Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
View Point
What’s new in Dermatology

Translate this page into:

Case Report

Atypical clear cell hidradenoma

GP Thami, S Kaur, H Mohan
 Department of Dermatology and Venereology and Pathology, Government Medical College Hospital, Sector 32, Chandigarh, India

Correspondence Address:
G P Thami
Department of Dermatology and Venereology and Pathology, Government Medical College Hospital, Sector 32, Chandigarh
How to cite this article:
Thami G P, Kaur S, Mohan H. Atypical clear cell hidradenoma. Indian J Dermatol Venereol Leprol 2003;69:43-45
Copyright: (C)2003 Indian Journal of Dermatology, Venereology, and Leprology


Clear cell hidradenoma is a rare and benign cutaneous neoplasm of the eccrine sweat glands. Malignant transformation of these lesions is very rare. In the present communication, a histologically benign clear cell hidrademoma having an aggressive clinical behavior with rapid growth, pigmentation and ulceration is described. Differential diagnosis and management of atypical clear cell hidradenoma is discussed.
Keywords: Hidradenoma, Clear cell, Atypical


Clear cell hidradenoma (CCH) is an uncommon, benign, slowly growing cutaneous tumor of the sweat glands. It has been known by various other names such as nodular hidradenoma, eccrine acrospiroma, and solid-cystic hidradenoma.[1] It is mostly seen in adults and is characterized clinically by solitary and firm intradermal nodule. Histopathologically both solid and cystic portions are present with characteristic clear cells, which contain a large amount of glycogen and thus appear clear under light microscopy.[1],[2] Presence of malignant change is suggested clinically by a rapid growth and cutaneous ulceration and histologically by an increased number of mitotic figures, nuclear atypia and angiolymphatic or perineural invasion.[3] Lesions having frequent mitoses or nuclear atypia but lacking clear evidence of asymmetric invasive growth are termed as atypical CH and require an aggressive management in view of a risk of recurrence and malignant transormation.[1],[2] We report a patient with large, pigmented and ulcerated CCH that clinically resembled a pigmented basal cell carcinoma.

Case Report

A 72-year-old man presented with a 2-year history of an asymptomatic dark, raised lesion over the trunk. The lesion was noticed to have ulcerated along with an increase in size for the last two months. His general health was preserved and he had no significant past or medical history. Examination revealed a single, non-tender, round, firm, blackish brown, 3x3 cm sized nodulo-plaque lesion over the left lateral chest wall with superficial ulceration and exudation [Figure - 1]. It had a well-defined, pigmented, regular and raised margins and was free from underlying structures. There was no regional lymphadenopathy; general physical and systemic examination was normal. A clinical possibility of pigmented basal cell carcinoma was considered. An incisional skin biopsy revealed a well circumscribed tumor in the dermis composed of variably sized tubular lumina and cystic spaces. In addition the tumor had numerous polyhedral and clear cells and a moderate number of mitotic figures, but without nuclear atypia or vascular invasion [Figure - 2], [Figure - 3] consistent with the diagnosis of atypical CCH. Surgical excision was carried out with adequate tumor free margins, confirmed on histopathology. No recurrence has been observed over 6 months of follow up.


Clear cell hidradenomas CCH are usually seen in 4th to 8th decade of life and are twice more common in females.[2] Clinically the tumor appears as asymptomatic, usually solitary, 0.5 to 1 cm sized, skin colored intradermal nodule, slightly elevated above the surrounding skin.[1],[2] Occasionally brown, blue or red discoloration and surface erosions or ulceration may be observed. It is a slow growing tumour and rapid growth may represent trauma, hemorrhage or a malignant change.[2],[5]

Clinical differential diagnosis includes basal cell and squamous cell carcinoma, melanoma, metastatic tumor, dermatofibroma, pyogenic granulomas, hemangioma, leiomyoma and other cutaneous adenexal tumors.[1],[2] Differentiation depends upon biopsy and immunohistochemical staining.[2] Histopathology shows both solid and cystic components in varying proportions. The tumor has tubular lumina lined by cuboidal or columnar cells and variably sized cystic spaces. The solid portions contain two types of cells: polyhedral cells with basophilic cytoplasm and glycogen containing pale or clear cells with a clear cytoplasm and a round nucleus.[1]

Criteria for assessing malignancy include overt nuclear atypia, readily observed mitotic figures, infiltrative patterns, lymphatic or perineural invasion and areas of necrosis. CCH is labeled as atypical when there is no evidence of invasive features but it has a high mitotic rate or nuclear atypia. The exact frequency of atypical CCH and their risk of transformation into malignant tumors is not known. However, mitotic activity and cellular pleomorphism may not be accurate predictors of clinical behavior. Malignant CCH usually arise de novo and malignant transformation of benign CCH has rarely been reported.[3] Biddlestone et al have described a young girl with progression of a histologically benign hidradenoma to a malignant sweat gland carcinoma with metastasis over a period of 11 years.[3] However, mitotic activity and cellular pleomorphism may not be accurate predictors of clinical behavior.[2] Clinically benign CCH with focal nuclear pleomorphism and increased mitotic activity have been reported, while tumors with aggressive clinical behavior and metastasis may have deceptively benign histological appearance.[3],[5] In the reported case, potential for aggressive behavior was suggested by the clinical findings of a rapid growth, pigmentation and ulceration. However there were no features of nuclear atypia or angiolymphatic invasion and thus the lesion was histologically benign. It was labelled as an atypical CCH because of presence of mitotic figures. The present case thus illustrates that an aggressive clinical behavior may not always parallel the histologic features.

Treatment of benign, atypical and malignant CCH is surgical excision with adequate margins to minimize the risk of recurrence followed by histologic confirmation of adequacy of excision.2,3 In view of reported malignant transformation, howsoever rare, even the histologically benign lesions should be promptly diagnosed followed by surgical excision and histologic confirmation of clearance.

Elder D, Elentisas R, Ragsdale BD: Tumors of the epidermal appendages, in David E (ed): Lever's Histopathology of the Skin, Philadelphia: Lippincott-Raven Publisheres, 1997, p 747-804.
[Google Scholar]
Wilhelmi BJ, Appelt EA, Philips LG: A rare case of atypical eccrine acrospinoma of the scalp and a literature review, Ann Plast Surg, 1999; 42: 568-569.
[Google Scholar]
Biddlestone LR, Mc Laren KM, Tidman MJ: Malignant hidradenoma: a case report demonstrating insidious histological and clinical progression. Clin Exp. Dermatol, 1991; 16:474-477.
[Google Scholar]
Gianotti R, Alessi E: Clear cell hidradenoma associated with the folliculosebaceous apderine unit. Am J Dermatopathol, 1997; 19:351-357.
[Google Scholar]
Dumont K, Humph rays T, Malhotra R: Stump the experts. Dermatol Rev. 1996; 22:998-999.
[Google Scholar]
Show Sections