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CASE REPORT
Year : 2016  |  Volume : 7  |  Issue : 2  |  Page : 111-113  

Apocrine hidrocystoma arising from nevus sebaceous on the scalp


Department of Dermatology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India

Date of Web Publication4-Mar-2016

Correspondence Address:
Dr. Kaliaperumal Karthikeyan
Department of Dermatology, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Madagadipet, Pondicherry - 605 107
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.178088

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   Abstract 

Nevus sebaceous is a hamartoma with an uneventful course since birth but many benign or malignant tumors are known to develop in about one third of the patients. A 37-year-old woman with asymptomatic hairless raised lesion over the scalp since birth presented with change in the morphology of the lesions associated with itching and irritation since one month. On examination, multiple well-defined hyperpigmented verrucous plaques coalescing with each other were seen over the right parietal scalp associated with alopecia. A single well-defined soft skin-colored cystic swelling of size 1 × 2 cm was seen interspersed within the plaque. After a clinical diagnosis of nevus sebaceous, a biopsy of the cyst was done, which revealed a large cyst lined by columnar and myoepithelial cells in the dermis. The columnar cells at a few places showed “decapitation secretion” giving the impression of apocrine hidrocystoma. Post-excision of the cyst, biopsy of the entire nevus was done and the histopathological diagnosis correlated with the clinical diagnosis of nevus sebaceous. Apocrine hidrocystoma developing from a sebaceous nevus over the scalp is a rarity with only three other cases of it arising on the scalp being reported and none of them developed from a sebaceous nevus.

Keywords: Apocrine hidrocystoma, nevus sebaceous, scalp


How to cite this article:
Tejaswi C, Rangaraj M, Karthikeyan K. Apocrine hidrocystoma arising from nevus sebaceous on the scalp. Indian Dermatol Online J 2016;7:111-3

How to cite this URL:
Tejaswi C, Rangaraj M, Karthikeyan K. Apocrine hidrocystoma arising from nevus sebaceous on the scalp. Indian Dermatol Online J [serial online] 2016 [cited 2020 Nov 27];7:111-3. Available from: https://www.idoj.in/text.asp?2016/7/2/111/178088


   Introduction Top


Nevus sebaceous also known as organoid nevus is a hamartoma that is generally found on the scalp at birth. Although the nevus as such has an uneventful course, many benign or malignant tumors are known to develop in about one third of the patients with nevus sebaceous.[1] However, apocrine hidrocystoma arising from a sebaceous nevus is rare.


   Case Report Top


A 37-year-old woman with asymptomatic raised hairless lesion over the scalp since birth presented with complaints of change in the morphology of the lesions associated with itching and irritation for the past one month. The patient had not received any treatment for the lesion. There was no history suggestive of any systemic involvement. On examination, multiple well-defined hyperpigmented verrucous plaques coalescing with each other were seen over the right parietal region of the scalp associated with alopecia. A single well-defined soft skin-colored cystic swelling of size 1 × 2 cm was seen interspersed within the plaque [Figure 1]. A clinical diagnosis of nevus sebaceous was made and a biopsy of the nevus and the nodule was done in view of suspected malignancy. Biopsy report revealed a large cyst lined by columnar and myoepithelial cells in the dermis. The columnar cells at a few places showed “decapitation secretion” giving the impression of apocrine hidrocystoma [Figure 2] and [Figure 3] Post-excision of the cyst, histopathological examination correlated with clinical diagnosis of nevus sebaceous [Figure 4] and [Figure 5].
Figure 1: Cystic lesion arising from the nevus sebaceous over the right parietal region of the scalp

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Figure 2: H and E (10×)—Multiloculated cystic lesion in the dermis lined by epithelium

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Figure 3: H and E (40×)—Double layer of columnar cells with decapitation secretions

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Figure 4: Post nevus excision and double opposing rotation flap

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Figure 5: H and E (10×)—Nevus sebaceous showing multiple immature sebaceous glands in the upper dermis

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   Discussion Top


Nevus sebaceous, also known as nevus sebaceous of Jadasohn or organoid nevus, is a hamartoma comprised predominantly of sebaceous glands. In 1904, Albrecht used the word hamartoma for a tumor that developed due to overdevelopment of some kind of tissue, which normally belonged at the site where it was formed or to any abnormal relationship of a normally situated tissue element.[2] They are cell nests or collection of abnormal number of normal cells that can be epidermal or dermal—sebaceous, apocrine, or eccrine.

