Indian Journal of Dermatology
E-IJD QUIZ
Year
: 2017  |  Volume : 62  |  Issue : 1  |  Page : 111-

Solitary nodule on the thigh


Piyush Kumar1, Anupam Das2,  
1 Department of Dermatology, Katihar Medical College and Hospital, Katihar, Bihar, India
2 Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India

Correspondence Address:
Dr. Anupam Das
Department of Dermatology, KPC Medical College and Hospital, Kolkata - 700 086, West Bengal
India




How to cite this article:
Kumar P, Das A. Solitary nodule on the thigh.Indian J Dermatol 2017;62:111-111


How to cite this URL:
Kumar P, Das A. Solitary nodule on the thigh. Indian J Dermatol [serial online] 2017 [cited 2020 Oct 20 ];62:111-111
Available from: https://www.e-ijd.org/text.asp?2017/62/1/111/198054


Full Text

A 65-year-old apparently healthy male presented with an asymptomatic growth over the right thigh, present for the past 1 year. Initially, the lesion was a pea-sized growth which gradually increased in its dimension and morphology to attain the the present size. (2.5 cm × 3 cm). Cutaneous examination showed a solitary moist firm slightly tender nodule over the lateral aspect of the right thigh. The mass had an eroded surface, fixed to the underlying structures, and bled on touch [Figure 1]. Regional lymphadenopathy was notably absent. The mass was excised in toto and histology showed a well-circumscribed epithelial neoplasm, connected to the epidermis at multiple points. The neoplasm was composed of monomorphous cells, with several of them showing abundant pale or clear cytoplasm. Besides, there were features of ductal differentiation, cystic changes, and necrosis [Figure 2] and [Figure 3]. The stroma was characterized by thickening and hyalinization of collagen.{Figure 1}{Figure 2}{Figure 3}

 Question



What is your diagnosis?

 View Answer

 Answer



Nodular hidradenoma.

 Discussion



Clear cell hidradenoma was first described in 1949; since then, it has been reported under various designations such as nodular hidradenoma and eccrine acrospiroma.[1] Clinically, it presents as a slow growing, solitary firm nodule, mostly distributed over the scalp, face, thorax, abdomen, and gluteal region; mainly in adults. Some tumors discharge serous material while others have a tendency to ulcerate.[1],[2]

The histopathological findings of nodular hidradenoma are classical. It is seen as a well circumscribed (often encapsulated) tumor containing an admixture of both solid and cystic components. The solid portion is composed of two types of cells, one cell type is polyhedral with a rounded nucleus and slightly basophilic cytoplasm; whereas the other cell type being round and having a clear cytoplasm due to the presence of glycogen. Nuclear grooving is found to be a useful morphological feature to aid in its diagnosis.[1],[3] Squamous differentiation may be found, with infundibular type of keratinization being the most common type. Sebaceous differentiation is also common.[4] Immunohistochemistry shows positive staining with antibodies against cytokeratin-CAM 5.2, Ber-EP4, p63, epithelial membrane antigen, S-100 protein, smooth muscle actin, and vimentin.[2],[3],[4]

The tumor has a high rate of local recurrence (10%) and limited potential for malignant transformation. Malignant sweat gland adnexal tumors are rare with an incidence of 0.001%. Of these, clear cell hidradenocarcinoma accounts for 6% of malignant eccrine sweat gland tumors. Therapeutic options include surgical excision and Mohs micrographic surgery.[5] The case is being reported for its rarity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Ahmed TS, Priore JD, Seykora JT. Tumors of the epidermal appendages. In: Elder DE, Elenitsas R, Johnson BL, Murphy GF, Xu X, editors. Lever's Histopathology of the Skin. 10th ed. Philadelphia: Lippincott Williams and Wilkins Publishers; 2009. p. 891-2.
2Das A, Gayen T, Podder I, Shome K, Bandyopadhyay D. A weeping tumor in a young girl: An unusual presentation of nodular hidradenoma. Indian J Dermatol 2016;61:321-3.
3Khurshid A, Yaqoob N, Devan HA, Pervez S. 'Nuclear grooves' in nodular hidradenoma: Frequency and significance of an unrecognized histopatological feature. J Cutan Pathol 2007;34:871-5.
4Nandeesh BN, Rajalakshmi T. A study of histopathologic spectrum of nodular hidradenoma. Am J Dermatopathol 2012;34:461-70.
5Lane JE, Kent DE. Malignant nodular hidradenoma treated with Mohs micrographic surgery. Cutis 2011;88:173-4.