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CASE REPORT
Year : 1991  |  Volume : 57  |  Issue : 6  |  Page : 296-298

Clear cell hydradenoma masquerading as umbilical polyp




Correspondence Address:
Veena Maheshwari


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Source of Support: None, Conflict of Interest: None


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  Abstract 

A one-year-male child presented with red polypoidal umbilical mass of 2 cm diameter since birth. Excision of the mass was done under general anaesthesia. The tumour under microscope revealed the presence of large clear round cells and intervening at places were slit like spaces lined by cuboidal epithelium. The diagnosis of clear cell hidradenoma was made.


Keywords: Clear cell hidradenoma, Skin tumour, Sweat gland tumour


How to cite this article:
Maheshwari V, Tyagi S P, Channa R, Tyagi N. Clear cell hydradenoma masquerading as umbilical polyp. Indian J Dermatol Venereol Leprol 1991;57:296-8

How to cite this URL:
Maheshwari V, Tyagi S P, Channa R, Tyagi N. Clear cell hydradenoma masquerading as umbilical polyp. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2019 Oct 20];57:296-8. Available from: http://www.ijdvl.com/text.asp?1991/57/6/296/3712


Clear cell hidradenoma (CCH) is also known as nodular hidradenoma or solid-cystic hidradenoma [1], eccrine acrospiroma [2] and clear cell myoepithelioma [3]. It occurs as a slowly growing single nodular, solid or cystic, occa­sionally protruding mass. Some tumours dis­charge serous material while others tend to ulcerate [4]. The lesion can occur anywhere on the body e.g. axillae, face, arms, thighs, trunk, scalp and pubic region. Most commonly it is seen in the age group of 20 to 50 years and is rare in children[2].


  Case Report Top


A one-year-old boy presented with an umbilical mass since birth. There was .a his­tory of serous and occasional blood stained discharge from the mass. Before coming to the hospital he was treated with repeated local application of copper sulphate. There were no constitutional symptoms.

A red polypoidal mass of 2x2 cm in size was found in the umbilicus [Figure - 1].The tumour was firm and nontender with a nodular and glistening surface. Serous discharge was present. The skin around the umbilicus was normal. General and systemic examinations did not reveal any abnormality.

The presentation of the child was quite suggestive of umbilical polyp and excision under general anaesthesia was done. The excised mass was sent for histopathology.


  Pathology Top


A red multilocular mass measuring 2x2 cm in size was received. The tumour was firm in consistency. The cut surface was grayish white and homogenous. On microscopic ex­amination the overlying epidermis was de­nuded. The dermis showed tumour lobules comprised of cellular masses separated by thin vascular connective tissue stroma. These cell masses were extending into the subcuta­neous tissue and contained at times slit-like spaces lined by cuboidal. epithelium [Figure - 2]. The tumour cells were of two types. Most of them were large clear round cells with small eccentric nuclei and glycogen laden cytoplasm whereas the other type of cells had a finely granular, faintly eosinophilic cytoplasm with a round to oval nucleus. No mitotic figures were noticed. A diagnosis of clear cell hidradenoma (CCH) was made.

The patient was followed for one year. He remained well and there was no recurrence.


  Comments Top


Umbilical masses in children are the manifestations of disease in remnants of the vitelline duct or urachus or vestiges of other structures which during embryonic life are re-. fated to the umbilical cord or have traversed the umbilical ring. Umbilical polyp appear as a cherry red, moist raised nodule in the um­bilical dimple and is a remnant of vitelline duct. Umbilical polyps are often mistaken for granulomas. However, they do not yield to copper sulphate or silver nitrate applications and should be excised.

In our patient the diagnosis of umbilical polyp was made on the basis of the pres­ence of umbilical mass since birth and failure of any response to repeated application of copper sulphate. The mass proved to be CCH on histology. CCH is very rare in children. Sharma and Sharma [5] have reported a case occurring in a boy aged 13 years. The present case was only one year old and the tumour was present since birth. The site was also very unusual.

Histological picture of CCH is very typical as had been observed in the present case, characterised by two types of cells with a zone of transition between eosinophilic cells and clear cells and duct like spaces lined by low cuboidal cells. In some tumours groups of keratinising epithelial cells or epithelial pearls are also present. [6]

Though it is a benign tumour originating from the ductule portion of eccrine sweat gland but in adults one has to rule out the possibilities of metastases of renal cell carci­noma and clear cell variety of squamous cell carcinoma. However, very rarely a malignant from of CCH can exist. [7] Complete surgical removal is the treatment of choice.

 
  References Top

1.Winkelmann RK and Wolff K : Solid-cystic hidradenoma of the skin,Clnical and histopathological study; Arch Dermatol, 1968 ; 97 : 651-661,  Back to cited text no. 1    
2.Johnson BL Jr and Helwig EB : Eccrine acrospiroma : A clinicopathological study, Cancer, 1969 ; 23 641-657  Back to cited text no. 2    
3.Lever WF and Castleman B: Clear cell myoepithelioma of the skin. Report of 10 cases, Amer J Pathol, 1952 ; 28 : 691-699.  Back to cited text no. 3    
4.Kersting DW : Clear cell hidradenoma andhidradenocarcinoma, Arch Dermatol, 1963 ; 87 323-333.  Back to cited text no. 4    
5.Sharma DN, Sharma RD : Clear cell hidradenoma A case report, Ind J Pathol Microbiol, 1987 ; 30 7-9.  Back to cited text no. 5    
6.Hashimoto K, DiBella RJ and Lever WF :Clear cell hidradenomas. Histological, histochemical and electron microscopic studies, Arch Dermatol, 1967 ; 96 : 18-38.  Back to cited text no. 6    
7.Headington JT, Niederhuber JE and Beals TF Malignant clear cell acrospiroma. Cancer, 1978 ; 41 : 641-647.  Back to cited text no. 7    


    Figures

[Figure - 1], [Figure - 2]



 

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