was covered with rough crusts. The tumor was firm, nontender and nonbleeding. Lymph node ultrasound showed no abnormal inguinal lymph nodes. Dermoscopy of the hyperkeratotic, brownish part of the tumor showed fine black dots/globules and fine scales arranged annularly [Figure 2]. Under local anesthesia, a biopsy was taken from the edge of the tumor. The histopathology showed well-demarcated nests within the epidermis [Figure 3]a. The nests were constructed by basal-like cells with uniform size and shape. Cellular and nuclear atypia were absent [Figure 3]b, [Figure 3]c. From the above findings, we diagnosed this tumor as hidroacanthoma simplex.
Figure 1: Several well-circumscribed, brown-colored, sessile lesions, 3-15 mm in diameter, on the right hip

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Figure 2: Dermoscopy of the hyperkeratotic, brownish part of the tumor showing fine black dots/globules (yellow arrows) and fine scales arranged annularly (black arrows)

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Figure 3:(a) Well-defined nested basaloid cell population in the verrucous epidermis (H and E, ×40). (b). Discreet collections of tumor cells in the acanthotic epidermis with sharp boundary between the keratinocytes and tumor cells. Intracytoplasmic ductal structure visible locally (Black arrow) (H and E, ×100). (c). The tumor cells are smaller than the adjacent keratinocytes, being very uniform showing intercellular bridges, cellular and nuclear atypia not seen. (H and E, ×400)

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Hidroacanthoma simplex, also reported as intraepidermal eccrine poroma, is a rare benign eccrine tumor that originates from the acrosyringium.[1] It was first described by Coburn and Smith in 1965.[2] Hidroacanthoma simplex is more common in elderly and without gender preference. It occurs most frequently on the lower extremities and trunk, sometimes on the chest, upper arm and face. Hidroacanthoma simplex is usually characterized by flat or slightly elevated, irregularly brown or red keratinized plaques. Most cases of hidroacanthoma simplex are easily misdiagnosed as other types of benign and malignant tumors clinically, such as clonal-type seborrheic keratosis and Bowen's disease. Although clonal-type seborrheic keratosis can form nested tumor masses in the epidermis, the tumor cells are squamous cells or basal-like epithelial cells and the intracytoplasmic ductal structure is not visible. The histopathological characteristics of Bowen's disease are mitoses and clumping cells. They are not observed in hidroacanthoma simplex. In 2015, Shiiya et al

. reported three main dermoscopic features that characterize hidroacanthoma simplex—(i) scattered fine black dots/globules; (ii) fine scales arranged annularly; and (iii) the absence of the glomerular vessels that are usually observed in Bowen's disease.[3] Though rarely reported, hidroacanthoma simplex can develop porocarcinoma. Anzai et al

. analyzed 70 patients with hidroacanthoma simplex, of which about 10% patients developed malignancy.[4] In our case, the tumor was circumscribed with multiple lesions. Our case showed intracytoplasmic ductal structure, which was not visible in clonal-type seborrheic keratosis. Also dermoscopic findings of clonal-type seborrheic keratosis, namely blue globules and milia-like cysts,[5] are different from dermoscopic findings in our case. The results of histopathology and of dermoscopy confirmed our diagnosis of hidroacanthoma simplex.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Furlan KC, Kakizaki P, Chartuni JCN, Sittart JA, Valente NYS. Hidroacanthoma simplex: dermoscopy and cryosurgery treatment. An Bras Dermatol 2017;92:253-5.  Back to cited text no. 1
    
2.
Coburn JG, Smith JL. Hidroacanthoma simplex; an assessment of a selected group of intrapeidermal basal cell epitheliomata and of their malignant homologues. Br J Dermatol 1956;68:400-18.  Back to cited text no. 2
    
3.
Shiiya C, Hata H, Inamura Y, Imafuku K, Kitamura S, Fujita H, et al. Dermoscopic features of hidroacanthoma simplex: Usefulness in distinguishing it from Bowen's disease and seborrheic keratosis. J Dermatol 2015;42:1002-5.  Back to cited text no. 3
    
4.
Anzai S, Arakawa S, Fujiwara S, Yokoyama S. Hidroacanthoma simplex: A case report and analysis of 70 Japanese cases. Dermatology (Basel) 2005;210:363-5.  Back to cited text no. 4
    
5.
Longo C, Zalaudek I, Moscarella E, Lallas A, Piana S, Pellacani G, et al. Clonal seborrheic keratosis: dermoscopic and confocal microscopy characterization. J Eur Acad Dermatol Venereol 2014;28:1397-400.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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