Case and Research Letters
Ultrasound Diagnosis of Nodular Hidradenoma
Diagnóstico ecográfico del hidradenoma nodular
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A)<span class="elsevierStyleHsp" style=""></span>Lesión dermohipodérmica, ovalada, anecoica, con una zona hiperecogénica triangular que protruye desde su pared (asterisco). B)<span class="elsevierStyleHsp" style=""></span>Aumento de flujo a nivel periférico y en la porción sólida triangular (modo Doppler).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Vázquez-Osorio, P. Gonzalvo-Rodríguez, E. Rodríguez-Díaz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Vázquez-Osorio" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Gonzalvo-Rodríguez" ] 2 => array:2 [ "nombre" => "E." 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Mild desquamation can be observed on some.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Allegue, C. Fachal, D. González-Vilas, A. Zulaica" "autores" => array:4 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Allegue" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Fachal" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "González-Vilas" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Zulaica" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017305410" "doi" => "10.1016/j.ad.2017.08.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017305410?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301306?idApp=UINPBA000044" "url" => "/15782190/0000010900000005/v1_201806040407/S1578219018301306/v1_201806040407/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219018301252" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.04.007" "estado" => "S300" "fechaPublicacion" => "2018-06-01" "aid" => "1804" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:450-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 50 "formatos" => array:2 [ "HTML" => 49 "PDF" => 1 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "A Typical Case of Lipoblastoma on the Lower Limb of an Infant" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "450" "paginaFinal" => "452" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lipoblastoma en la extremidad inferior de un lactante. Un caso representativo" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 919 "Ancho" => 1667 "Tamanyo" => 320556 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A and B, Mesenchymal lesion composed of immature fat cells (hematoxylin-eosin, original magnification ×10) and spindle cells (hematoxylin-eosin, original magnification ×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Giraldo Mordecay, M.P. Novoa Candia, C.E. Torres Fuentes, A.M. Sastre Zuluaga" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L. Giraldo" "apellidos" => "Mordecay" ] 1 => array:2 [ "nombre" => "M.P. 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Vázquez-Osorio, P. Gonzalvo-Rodríguez, E. Rodríguez-Díaz" "autores" => array:3 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Vázquez-Osorio" "email" => array:1 [ 0 => "rogivaos@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" => "P." "apellidos" => "Gonzalvo-Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Rodríguez-Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico ecográfico del hidradenoma nodular" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 938 "Ancho" => 1250 "Tamanyo" => 304226 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathology. A,<span class="elsevierStyleHsp" style=""></span>Well-defined, nonencapsulated dermal-hypodermal lesion with solid cystic areas (hematoxylin-eosin, original magnification ×10). B and C,<span class="elsevierStyleHsp" style=""></span>Two types of cell can be distinguished in the solid portion of the tumor. Polyhedral cells, with a long vesicular nucleus and eosinophilic cytoplasm (B), and large cells with an eccentric nucleus and abundant clear cytoplasm (C) (hematoxylin-eosin, original magnification, ×20 and ×40). D)<span class="elsevierStyleHsp" style=""></span>Positive immunohistochemistry result for CK-7 (CK-7, ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Nodular hidradenoma (NH), also known as solid cystic or clear cell hidradenoma, is an uncommon and benign adnexal tumor. Its clinical heterogeneity can lead it to be confused with other neoplasms, both benign and malignant.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Although the initial diagnosis is based on histopathology findings, a previous skin ultrasound could prove to be of considerable help. We present a case of NH at an unusual site in an elderly woman and in which ultrasound was very useful for diagnosis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was an 87-year-old woman with a history of arterial hypertension and carcinoma in situ of the larynx in complete remission who consulted for a painful lesion on her lower back. The lesion had grown gradually, and the patient could not remember when it first appeared.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed a painful subcutaneous lesion measuring 2<span class="elsevierStyleHsp" style=""></span>cm that was erythematous-violaceous in color and of a firm consistency (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesion had what appeared to be a dimple sign. The rest of the physical examination was unremarkable.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Cutaneous ultrasound (12-18<span class="elsevierStyleHsp" style=""></span>MHz) revealed an oval, well-defined dermal-hypodermal structure measuring 1.85<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.23<span class="elsevierStyleHsp" style=""></span>cm. This lesion was cystic in appearance, with an anechoic interior and posterior enhancement. A triangular hyperechogenic area protruding through the wall was clearly visible in the upper pole (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Color Doppler mode revealed increased peripheral vascularization, especially in the triangular solid portion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Given the patient's personal history and the fact that the time of onset was unknown, we decided to remove the lesion. Histopathology revealed a well-defined dermal-hypodermal lesion with solid and cystic areas (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). The solid areas were composed of 2 types of cell: cells with a round nuclei, granular chromatin, visible nucleoli, abundant cytoplasm, and eosinophils; and cells with a clear cytoplasm and eccentric nuclei (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B-<span class="elsevierStyleSmallCaps">C</span>). There was no cellular atypia, pleomorphism, vascular invasion, or necrosis. Immunohistochemistry revealed positive results for epithelial membrane antigen, cytokeratin (CK) 7, and CK AE1/AE3, and negative results for S100, enolase, melan-A, and D2-40 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>D). These findings enabled us to make a diagnosis of NH.