The sebaceous nevus usually presents as a linear, yellow, hairless, waxy, and verrucous plaque. It can be flat at birth but as the person ages, it undergoes surface changes. During puberty, due to the hormonal changes, it becomes thickened, verrucous, or papillomatous. Tumors can arise within the nevus sebaceous; the most common being syringocystadenoma papilliferum and trichoblastoma.[1] The list of tumors that arise in nevus sebaceous are given in [Table 1].[3]
Table 1: Tumors arising from nevus sebaceous

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Apocrine hidrocystomas or cystadenomas are benign cystic tumors that arise from the secretory portion of apocrine sweat glands. They were first described by Mehregan in 1964.[4] They usually occur as solitary cystic lesions from the adenomatous cystic proliferation of apocrine glands. The most common sites of predilection are the head and neck with occurrence on the scalp being extremely rare.[5] Hidrocystomas may show eccrine or apocrine differentiation with the classical differentiating feature being the presence of secretory cells showing decapitation secretion in case of apocrine hidrocystomas.[6]


   Conclusion Top


Apocrine hidrocystoma developing from a sebaceous nevus over the scalp is a very rare entity. Till date, only three other cases of an apocrine hidrocystoma arising on the scalp have been reported; this being the first case report from the Indian subcontinent.[7],[8],[9] To conclude, apocrine hidrocystoma should be considered as a differential diagnosis for any large cystic subcutaneous mass that occurs on the scalp.

Acknowledgment

Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Adams SP. Dermacase. Nevus sebaceous (Jadassohn's nevus). Can Fam Physician 1998;44:1459, 1464.  Back to cited text no. 1
    
2.
Way SC. Hamartoma of the skin; a case report. J Invest Dermatol 1948;10:189-96.  Back to cited text no. 2
[PUBMED]    
3.
Barankin B, Shum D, Guenther L. Tumors arising in nevus sebaceous: A study of 596 cases. J Am Acad Dermatol 2001;45:792-4.  Back to cited text no. 3
    
4.
Mehregan AH. Apocrine cystadenoma, a clinicopathologic study with special reference to the pigmented variety. Arch Dermatol 1964;90:274-9.  Back to cited text no. 4
[PUBMED]    
5.
Warrier S, Mohammed K, Safia B. Multiple apocrine hidrocystoma: An uncommon presentation. Indian J Dermatol Venereol Leprol 2003;69:64-5.  Back to cited text no. 5
  Medknow Journal  
6.
Numata Y, Okuyama R, Sasai S, Aiba S. Apocrine hidrocystoma on the finger. Acta Derm Venereol 2006;86:188-9.  Back to cited text no. 6
[PUBMED]    
7.
Matsushita S, Higashi Y, Uchimiya H, Ohtani K, Kanekura T. Case of giant eccrine hidrocystoma of the scalp. J Dermatol 2007;34:586-7.  Back to cited text no. 7
    
8.
Vittori F, Colomb D. Complex sweat gland tumor of the scalp. Association of a papillous syringocystadenoma and an apocrine hidrocystoma. Arch Anat Cytol Pathol 1976;24:51-5.  Back to cited text no. 8
[PUBMED]    
9.
El Demellawy D, Babay S, Elkhawaga S, Alowami S. A brief report of a rare case of giant apocrine hidrocystoma presenting as a scalp hematoma. Pol J Pathol 2011;62:116-7.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1]


This article has been cited by
1 Apocrine Hidrocystoma: A Rare Case Report
Basavaraj P. Belaldavar,Vijayalaxmi Suranagi,Mounika Kalakuntla,Bijjal Raj,Aniruddh Tiwari
Indian Journal of Otolaryngology and Head & Neck Surgery. 2016;
[Pubmed] | [DOI]



 

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