INTRODUCTION Eccrine hidradenoma is also referred to as nodular hidradenoma, eccrine spiradenoma, or clear cell hidradenoma. These lesions are uncommon on the eyelids. They presumably arise from eccrine sweat glands and do not show any apocrine differentiation. These tumors occur primarily in middle-aged females and have a predilection for the head region. Very rarely they may undergo malignant change.
CLINICAL PRESENTATION The eccrine hidradenoma presents as a solitary slowly progressive nodular intradermal swelling. Occasionally it may be exophytic in growth with a translucent appearance and fine telangiectatic vessels. Some lesions have been known to undergo spontaneous regression. Malignant change is suggested by ulceration and infiltration around the borders and these have a high potential for metastatic spread.
HISTOPATHOLOGY These tumors, usually located in the dermis, are well circumscribed and composed of lobules of cells forming tubules and solid sheets. The tubules vary widely in luminal diameter and number, and cuboidal or columnar cells line them. Solid areas of the tumor have a mixture of polyhedral cells with rounded nuclei and slightly basophilic cytoplasm and other cells that
Eccrine Nodular Hidradenoma (Contd.)
are round with clear cytoplasm due to glycogen dissolution during histological processing. The proportion of the two cell types varies considerably between tumors, and there may be cells that have features between the two extremes.
DIFFERENTIAL DIAGNOSIS These can be confused with many skin lesions. The differential diagnosis includes basal cell carcinoma, apocrine hidradenoma, seborrheic keratosis, leiomyosarcoma, and syringoma.
TREATMENT Treatment is usually with complete surgical excision. Recurrences are common, reported in up to 50% of cases. Malignant tumors are managed with wide surgical excision and regional lymph node dissection, with ancillary radiotherapy or chemotherapy.
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