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CASE REPORT
Year : 2015  |  Volume : 2  |  Issue : 2  |  Page : 78-79

Tubular apocrine adenoma


Department of Pathology, Assam Medical College and Hospital, Dibrugarh, Assam, India

Date of Web Publication16-Jul-2015

Correspondence Address:
Dr. Swagata Dowerah
Department of Pathology, Assam Medical College, Dibrugarh - 786 002, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2394-2010.160928

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  Abstract 

Tubular apocrine adenoma, the apocrine variant of papillary tubulopapillary hidradenoma is a rare well-circumscribed, intradermal benign tumor, with tubular structures showing apocrine differentiation. We present a 40 year female with swelling on the scalp of one year duration measuring 3 x 3.5 x 2 cm. On gross examination, a 2 x 2 x 1.5 cm grayish white mass was seen. H and E stained sections from the tumor mass revealed tubules of various sizes lined by two layers of cells, an outer cuboidal and inner columnar. Some of the tubules showed intraluminal papillary projections without a fibrovascular core. Diagnosis of tubular apocrine adenoma was made. Tubular apocrine adenoma is an unusual entity which may be mistaken for other adnexal tumors both clinically and cytologically. Histopathologic examination is essential for diagnosis.

Keywords: Hidradenoma, tubular apocrine adenoma, tubulopapillary


How to cite this article:
Dowerah S, Dutta A, Saikia P. Tubular apocrine adenoma. J Health Res Rev 2015;2:78-9

How to cite this URL:
Dowerah S, Dutta A, Saikia P. Tubular apocrine adenoma. J Health Res Rev [serial online] 2015 [cited 2019 Dec 9];2:78-9. Available from: http://www.jhrr.org/text.asp?2015/2/2/78/160928


  Introduction Top


Tubular apocrine adenoma (TAA), the apocrine variant of papillary tubulopapillary hidradenoma (TPH), is a rare, well-circumscribed, intradermal benign tumor with tubular structures, showing apocrine differentiation. It is often difficult to accurately classify the tumor on cytopathologic examination, and histopathology is often required for definitive diagnosis of these unusual tumors.

First described in 1972, [1] additional cases of TAA have been reported. [2],[3],[4],[5] In the past, the term papillary eccrine adenoma (PEA) has been used to describe a TPH with eccrine differentiation, whereas the term TAA was used to designate a TPH with apocrine differentiation. [6],[7],[8] Histologically, the characteristic features are various sized dilated tubules with intraluminary papillary projection and apocrine decapitation secretion. It usually presents as a solitary lesion and is sometimes associated with nevus sebaceous and/or syringocystadenoma papilliferum.

Although cytology is a relatively inexpensive method for the diagnosis of cutaneous tumors, it is often not possible to give a definitive diagnosis on aspirate smears. It ultimately requires histopathologic examination to typify these benign adnexal tumors.


  Case Report Top


A 40-year-old female presented with swelling on the scalp of 1-year duration. The swelling was gradually increasing in size. The patient was a known case of tuberculosis on antitubercular treatment (ATT) for the past 7 months. Clinical examination revealed a well-defined swelling, measuring approximately 3 cm × 3.5 cm × 2 cm on the scalp. An area of surface ulceration was seen with some tenderness on palpation. Routine workup of the patient revealed hemoglobin (Hb) of 8 g/dL; total count and differential were within normal limits. An x-ray of the skull showed no obvious deformity. Cytologic evaluation was done and a diagnosis of benign adnexal tumor was made, with the possibility of syringocystadenoma papilliferum. The mass was excised and sent to the histopathology section of the Department of Pathology, Assam Medical College and Hospital, Dibrugarh, Assam, India for evaluation.