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">NH mainly affects women in the fourth and fifth decades of life. It is found on the head and upper limbs. Clinically, it is characterized by a slow-growing, solitary, round lesion measuring 0.5-2<span class="elsevierStyleHsp" style=""></span>cm with a firm consistency. It is usually asymptomatic, although it sometimes bleeds or is painful, as in the case we report. The overlying skin may be thickened, atrophic, or ulcerated and is erythematous-violaceous or brownish in color.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Although NH has traditionally been considered a neoplasm with eccrine differentiation, it is nowadays classified into 2 groups: hidradenoma with eccrine differentiation (poroid hidradenoma) and hidradenoma with apocrine differentiation (NH).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Few publications report ultrasound findings for NH, although these findings are similar in all of the reports.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2–7</span></a> In ultrasound terms, NH is defined as a well-demarcated, oval, dermal-hypodermal cystic lesion that has an anechoic or hypoechoic interior. In 7 of the 8 cases reported, the interior of the lesion contains a solid triangular hyperechoic area that protrudes from the wall of the lesion and that usually shows increased vascularization on Doppler.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2–7</span></a> These ultrasound findings are associated with the solid cystic areas observed in histopathology. Hyperechogenic foci compatible with calcifications can sometimes be observed.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The clinical differential diagnosis includes dermatofibroma, epidermal cyst, blue nevus, and basal cell carcinoma; the main histopathologic differential diagnosis is with apocrine mixed tumor.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In ultrasound, the differential diagnosis should be made first with other benign adnexal tumors, such as the following: hidrocistoma,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> a hypoechoic dermal-hypodermal lesion with no posterior enhancement or vascularization; eccrine spiradenoma,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> a heteroechoic lobulated dermal lesion with posterior enhancement and vascularization (both central and peripheral); and poroid hidradenoma,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> a hypoechoic hypodermal lesion with hyperechogenic areas, posterior enhancement, and a lateral acoustic shadow.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Other benign subcutaneous lesions that should also be ruled out include the following: epidermal cyst, a hypoechoic lesion with posterior enhancement, lateral acoustic shadow, and dermal-hypodermal tract or punctum; pilomatrixoma, a well-defined heteroechoic lesion that usually presents peripheral vascularization and calcifications in the interior; dermatofibroma, a poorly defined dermal-hypodermal lesion with no vascularization and that could present hypoechoic lines on the periphery. Finally, given the history of cancer, we should rule out cutaneous metastasis, which is characterized on ultrasound as intensely vascularized and as hypoechoic nodules with increased acoustic transmission in the subcutaneous cellular tissue.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Despite being a benign neoplasm, NH usually recurs after incomplete removal. There have been reports of isolated cases of malignant transformation, which should be suspected in the case of a rapidly growing tumor with an invasive pattern, pleomorphism, high mitotic index, and angiolymphatic invasion in histopathology.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Therefore, NH may prove difficult to differentiate clinically from other skin lesions. Application of a rapid, inexpensive, noninvasive technique such as cutaneous ultrasound can guide the presurgical diagnosis of NH. The presence of a cystic anechoic lesion with a vascularized hyperechogenic triangular area protruding through the wall are ultrasound findings that should point us to a diagnosis of NH.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vázquez-Osorio I, Gonzalvo-Rodríguez P, Rodríguez-Díaz E. Diagnóstico ecográfico del hidradenoma nodular. Actas Dermosifiliogr. 2018;109:453–455.</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" => 500 "Ancho" => 750 "Tamanyo" => 60451 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous-violaceous lesion (2<span class="elsevierStyleHsp" style=""></span>cm) with a firm consistency on the lower back.</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" => 493 "Ancho" => 1250 "Tamanyo" => 73173 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ultrasound study of the lesion. A,<span class="elsevierStyleHsp" style=""></span>Oval, anechoic, dermal-hypodermal lesion with a triangular hyperechogenic area that protrudes through the wall (asterisk). B,<span class="elsevierStyleHsp" style=""></span>Increased flow at the peripheral level and in the solid triangular portion (Doppler mode).</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" => 938 "Ancho" => 1250 "Tamanyo" => 304226 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathology. A,<span class="elsevierStyleHsp" style=""></span>Well-defined, nonencapsulated dermal-hypodermal lesion with solid cystic areas (hematoxylin-eosin, original magnification ×10). B and C,<span class="elsevierStyleHsp" style=""></span>Two types of cell can be distinguished in the solid portion of the tumor. Polyhedral cells, with a long vesicular nucleus and eosinophilic cytoplasm (B), and large cells with an eccentric nucleus and abundant clear cytoplasm (C) (hematoxylin-eosin, original magnification, ×20 and ×40). D)<span class="elsevierStyleHsp" style=""></span>Positive immunohistochemistry result for CK-7 (CK-7, ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A study of histopathologic spectrum of nodular hidradenoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.N. Nandeesh" 1 => "T. 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| año/Mes | Html | Total | |
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