Skin nonmelanocytic tumor
Cysts
Hidrocystoma
Authors: Ghassan A. Tranesh, M.D., Hong Qu, M.D.
Last author update: 1 January 2015
Last staff update: 28 October 2024 (update in progress)
Copyright: 2002-2024, PathologyOutlines.com, Inc.
PubMed Search: Apocrine cystadenoma [title] skin
Table of Contents
Definition / general | Sites | Clinical features | Case reports | Treatment | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Electron microscopy description | Differential diagnosis | Additional referencesCite this page: Tranesh GA, Qu H. Hidrocystoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skintumornonmelanocyticapocrinecystadenoma.html. Accessed December 23rd, 2024.
Definition / general
- Uncommon benign adenomatous cystic proliferation derived from apocrine glands
- Also called apocrine hidrocystoma, although apocrine cystadenoma may be preferable for lesions with true papillary projections and active epithelial secretions; these lesions are usually small (< 2 cm), on face of older adults (see also J Cutan Pathol 1997;24:249)
Sites
- Despite its apocrine derivation, rare at sites rich in normal apocrine glands (groin, axilla, anogenital region, eyelids [Moll's glands], ears [ceruminous glands])
- Usually solitary, but multiple lesions have been documented
- Often occurs as cystic lesion of head and neck (commonly check), rarely in axilla
- Similar lesion on eyelid known as Moll's gland cyst
Clinical features
- Presents as intradermal, moderately firm, dome-shaped, translucent, blue, bluish-black or purple cystic nodule up to 1 cm
- No gender preference
- Lesions on face, also called Robinson variant, usually in middle aged women
- Solitary lesions are not familial, but multiple apocrine hidrocystomas are a feature of ectodermal dysplasia (Acta Derm Venereol 2008;88:607) and focal dermal hypoplasia (Goltz syndrome)
- Although solitary apocrine hidrocystomas lack seasonal variation, multiple lesions in some patients worsen in summer or with excessive heat and improve during winter
- May be precursor to apocrine carcinoma
Case reports
- 29 year old woman with apocrine cystadenoma of axillary tail (Breast J 2013;19:109)
- 41 year old man with giant multicystic cystadenoma of Cowper's gland (Int Braz J Urol 2013;39:741)
- 58 year old man with giant multi-loculated apocrine hidrocystomas (Dermatol Online J 2010;16:16)
- 58 year old woman with apocrine hidrocystoma of cheek (Arch Plast Surg 2012;39:86)
- 64 year old man with apocrine hidrocystoma of lower lip (Head Neck Pathol 2014;8:117)
- 75 year old man with multiple apocrine hidrocystomas (J Clin Diagn Res 2013;7:171)
Treatment
- Complete excision recommended
Clinical images
Images hosted on other servers:
Eyelid, malar area, ear lobe
Dome shaped cystic mass
Lesion below lower lip
Capsule in subepidermis
Skin colored nodules
Gross description
- Unilocular cystic lesion with clear to brown fluid
Microscopic (histologic) description
- Large unilocular or multilocular cystic space within dermis
- Fibrous pseudocapsule is often present
- Typically, cystic spaces are lined by double layer of epithelial cells: an outer layer of flattened vacuolated myoepithelial cells and an inner layer of tall columnar cells with eosinophilic cytoplasm and basally located, round or oval vesicular nuclei
- Decapitation secretion is usually present
- Often adjacent to hyperplastic apocrine glands
Microscopic (histologic) images
Contributed by Angel Fernandez-Flores, M.D., Ph.D. and Dr. V. Zaitsev
Images hosted on other servers:
Decapitation secretion
Cyst wall
SMA, MIB1, GCDFP-15, CK7, CK18, CK19
Positive stains
- AE1 / AE3
- PAS-positive, diastase resistant granules may be evident in the cytoplasm of the inner lining cells and occasionally iron or melanin is also demonstrable
- Myoepithelial layer: smooth muscle actin (SMA), p63
- HER2: see Mod Pathol 2004;1:28
Negative stains
Electron microscopy description
- Two types of cells: secretory cells with granules resembling lipid droplets, and basal (myoepithelial) cells
- Lumen filled with cytoplasmic fragments detached from apical portions of secretory cells (Arch Dermatol 1979;115:194)
Differential diagnosis
- Eccrine cystadenoma
- Eccrine hidrocystoma
