Journal of Cytology
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Year : 2011  |  Volume : 28  |  Issue : 4  |  Page : 235-237
Nodular hidradenoma of male breast: Cytohistological correlation

Department of Pathology, S.D.M. College of Medical Sciences and Hospital, Dharwad, Karnataka, India

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Date of Web Publication20-Oct-2011


Nodular hidradenoma is an established entity as a skin adnexal tumor arising from eccrine sweat glands. A skin adnexal tumor located in the breast is unusual and is one of the differential diagnoses for subareolar breast nodules. With the exception of gynecomastia, other lesions of the male breast are not very common. The review of literature showed only 25 reported cases till date. The rarity of this neoplasm and failure to identify its morphologic features may lead to misdiagnosis. Being itself rare, cytological features of this lesion are hardly encountered in case reports. We report a case of an 18-year-old male who presented with a left breast lump and underwent fine needle aspiration and was diagnosed as having a benign skin adnexal tumor. Later it was confirmed by histopathology to be a nodular hidradenoma.

Keywords: Fine needle aspiration; male breast; nodular hidradenoma

How to cite this article:
Grampurohit VU, Dinesh U S, Rao R. Nodular hidradenoma of male breast: Cytohistological correlation. J Cytol 2011;28:235-7

How to cite this URL:
Grampurohit VU, Dinesh U S, Rao R. Nodular hidradenoma of male breast: Cytohistological correlation. J Cytol [serial online] 2011 [cited 2020 May 26];28:235-7. Available from:

   Introduction Top

Nodular hidradenoma (NH) is an established entity as a skin adnexal tumor arising from eccrine sweat glands. NH situated in the breast is very rare. It usually occurs in the nipple and subareolar region of the breast and is one of the differential diagnoses for subareolar breast tumors. It can also occur deep within the breast tissue. [1] Being rare in the breast, these lesions when aspirated are either inconclusive or misdiagnosed. [1],[2] They are usually reported only after histopathological examination.

   Case Report Top

An 18-year-old male patient presented with a history of painful left breast swelling involving the nipple and areolar region with nipple discharge of 2-month duration. On examination, the swelling was firm to hard and mobile and clinically was diagnosed as gynecomastia.

Fine needle aspiration of the swelling showed cellular smears composed of cells predominantly in cohesive clusters [Figure 1] and at places forming papillae with occasional single cells. Cells were polygonal with moderate cytoplasm varying from clear to eosinophilic and granular. Nuclei were oval with smooth nuclear membrane and distinct nucleoli. A large number of cells showed clear cytoplasm. The background showed hemorrhage ([Figure 1], inset). Cytological diagnosis of the benign adnexal tumor was given.
Figure 1: Photomicrograph showing cohesive clusters of cells. (Leishman's stain, ×100). Inset shows papillae with few vacuolated cells in hemorrhagic background (PAP, ×400)

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The excised specimen was skin covered, well encapsulated, globular measuring 4 Χ 3 Χ 2 cm, externally yellow brown, firm to hard. The cut surface showed grey white solid areas with cystic spaces.

Microscopic examination revealed a well-demarcated and well-circumscribed lobulated dermal tumor with solid and cystic areas. The solid areas showed two types of cells, the first being round to polyhedral with finely granular faintly eosinophilic cytoplasm having a round to oval nucleus and the second type having clear cytoplasm and small eccentric nucleus. The cysts were lined by dark cuboidal epithelium with lumina filled with eosinophilic material [Figure 2]. Occasional squamous morules and eosinophilic hyalinizing stroma were present ([Figure 2], inset). No nuclear atypia, necrosis or abnormal mitoses were present.
Figure 2: Photomicrograph showing a cystic space surrounded by two cell populations with a breast acinus (H and E, ×100). The inset shows hyalinizing stroma surrounded by cells with clear and eosinophilic cytoplasm (H and E, ×400)

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The diagnosis of nodular hidradenoma was offered. PAS-positive diastase resistant material was seen in clear cells and lumen of cysts. The tumor cells were negative for estrogen and progesterone receptor, smooth muscle actin (SMA), but were positive for epithelial membrane antigen (EMA) and S-100 protein.

