Multiple apocrine hidrocystoma-an uncommon presentation

S Warrier, K Mohammed, B Safia

 Department of Dermatology and Venereology, Government Medical College, Kozhikode - 673 008, India

Correspondence Address:
K Mohammed
Department of Dermatology and Venereology, Government Medical College, Kozhikode - 673 008
India

Introduction

Apocrine hidrocystomas (AHC) or cystadenomas are benign cystic tumours of the secretory portion of apocrine sweat glands. They were first described by Mehregan in 1893. They are most often seen in ophthalmic or surgical clinics and are usually solitary, commonest sites being around the eyes, especially lateral to outer canthus.[1] Males and females are equally affected. We are reporting a case with multiple such lesions occurring at unusual sites.

Case Report

A 35-year-old lady presented with multiple asymptomatic subcutaneous nodules over her forearms, anterior chest, axilla and labia majora of 0.5 to 1cm size [Figure - 1], [Figure - 2]. Some of the lesions ruptured spontaneously and discharged cheesy material. The overlying skin was normal in all areas except over forearms where it was hyperpigmented. Systemic examination did not reveal any abnormality. Routine blood and urine investigations were within normal limits. Our diagnosis was multiple sebaceous cysts. The forearm lesion was excised and histopathological examination showed the typical features of AHC namely cystic spaces with papillary projections [Figure - 3]. Excision biopsies from other lesions confirmed the multiple occurrence of AHC.

Discussion

AHC or cystadenomas are usually found singly. When they do occur in greater numbers they are usually confined to head and neck region (Robinson type).[1],[2],[3] In our case the lesions were found over forearms, anterior chest, axillae and labia majora. To the best of our knowledge this has not been reported so far. The tumours are soft, transilluminant, of various colours - light brown, red brown and bluish in Japanese, and darker colour in non Japanese.[4] The diagnosis is by histopathological study of biopsy specimens which show a cystic space in the dermis into which papillary projections extend which is characteristic of the tumor. Cyst wall is lined by columnar epithelium showing apocrine type secretion - ′decapitation secretion′; however they may be absent in some cases. Peripheral to this, myoepithelial cells are usually seen. Although not specific for the tumour, these cells are CD44+,4 S100 and CEA positive. Secretory cells may contain pigment. The secretion may be coagulated and stained with PAS stain. The cyst has no connection with the overlying epidermis.[2]

Multiple AHC may be a market of two inherited disorders - The Schopf-Schulz-Passarge syndrome, and a peculiar form of focal dermal hypoplasia. Treatment modalities include electro desiccation (for lesions < 1cm), excision (if> 1cm) and carbon dioxide laser for multiple lesions. We treated our patient with excision of the individual lesions.

1.	Rona M MacKie. Tumours of the skin appendages. Rook A, Wilkinson DS, Ebling FJG eds. Textbook of Dermatology Sixth edition 1998; 1703-1704. [Google Scholar]
2.	Torsekar RG, Vishalakshi V. Multiple apocrine hidrocy stomas. Indian J Dermatol Venereol 2001; Vol 67:89-90. [Google Scholar]
3.	Farina MC, Pique E, Olivares M, et al. Apocrine hidrocystomas of the face: three cases. Clin Exp Dermatol 1995; 20:323-327. [Google Scholar]
4.	Fukuda M, Kato H, Hamada T. Apocrine hidrocystomas - a report of five cases with review of Japanese literature. J Dermatol 1989; 16:315-320. [Google Scholar]