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Hidradenoma
papilliferum with oxyphilic metaplasia: a clinicopathological study of
18 cases, including detection of human papillomavirus.Am
J Dermatopathol. 2005 Apr;27(2):102-10.
Reported here are
18 cases of hidradenoma papilliferum with oxyphilic metaplasia. All
patients were women ranging in age from 29 to 74 years. Each presented
clinically with a small, solitary tumor in the anogenital region.
Microscopically, in addition to classic histopathological features, in
every case there was oxyphilic metaplasia of the constituent
epithelial cells. This finding could be likened to apocrine metaplasia,
a term used in breast pathology. Other histopathological findings
observed in this series, analogous to benign breast disease, included
sclerosing adenosis-like changes, atypical apocrine adenosis-like
changes, changes corresponding to usual ductal epithelial hyperplasia,
epitheliomatosis with a streaming growth pattern, lamprocyte-like
changes, clear cell change of the myoepithelium, foamy histiocyte
reaction, and stromal fibrosis. Immunohistochemistry inferred that in
the majority of cases oxyphilic metaplasia resulted from more
lysosomes, whereas numerous mitochondria were detected in only 3
cases. Using 2 different PCR methods we identified HPV in 4 of 15
cases of hidradenoma with oxyphilic metaplasia. In addition, HPV was
detected in 3 of 16 conventional papillary hidradenomas used as a
control group. The following HPV types were identified: 16, 31, 33,
53, and 56. The last type was found in 5 cases. More than one HPV type
from a single lesion was seen in 5 cases. Our observations are
consistent with previous publications noting similarities between
tumors of the breast and sweat glands. Oxyphilic metaplasia, areas
with solid growth, and changes simulating atypical apocrine adenosis
are rare and poorly recognized in hidradenoma papilliferum and may
cause diagnostic difficulties; in our cases several submitting
pathologists suspected malignancy. A causal role for HPV in
hidradenoma papilliferum cannot be confirmed from our results, as the
detection rate is too low. The exact role of the HPV in etiology and
pathogenesis of this neoplasm has yet to be determined. |
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Hidradenoma Papilliferum
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| Hidradenoma
papilliferum of nasal skin.Arch
Pathol Lab Med. 2003 Feb;127(2):E86-8.
Pathologic examination
of an excisional biopsy specimen of a subepidermal nodule from the nasal tip
of a 37-year-old black man demonstrated papillae covered by eosinophilic
columnar epithelial cells, suggesting cylindric cell papilloma or
well-differentiated papillary adenocarcinoma of nasal mucosa. The patient
did not submit to further investigation of the sinonasal tract but sought
attention 15 months later because of local recurrence of the lesion. A
protuberant, 3-cm, cystic nodule of the subcutis over the left nasal ala and
tip was excised completely and found to have characteristics of hidradenoma
papilliferum, an apocrine gland neoplasm most commonly occurring in the
anogenital skin of white women. This case demonstrates how easily an
apocrine neoplasm arising near a mucocutaneous junction can be confused with
a mucosal tumor, potentially leading to inappropriate treatment.
Extramammary Paget disease
with underlying hidradenoma papilliferum: guilt by association?Am
J Dermatopathol. 2000 Oct;22(5):439-42.
Extramammary Paget
disease (EMPD) is a heterogenous entity representing either an
intraepidermal adenocarcinoma in situ with apocrine differentiation or an
expression of underlying malignancy of the skin or of the intestinal or
genitourinary tract. The coexistence of EMPD with a benign underlying
hidradenoma papilliferumn (HP) is, however, exceptional. We present the case
of a 79-year-old woman with diffuse and patchy gray-white lesions involving
her left vulva as well as an underlying 0.7-cm asymptomatic firm nodule.
Histologically, the epidermis and dermis showed features characteristic of
EMPD and HP, respectively. Malignant transformation in HP giving rise to
EMPD in the overlying epithelium has been reported. In our case, however,
failure to demonstrate continuity between the two lesions together with the
lack of cytologic atypia, mitoses, and necrosis in the HP lends additional
support to the possibility that the HP is "innocent" and that its
association with EMPD is thus coincidental. A common histogenetic derivation
of these two lesions from the mammary-like glands or from related
germinative cells in the epidermis is suggested to explain this rare
presentation.
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February 2008
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