Case and Research Letters
Dermatoscopy of Apocrine Tumors: Report of 4 Cases
Dermatoscopia de tumores apocrinos: presentación de 4 casos
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Quiste en la dermis revestido por una doble capa de células cuboideas (a y b). Tumor bien circunscrito constituido por células de citoplasma amplio y eosinófilo y otras de aspecto más basaloide. Estructuras quísticas en el centro de la lesión (c).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D.E. Cieza-Díaz, J.A. Avilés-Izquierdo, C. Ciudad-Blanco, V. Parra-Blanco" "autores" => array:4 [ 0 => array:2 [ "nombre" => "D.E." "apellidos" => "Cieza-Díaz" ] 1 => array:2 [ "nombre" => "J.A." "apellidos" => "Avilés-Izquierdo" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Ciudad-Blanco" ] 3 => array:2 [ "nombre" => "V." 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Cieza-Díaz, J.A. Avilés-Izquierdo, C. Ciudad-Blanco, V. Parra-Blanco" "autores" => array:4 [ 0 => array:4 [ "nombre" => "D.E." "apellidos" => "Cieza-Díaz" "email" => array:1 [ 0 => "deysycieza@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.A." "apellidos" => "Avilés-Izquierdo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Ciudad-Blanco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "V." "apellidos" => "Parra-Blanco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatoscopia de tumores apocrinos: presentación de 4 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 948 "Ancho" => 1267 "Tamanyo" => 179400 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermatoscopic images. Homogeneous pattern of pale grey/bluish color, with whitish cotton -wool –-like structures and linear irregular vessels (A-D) and regions of brown-orange color (B and D).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hidrocystomas and hidradenomas are adnexal tumors that originate from sweat glands and are typically of apocrine origin. They are usually diagnosed histologically because they lack characteristic clinical findings.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Dermatoscopy is a noninvasive technique that can help in the diagnosis of these tumors. We present the dermatoscopic features of 3 cases of apocrine hidrocystomas and 1 case of a solid-cystic apocrine hidradenoma.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Case 1: A 68-year-old man attended the clinic because of an asymptomatic lesion that had appeared 6 months earlier in the right parietal region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The mildly erythematous nodule measured 1<span class="elsevierStyleHsp" style=""></span>cm in diameter. The dermatoscopic image showed a homogeneous pattern of pale grey/bluish color, with whitish cotton wool-like structures and linear irregular vessels (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Histopathology showed a cystic structure lined by an epithelium formed of a double layer of cuboidal cells with no cytologic atypia and areas of decapitation secretion, consistent with diagnosis of apocrine hidrocystoma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Case 2: A 62-year-old woman attended the clinic because of an asymptomatic lesion on the right helix that had been present for several years. The translucent cystic lesion measured 1<span class="elsevierStyleHsp" style=""></span>cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The dermatoscopic image showed a homogeneous pattern of pale grey/bluish color, with brown-orange regions to the left of the lesion, whitish cotton wool-like structures, and linear irregular vessels (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). Histology was consistent with apocrine hidrocystoma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Case 3: A 30-year-old woman had a 1<span class="elsevierStyleHsp" style=""></span>cm nodule on a sebaceous nevus in the interparietal region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). The dermatoscopic image showed a homogeneous pattern of pale grey/bluish color, with whitish cotton wool-like structures, and linear irregular vessels (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). Histology confirmed the diagnosis of apocrine hidrocystoma.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Case 4: An 81-year-old woman attended the clinic because of an asymptomatic lesion on the right arm. Clinical examination revealed a well-defined, erythematous nodule measuring 1.5<span class="elsevierStyleHsp" style=""></span>cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). The dermatoscopic image showed a homogeneous pattern of pale grey/bluish color, with brown-orange areas, whitish cotton wool-like structures, and linear irregular vessels peripherally (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D). Histologically, the lesion was a nonencapsulated dermal tumor comprised of cells with no atypia and abundant eosinophilic cytoplasm and cells whose nuclei had a more basaloid and hyperchromatic appearance. Foci of clear cells could be seen. The lesion showed cystic formations with mucin in the lumen, as well as a sclerotic and vascularized stroma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>C). The above was compatible with a diagnosis of solid-cystic apocrine hidradenoma.