We report the case of a 70-year-old woman with no relevant past history who presented 2 lesions on the dorsum of the right hand that had appeared 6 months earlier. The lesions were asymptomatic and had developed gradually.

Physical examination revealed 2 violaceous papules located close together on the dorsum of the right hand and that measured 1cm and 0.5cm in diameter (Fig. 1). The lesions had a smooth surface and firm consistency and were not tender to palpation.

Figure 1

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A punch biopsy was taken from 1 of the lesions. Histology showed a normal epidermis, but in the middle and deep dermis there was a disorganized proliferation of mature eccrine glands and ducts with interspersed mature adipocytes (Fig. 2). In addition, there were numerous vascular structures with walls of varying thickness that were positive for CD31 on immunohistochemistry (Fig. 3).

Figure 2.

Hematoxylin-eosin, original magnification×10.

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Figure 3.

CD31 immunohistochemical staining, original magnification×10.

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What Is Your Diagnosis?

Eccrine angiomatous hamartoma

As the lesions showed persistent growth, they were excised.

Eccrine angiomatous hamartoma (EAH) is a rare benign skin tumor combining eccrine and vascular elements. The first case was described by Lotzbeck in 1859, but the term EAH was later proposed by Hyman in 1968.1

EAH typically appears in early childhood, often in congenital form, and during later stages of childhood or even puberty. While infrequent, there have been reports of onset in adults, as in our patient.2,3

Clinically the lesions are usually single, though multiple lesions are observed, and they typically arise on the limbs (80%), although they have been described on other areas of the body. Morphologically, the lesions may consist of papules, nodules, or plaques that can be erythematous, violaceous, bluish, yellowish, or even skin colored. Although EAH is normally asymptomatic, the 2 most common symptoms are pain (42%) and hyperhidrosis (34%).4

Histopathology of EAH reveals a proliferation of mature eccrine glands in the middle and deep dermis in close association with dilated or collapsed angiomatous channels with thin, clearly differentiated walls. Some histopathologic variants also include pilar structures, apocrine glands, lipomatous foci, lymph vessels, and, rarely, bone.5

The clinical differential diagnosis must include vascular malformations, smooth muscle hamartoma, juvenile xanthogranuloma, glomus tumor, tufted angioma, blue rubber bleb nevus syndrome, and macular telangiectatic mastocytosis.4 The most relevant disorders in the histologic differential diagnosis are sudoriparous angioma, which involves dilation rather than proliferation of the eccrine glands, and eccrine nevus, in which angiomatous proliferation is absent.6

As EAH is benign and occasionally presents spontaneous involution, it does not require aggressive measures. However, in patients with painful lesions or cosmetic concerns, surgical excision is the only definitive treatment.