   Discussion Top

Nodular hidradenoma (NH) is also known as clear cell hidradenoma, solid-cystic hidradenoma or eccrine acrospiroma. [3] NH is a benign eccrine sweat gland tumor. It tends to be confined to the dermis and is covered by normal epidermis. These lesions occur mainly in the axilla, face, arm, thigh, scalp and pubic regions. Occurrence in the breast is rare. [1],[4] The review of literature showed only 25 reported cases till date. [1],[5] Most of the patients of NH of breast were females during fourth to eighth decade. With the exception of gynecomastia, other non-neoplastic and neoplastic lesions of the male breast are not very common. The present case of NH is probably the 7 th documented case occurring in male breast. [1],[5]

Clinically, NH presents as a slowly growing palpable breast lump with nipple discharge and ulceration of skin. NH presents as a solitary nodular swelling of 0.5-2 cm size and rarely may grow larger like in our case. According to the literature 47% of NH of breast originated from the nipple or areola whereas 53% originated from deep mammary glands. [5] So, NH of breast probably has two distinct histogenetic origins: From skin adnexal glands when located superficially and from mammary ducts if located deep in breast parenchyma. Morphologically, they are identical with their counterparts occurring in the skin. [1],[2],[4] Other benign skin adnexal tumors known to arise from the breast include eccrine spiradenoma, syringomatous squamous tumor, papillary syringocystadenoma and cylindroma. Lesions with a deep mammary gland location were often initially diagnosed as adenomyoepithelioma or ductal carcinoma. The lack of cytologic atypia, proliferation of monotonous cells and presence of single bland bare nuclei in a case of NH should be helpful for differentiating from ductal carcinoma. However, adenomyoepithelioma is also an important consideration because of similar two-cell pattern. Adenomyoepithelioma is positive for myoepithelial markers such as SMA, CD10, p63 and anti-muscle actin by immunohistochemistry while NH is negative for SMA, CD10, p63 and anti-muscle actin. [5] Complete surgical excision is the treatment of choice for breast NH. [4] Inadequate excision leads to its recurrence though exact incidence is not reported by authors. [3],[6] Malignant transformation of NH is observed in only 5% of the cases. [1]

These tumors are usually diagnosed cytologically as benign cystic lesion or as ductal carcinoma. [2],[4],[7] Accurate diagnosis remains a problem. [7] In our case, the presence of papillae, two-cell pattern composed of polygonal cells with eosinophilic cytoplasm and clear cells and characteristic subareolar location with nipple discharge; the diagnosis of the benign skin adnexal tumor was offered. The FNAC diagnosis was confirmed by typical histopathological appearance of two-cell pattern of proliferation and characteristic hyalinizing eosinophilic stroma. The presence of squamous morules has been reported in some cases. PAS-positive diastase resistant material is typically seen in the clear cells. Immunohistochemical staining reactivity for keratin, EMA, CEA, S-100 protein and vimentin is characteristic [3] and is negative for ER, PR and smooth muscle actin. [5] Gross cystic disease fluid (GCDF) is a useful marker to exclude apocrine differentiation but rarely performed. [2],[4]

To conclude, NH should be considered in both sexes in the differential diagnosis of breast neoplasms, especially when the lump is situated in the nipple and areolar region. FNAC plays an important and easy diagnostic modality in these benign but unusual rare cases and awareness of the lesions is essential in their management.

   References Top

1.Mote DG, Ramamurti T, Naveen Babu B. Nodular hidradenoma of the breast: A case report with literature review. Ind J Surg 2009;71:43-5  Back to cited text no. 1
2.Domoto H, Terahata S, Soto K, Tamai S. Nodular hidradenoma of the breast: report of two cases with literature review. Pathol Int 1998;48:907-11  Back to cited text no. 2
3.Ahmed TS, Priore JD, Seykora JT. Tumors of the epidermal appendages. In: Elder DE, Elenitsas R, Murphy GF, Johnson BL, Xu X, editors. Lever's histopathology of the skin, 10 th edition. Philadelphia: Lippincott Williams and Wilkins;2009.p.891-2  Back to cited text no. 3
4.Dhingra KK, Mandal S, Khurana N. An unusual case of nodular hidradenoma of breast. Iranian J Pathology 2007;2:80-2  Back to cited text no. 4
5.Ohi Y, Umekita Y, Rai Y, Kukita T, Sagara Y, Takahama T. et al. Clear cell hidradenoma of the breast: A case report with review of literature. Breast Cancer 2007;14:307-11  Back to cited text no. 5
6.Girish G, Gopasetty M, Stewart R. Recurrent clear cell hidradenoma of the breast: A case report. The Internet J Surgery 2007;10:1-5  Back to cited text no. 6
7.Kumar N, Verma K. Clear cell hidradenoma: a diagnostic pitfall in fine-needle aspiration of breast. Diagn Cytopathol 1996;15:70-2.  Back to cited text no. 7

Correspondence Address:
Vandana U Grampurohit
Associate Professor, SDMCMSH, Dharwad, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-9371.86364

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  [Figure 1], [Figure 2]

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