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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B, Detail showing interface alteration, fibrinoid necrosis in the vessel walls, and isolated necrotic keratinocytes (hematoxylin-eosin, original magnification ×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.T. López-Villaescusa, Á. Hernández-Martín, I. Colmenero, A. Torrelo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.T." "apellidos" => "López-Villaescusa" ] 1 => array:2 [ "nombre" => "Á." "apellidos" => "Hernández-Martín" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Colmenero" ] 3 => array:2 [ "nombre" => "A." 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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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 13 | 10 | 23 |
| 2024 Octubre | 88 | 32 | 120 |
| 2024 Septiembre | 93 | 19 | 112 |
| 2024 Agosto | 116 | 35 | 151 |
| 2024 Julio | 98 | 21 | 119 |
| 2024 Junio | 138 | 42 | 180 |
| 2024 Mayo | 82 | 36 | 118 |
| 2024 Abril | 77 | 18 | 95 |
| 2024 Marzo | 110 | 26 | 136 |
| 2024 Febrero | 77 | 30 | 107 |
| 2024 Enero | 102 | 37 | 139 |
| 2023 Diciembre | 70 | 18 | 88 |
| 2023 Noviembre | 122 | 25 | 147 |
| 2023 Octubre | 117 | 30 | 147 |
| 2023 Septiembre | 106 | 42 | 148 |
| 2023 Agosto | 85 | 29 | 114 |
| 2023 Julio | 113 | 59 | 172 |
| 2023 Junio | 91 | 32 | 123 |
| 2023 Mayo | 109 | 45 | 154 |
| 2023 Abril | 121 | 27 | 148 |
| 2023 Marzo | 89 | 29 | 118 |
| 2023 Febrero | 79 | 24 | 103 |
| 2023 Enero | 67 | 43 | 110 |
| 2022 Diciembre | 74 | 63 | 137 |
| 2022 Noviembre | 40 | 27 | 67 |
| 2022 Octubre | 49 | 21 | 70 |
| 2022 Septiembre | 60 | 42 | 102 |
| 2022 Agosto | 50 | 35 | 85 |
| 2022 Julio | 40 | 41 | 81 |
| 2022 Junio | 32 | 29 | 61 |
| 2022 Mayo | 67 | 46 | 113 |
| 2022 Abril | 61 | 34 | 95 |
| 2022 Marzo | 71 | 49 | 120 |
| 2022 Febrero | 70 | 25 | 95 |
| 2022 Enero | 65 | 32 | 97 |
| 2021 Diciembre | 71 | 36 | 107 |
| 2021 Noviembre | 61 | 43 | 104 |
| 2021 Octubre | 76 | 56 | 132 |
| 2021 Septiembre | 63 | 41 | 104 |
| 2021 Agosto | 46 | 19 | 65 |
| 2021 Julio | 40 | 26 | 66 |
| 2021 Junio | 38 | 29 | 67 |
| 2021 Mayo | 49 | 33 | 82 |
| 2021 Abril | 97 | 97 | 194 |
| 2021 Marzo | 62 | 32 | 94 |
| 2021 Febrero | 45 | 24 | 69 |
| 2021 Enero | 39 | 24 | 63 |
| 2020 Diciembre | 50 | 16 | 66 |
| 2020 Noviembre | 26 | 13 | 39 |
| 2020 Octubre | 20 | 5 | 25 |
| 2020 Septiembre | 33 | 13 | 46 |
| 2020 Agosto | 21 | 21 | 42 |
| 2020 Julio | 23 | 12 | 35 |
| 2020 Junio | 24 | 20 | 44 |
| 2020 Mayo | 28 | 18 | 46 |
| 2020 Abril | 72 | 15 | 87 |
| 2020 Marzo | 23 | 22 | 45 |
| 2020 Febrero | 0 | 3 | 3 |
| 2020 Enero | 4 | 1 | 5 |
| 2019 Diciembre | 10 | 5 | 15 |
| 2019 Noviembre | 4 | 2 | 6 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 1 | 5 |
| 2019 Julio | 4 | 3 | 7 |
| 2019 Junio | 4 | 16 | 20 |
| 2019 Mayo | 6 | 20 | 26 |
| 2019 Abril | 2 | 20 | 22 |
| 2019 Marzo | 4 | 6 | 10 |
| 2019 Febrero | 2 | 2 | 4 |
| 2019 Enero | 2 | 3 | 5 |
| 2018 Diciembre | 3 | 5 | 8 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 6 | 0 | 6 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Mayo | 0 | 12 | 12 |
| 2018 Abril | 0 | 2 | 2 |
| 2018 Marzo | 19 | 2 | 21 |
| 2018 Febrero | 69 | 4 | 73 |
| 2018 Enero | 87 | 9 | 96 |
| 2017 Diciembre | 76 | 9 | 85 |
| 2017 Noviembre | 72 | 8 | 80 |
| 2017 Octubre | 75 | 4 | 79 |
| 2017 Septiembre | 65 | 5 | 70 |
| 2017 Agosto | 101 | 31 | 132 |
| 2017 Julio | 61 | 12 | 73 |
| 2017 Junio | 84 | 33 | 117 |
| 2017 Mayo | 54 | 13 | 67 |
| 2017 Abril | 44 | 7 | 51 |
| 2017 Marzo | 49 | 21 | 70 |
| 2017 Febrero | 38 | 4 | 42 |
| 2017 Enero | 53 | 5 | 58 |
| 2016 Diciembre | 52 | 11 | 63 |
| 2016 Noviembre | 114 | 5 | 119 |
| 2016 Octubre | 133 | 9 | 142 |
| 2016 Septiembre | 192 | 17 | 209 |
| 2016 Agosto | 182 | 10 | 192 |
| 2016 Julio | 98 | 7 | 105 |
| 2016 Junio | 6 | 5 | 11 |
| 2016 Mayo | 10 | 18 | 28 |
| 2016 Abril | 3 | 17 | 20 |
| 2016 Marzo | 10 | 6 | 16 |
| 2016 Febrero | 13 | 1 | 14 |
| 2016 Enero | 17 | 1 | 18 |
| 2015 Diciembre | 11 | 1 | 12 |
| 2015 Noviembre | 8 | 0 | 8 |
| 2015 Octubre | 5 | 2 | 7 |
| 2015 Septiembre | 4 | 2 | 6 |
| 2015 Agosto | 4 | 2 | 6 |
| 2015 Julio | 117 | 2 | 119 |
| 2015 Junio | 82 | 7 | 89 |
| 2015 Mayo | 72 | 14 | 86 |
| 2015 Abril | 55 | 4 | 59 |
| 2015 Marzo | 47 | 3 | 50 |
| 2015 Febrero | 61 | 1 | 62 |
| 2015 Enero | 41 | 2 | 43 |
| 2014 Diciembre | 61 | 5 | 66 |
| 2014 Noviembre | 38 | 4 | 42 |
| 2014 Octubre | 48 | 4 | 52 |
| 2014 Septiembre | 47 | 0 | 47 |
| 2014 Agosto | 49 | 7 | 56 |
| 2014 Julio | 50 | 6 | 56 |
| 2014 Junio | 56 | 4 | 60 |
| 2014 Mayo | 48 | 8 | 56 |
| 2014 Abril | 33 | 1 | 34 |
| 2014 Marzo | 42 | 6 | 48 |
| 2014 Febrero | 32 | 5 | 37 |
| 2014 Enero | 30 | 4 | 34 |
| 2013 Diciembre | 21 | 4 | 25 |
| 2013 Noviembre | 15 | 5 | 20 |
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