Multiple apocrine hidrocystomas

Introduction

Appendageal tumours commonly present on the face and scalp, majority of them being rela-tively benign and are diagnosed only on pathologi-cal examination. We report a case of multiple apocrine hidrocystomas in a 35- year - old woman.

Case Report

A 35- year- old woman presented with asymptomatic lesions on the face since-3 years. The patient had not received any treatment and denied history of any topical application. No sea-sonal exacerbation or remissions were noted.

Clinically, multiple discrete yellowish dome shaped translucent nodules were seen on the forehead, cheeks and chin varying in size from 2mm to 15mm, surface being smooth. No lesions were seen elsewhere. A diagnosis of multiple steatocystoma or? appendageal tumour was considered.

Biopsy of a lesion revealed a normal epider-mis and the dermis showed a large cystic space with papillary projections. There was no connec-tion between the epidermis and the cyst. The cyst wall and papillary projections were lined by a row of secretory cells with decapitation secretion suggesting apocrine origin. [Figure - 1]. A diagnosis of apocrine hidrocystoma was made. Electrofulguration of the remaining lesions was done with a good cosmetic result.

Discussion

Apocrine hidrocystomas or cystadenomas are benign cystic neoplasms of apocrine origin. Clini-cally the lesions are characterised by solitary, skin coloured translucent nodular lesions with a bluish hue.[1] These are commonly located on the face. Multiple apocrine hidrocystomas are rarely encoun-tered.[2] A clinical differential diagnosis includes pigmented nevus, melanoma, blue nevus or a cystic basal cell carcinoma.

A diagnosis of apocrine hidrocystoma solely on clinical findings is difficult and clinico- pathologi-cal correlation is needed. Histologically a cystic space in the dermis into which papillary projections ex-tend is characteristic and the cyst has no connec-tion with the overlying epidermis.[3] Lining of the cyst is by secretory cells of apocrine nature as illustrated in our case. In syringocystadenoma papilliferum, the lining of cystic invagination is simi-lar, but they extend downwards from the epider-mis. Eccrine hidrocystomas differ from apocrine by absence of decapitation secretion, of PAS positive granules and of myoepithelial cells. Also cysts of eccrine origin are unilocular and of apocrine origin tend to be multilocular.

Appendageal tumours on the face pose a cosmetic problem and a therapeutic challenge. A final diagnosis is possible only on histopathology as illustrated by our case. Also, gratifying results were obtained in our patient by electrofulguration.