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Apocrine hidrocystomas are benign adnexal cystic tumors of unknown etiology. Possible causes include sweat duct occlusion or adenomatous cystic proliferation of apocrine glands (apocrine cystadenoma). Histologically, they usually have multiple cystic spaces, with papillary protrusions and a wall composed of an inner layer of cuboidal cells and an outer layer of myoepithelial cells. These lesions are usually surrounded by a fibrous stroma with small-diameter vessels inside.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Apocrine hidradenoma is a benign adnexal tumor of uncertain histogenesis. It is a multilobed, nonencapsulated, well-defined neoplasm comprised mainly of neoplastic epithelial cells and small ductal lumens. There are several histologic patterns: nodular hidradenoma, solid-cystic hidradenoma, and clear-cell hidradenoma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Correct diagnosis of hidrocystoma and hidradenoma is difficult solely on the clinical presentation and subsequent histologic confirmation is required. The clinical differential diagnosis is very broad and includes conditions such as other adnexal tumors, epidermal cysts, basal cell carcinoma, and amelanocytic melanoma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Correia et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> described the dermatoscopic findings from 2 eccrine hidrocystomas, but they only reported the presence of a well-defined cystic lesion free of vessels. Although not mentioned in the text of the article, a homogeneous pale grey/bluish pattern could be observed in the photograph of one of the cases. There is also a dermatoscopic description of a case of clear-cell hidradenoma, in which the presence of purpuric areas and some linear and hairpin vessels are noted on the tumor surface.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The purpuric areas correspond histologically to hemorrhage into the cystic spaces of the tumor. In addition, there is a description of a case of malignant nodular hidradenoma, in which polymorphic vascular structures were observed.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The authors suggested that these can be seen in tumors of eccrine origin.</p><p id="par0055" class="elsevierStylePara elsevierViewall">All of our cases (3 apocrine hidrocystomas and 1 solid-cystic hidradenoma) had a homogeneous pale grey/bluish pattern, whitish cotton wool-like structures, and linear vessels. In 2 cases, focal brown-orange areas were observed. No purpuric areas were observed in any of our cases. The greyish color arises probably because these tumors contain sialomucin, which causes a diffraction effect similar to that observed in Kaposi sarcoma. The whitish cotton wool-like structures are a reflection from the stroma or connective tissue, while the dilated vessels in the superficial dermis correspond to the peripheral linear vessels in the dermatoscopic image. The presence of clear cells laden with glycogen could be responsible for the brown-orange focal structures. In conclusion, we should suspect these tumors in the case of nodular lesions, particularly on the head. Dermatoscopy is a technique that can help in diagnosis, particularly in the absence of dermatoscopic findings suggestive of other clinically similar tumors such as basal cell carcinoma and amelanotic melanoma<span class="elsevierStyleItalic">.</span></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cieza-Díaz D, Avilés-Izquierdo J, Ciudad-Blanco C, Parra-Blanco V. Dermatoscopia de tumores apocrinos: presentación de 4 casos. Actas Dermosifiliogr. 2013;104:826–828.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1301 "Ancho" => 1260 "Tamanyo" => 365846 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical images. A, Nodule in the right parietal region. B, Cystic lesion on the helix. C, Nodule on sebaceous nevus on the scalp. D, Nodule on the right arm.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 948 "Ancho" => 1267 "Tamanyo" => 179400 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermatoscopic images. Homogeneous pattern of pale grey/bluish color, with whitish cotton -wool –-like structures and linear irregular vessels (A-D) and regions of brown-orange color (B and D).