Indian Dermatology Online Journal

SKINDIA QUIZ
Year
: 2016  |  Volume : 7  |  Issue : 6  |  Page : 556--557

SkIndia Quiz 30: A cystic nodule in the periorbital region


Vishalakshi S Pandit, Arun C Inamadar, Aparna Palit, M Sneha 
 Department of Dermatology, Venereology and Leprosy, SBMP Medical College, Hospital and Research Centre, BLDE University, Bijapur, Karnataka, India

Correspondence Address:
Arun C Inamadar
Department of Dermatology, Venereology and Leprosy, SBMP Medical College, Hospital and Research Centre, BLDE University, Bijapur - 586 103, Karnataka
India




How to cite this article:
Pandit VS, Inamadar AC, Palit A, Sneha M. SkIndia Quiz 30: A cystic nodule in the periorbital region.Indian Dermatol Online J 2016;7:556-557


How to cite this URL:
Pandit VS, Inamadar AC, Palit A, Sneha M. SkIndia Quiz 30: A cystic nodule in the periorbital region. Indian Dermatol Online J [serial online] 2016 [cited 2020 Sep 26 ];7:556-557
Available from: http://www.idoj.in/text.asp?2016/7/6/556/190557


Full Text

A 20-year-old lady presented with an asymptomatic lesion around her right eye since one year. There was no history of bleeding, discharge from the lesion or ulceration. No history of seasonal variation, or family history of similar lesions. Clinical examination showed a single, sessile, translucent skin-colored, dome-shaped nodule seen near right medial canthus of eye [Figure 1]. The surface of the nodule was smooth. Hair, nail, mucous membranes, general physical, and systemic examinations were normal. A punch biopsy was done from the nodule. Histopathological features from hematoxylin and eosin-stained tissue section are shown in [Figure 2] and [Figure 3].{Figure 1}{Figure 2}{Figure 3}

 What Is Your Diagnosis?



 View Answer

 Answer



Apocrine hidrocystoma (AH).

 Discussion



Apocrine hidrocystomas are benign proliferations derived from apocrine sweat glands. They occur most often in adults with no age or sex predilection. The lesions occur as asymptomatic solitary, or occasionally multiple, dome-shaped, cystic translucent nodules. The color varies from skin color, light-brown to bluish-black,[1] thought to be due to Tyndall phenomenon or the presence of lipofuscin.[2] The most common site is the periorbital region, particularly lateral to the outer canthus; they may also occur on the scalp, chest, or feet.

Histologically, they are characterized by unilocular or multilocular cysts lined by a double lining of epithelium with the outer layer comprising flat myoepithelial cells and the inner layer containing large columnar or cuboidal cells with eosinophilic cytoplasm and round or oval vesicular nuclei. Decapitation secretion is a hallmark of AH. It is not unusual to find it with nevus sebaceous and other organoid adnexal naevi.[3]

Multiple AHs may be a marker for rare inherited conditions: Schopf–Schulz–Passarge syndrome and Goltz syndrome.[2]

Differential diagnoses include Moll's gland cysts, eccrine hidrocystoma, apocrine cystadenoma. Eccrine hidrocystomas are lined by two layers of cuboidal cells and lack decapitation secretion. Apocrine ducts show positivity for human milk fat globulin 1, whereas eccrine tissue does not stain.[4] Apocrine cystadenoma can be differentiated by the presence of apocrine lesions with Ki67 staining, and extraluminal proliferation/infiltration.[5]

Treatment includes a simple needle puncture or excision, anticholinergic creams, electrodessication, and laser treatment.[6]

References

1Numata Y, Okuyama R, Sasai S, Aiba S. Apocrine hidrocystoma on the finger. Acta Derm Venereol 2006;86:188-9.
2Talsania N, Langman G, Orpin SD. A blue nodule on the forehead. Clin Exp Dermatol 2009;34:645-6.
3Veraldi S, Gianotti R, Pabisch S, Gasparini G. Pigmented apocrine hidrocystoma – A report of two cases and review of the literature. Strike off. Clin Exp Dermatol 1991;16:18-21.
4Weedon D. Skin Pathology. 3rd ed. Edinburgh: Churchill Livingstone; 2010. p. 779-97.
5Hunold AC, Herwig MC, Holz FG, Fischer HP, Loeffler KU. Pigmented tumour of the eyelid with unexpected findings. Case Rep Pathol 2012;2012:471368.
6Gupta S, Handa U, Handa S, Mohan H. The efficacy of electrosurgery and excision in treating patients with multiple apocrine hidrocystomas. Dermatol Surg 2001;27:382-4.