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 702 "Ancho" => 1588 "Tamanyo" => 237392 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histologic images (hematoxylin-eosin, original magnification ×20). A and B, Dermal cysts enveloped in a double layer of cuboidal cells. Well-defined tumor composed of cells with abundant eosinophilic cytoplasm and other cells of a more basaloid appearance. C, Cystic structures in the center of the lesion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin adnexal neoplasms-part 2: an approach to tumours of cutaneous sweat glands" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.A. Obaidat" 1 => "K.O. Alsaad" 2 => "D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 10 | 23 |
| 2024 October | 88 | 32 | 120 |
| 2024 September | 93 | 19 | 112 |
| 2024 August | 116 | 35 | 151 |
| 2024 July | 98 | 21 | 119 |
| 2024 June | 138 | 42 | 180 |
| 2024 May | 82 | 36 | 118 |
| 2024 April | 77 | 18 | 95 |
| 2024 March | 110 | 26 | 136 |
| 2024 February | 77 | 30 | 107 |
| 2024 January | 102 | 37 | 139 |
| 2023 December | 70 | 18 | 88 |
| 2023 November | 122 | 25 | 147 |
| 2023 October | 117 | 30 | 147 |
| 2023 September | 106 | 42 | 148 |
| 2023 August | 85 | 29 | 114 |
| 2023 July | 113 | 59 | 172 |
| 2023 June | 91 | 32 | 123 |
| 2023 May | 109 | 45 | 154 |
| 2023 April | 121 | 27 | 148 |
| 2023 March | 89 | 29 | 118 |
| 2023 February | 79 | 24 | 103 |
| 2023 January | 67 | 43 | 110 |
| 2022 December | 74 | 63 | 137 |
| 2022 November | 40 | 27 | 67 |
| 2022 October | 49 | 21 | 70 |
| 2022 September | 60 | 42 | 102 |
| 2022 August | 50 | 35 | 85 |
| 2022 July | 40 | 41 | 81 |
| 2022 June | 32 | 29 | 61 |
| 2022 May | 67 | 46 | 113 |
| 2022 April | 61 | 34 | 95 |
| 2022 March | 71 | 49 | 120 |
| 2022 February | 70 | 25 | 95 |
| 2022 January | 65 | 32 | 97 |
| 2021 December | 71 | 36 | 107 |
| 2021 November | 61 | 43 | 104 |
| 2021 October | 76 | 56 | 132 |
| 2021 September | 63 | 41 | 104 |
| 2021 August | 46 | 19 | 65 |
| 2021 July | 40 | 26 | 66 |
| 2021 June | 38 | 29 | 67 |
| 2021 May | 49 | 33 | 82 |
| 2021 April | 97 | 97 | 194 |
| 2021 March | 62 | 32 | 94 |
| 2021 February | 45 | 24 | 69 |
| 2021 January | 39 | 24 | 63 |
| 2020 December | 50 | 16 | 66 |
| 2020 November | 26 | 13 | 39 |
| 2020 October | 20 | 5 | 25 |
| 2020 September | 33 | 13 | 46 |
| 2020 August | 21 | 21 | 42 |
| 2020 July | 23 | 12 | 35 |
| 2020 June | 24 | 20 | 44 |
| 2020 May | 28 | 18 | 46 |
| 2020 April | 72 | 15 | 87 |
| 2020 March | 23 | 22 | 45 |
| 2020 February | 0 | 3 | 3 |
| 2020 January | 4 | 1 | 5 |
| 2019 December | 10 | 5 | 15 |
| 2019 November | 4 | 2 | 6 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 4 | 1 | 5 |
| 2019 July | 4 | 3 | 7 |
| 2019 June | 4 | 16 | 20 |
| 2019 May | 6 | 20 | 26 |
| 2019 April | 2 | 20 | 22 |
| 2019 March | 4 | 6 | 10 |
| 2019 February | 2 | 2 | 4 |
| 2019 January | 2 | 3 | 5 |
| 2018 December | 3 | 5 | 8 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 6 | 0 | 6 |
| 2018 September | 2 | 0 | 2 |
| 2018 May | 0 | 12 | 12 |
| 2018 April | 0 | 2 | 2 |
| 2018 March | 19 | 2 | 21 |
| 2018 February | 69 | 4 | 73 |
| 2018 January | 87 | 9 | 96 |
| 2017 December | 76 | 9 | 85 |
| 2017 November | 72 | 8 | 80 |
| 2017 October | 75 | 4 | 79 |
| 2017 September | 65 | 5 | 70 |
| 2017 August | 101 | 31 | 132 |
| 2017 July | 61 | 12 | 73 |
| 2017 June | 84 | 33 | 117 |
| 2017 May | 54 | 13 | 67 |
| 2017 April | 44 | 7 | 51 |
| 2017 March | 49 | 21 | 70 |
| 2017 February | 38 | 4 | 42 |
| 2017 January | 53 | 5 | 58 |
| 2016 December | 52 | 11 | 63 |
| 2016 November | 114 | 5 | 119 |
| 2016 October | 133 | 9 | 142 |
| 2016 September | 192 | 17 | 209 |
| 2016 August | 182 | 10 | 192 |
| 2016 July | 98 | 7 | 105 |
| 2016 June | 6 | 5 | 11 |
| 2016 May | 10 | 18 | 28 |
| 2016 April | 3 | 17 | 20 |
| 2016 March | 10 | 6 | 16 |
| 2016 February | 13 | 1 | 14 |
| 2016 January | 17 | 1 | 18 |
| 2015 December | 11 | 1 | 12 |
| 2015 November | 8 | 0 | 8 |
| 2015 October | 5 | 2 | 7 |
| 2015 September | 4 | 2 | 6 |
| 2015 August | 4 | 2 | 6 |
| 2015 July | 117 | 2 | 119 |
| 2015 June | 82 | 7 | 89 |
| 2015 May | 72 | 14 | 86 |
| 2015 April | 55 | 4 | 59 |
| 2015 March | 47 | 3 | 50 |
| 2015 February | 61 | 1 | 62 |
| 2015 January | 41 | 2 | 43 |
| 2014 December | 61 | 5 | 66 |
| 2014 November | 38 | 4 | 42 |
| 2014 October | 48 | 4 | 52 |
| 2014 September | 47 | 0 | 47 |
| 2014 August | 49 | 7 | 56 |
| 2014 July | 50 | 6 | 56 |
| 2014 June | 56 | 4 | 60 |
| 2014 May | 48 | 8 | 56 |
| 2014 April | 33 | 1 | 34 |
| 2014 March | 42 | 6 | 48 |
| 2014 February | 32 | 5 | 37 |
| 2014 January | 30 | 4 | 34 |
| 2013 December | 21 | 4 | 25 |
| 2013 November | 15 | 5 | 20 |
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