On gross examination, a 2 cm × 2 cm × 1.5 cm mass was seen, which was grayish white in color. On cut section, it was whitish and solid. Hematoxylin and eosin (H and E)-stained sections from the tumor mass revealed tubules of various sizes lined by two layers of cells, namely, an outer cuboidal and an inner columnar. Some of the tubules showed intraluminal papillary projections without a fibrovascular core. The lining cells showed apocrine changes. Decapitation secretion was seen in some of the tubules [Figure 1], [Figure 2], [Figure 3]. A diagnosis of TAA was done based on these features. The patient was discharged and is currently doing well.
Figure 1: Photomicrograph showing the tumor mass in the dermis (H and E, ×10)

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Figure 2: Photomicrograph showing numerous irregularly shaped tubular structures lined by two layers of cells. Decapitation secretion is seen in many areas (H and E, ×40)

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Figure 3: Photomicrograph showing a tubule with dilated lumen and papillary projection (H and E, 100)

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  Discussion Top


TAA is a relatively rare tumor, with only a limited number of cases described so far. The tumor has a female predominance (2:1), a wide age range (18-78 years), and usually presents as a well-defined nodule most often located on the scalp. Most of the lesions are <2 cm in size, nontender, and slightly mobile with no significant overlying skin changes. In some cases, TPH has been seen in association with syringocystadenoma papilliferum, with the latter component being situated in the superficial portion of the combined lesion. [9]

Clinically, it may be confused with a cylindroma. Cytologically, it may be mistaken for syringocystadenoma papilliferum, which also shows papillary structures. Histologically, syringocystadenoma papilliferum also shows papillary projections into cystic invaginations but the lesion shows connection with the overlying epidermis. The papillae are thicker and taller with fibrovascular cores, and the papillary stroma contains abundant plasma cells. [10]


  Conclusion Top


TAA is an unusual entity that may be mistaken for other adnexal tumors, both clinically and cytologically. This tumor must be borne in mind when we come across scalp tumors with papillary structures on fine-needle aspiration (FNA). A histopathologic examination is essential for definite typing of these neoplasms.


  Acknowledgements Top


Source of funding

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Landry M, Winkelmannn RK. An unususal tubular apocrine adenoma. Arch Dermatol 1972;105:869-79.  Back to cited text no. 1
    
2.
Okun MR, Finn R, Blumental G. Apocrine adenoma versus porocrine carcinoma. Report of two cases. J Am Acad Dermatol 1980;2:322-6.  Back to cited text no. 2
    
3.
Toribio J, Zulaica A, Peteiro C. Tubular apocrine adenoma. J Cutan Pathol 1987;14:114-7.  Back to cited text no. 3
    
4.
Umbert P, Winklemann RK. Tubular apocrine adenoma. J Cutan Pathol 1976;3:75-87.  Back to cited text no. 4
    
5.
Civatte J, Belaïch S, Lauret P. Tubular apocrine adenoma (4 cases). Ann Dermatol Venereol 1979;106:665-9.  Back to cited text no. 5
    
6.
Falck VG, Jordaan HF. Papillary eccrine adenoma. A tubulopapillary hidradenoma with eccrine differentiation. Am J Dermatopathol 1986;8:64-72.  Back to cited text no. 6
    
7.
Ishiko A, Shimizu H, Inamoto N, Nakmura K. Is tubular apocrine adenoma a distinct clinical entity? Am J Dermatopathol 1993;15:482-7.  Back to cited text no. 7
    
8.
Tellechea O, Reis JP, Marques C, Baptista AP. Tubular apocrine adenoma with eccrine and apocrine immunophenotypes or papillary tubular adenoma? Am J Dermatopathol 1995;17:499-505.  Back to cited text no. 8
    
9.
Hsu PJ, Liu CH, Huang CJ. Mixed tubulopapillary hidradenoma and syringocystadenoma papilliferum occurring as a verrucous tumor. J Cutan Pathol 2003;30:206-10.  Back to cited text no. 9
    
10.
Rammeh-Rommani S, Fezaa B, Chelbi E, Kammoun MR, Ben Jilani SB, Zermani R. Syringocystadenoma papilliferum: Report of 8 cases. Pathologica 2006;98:178-80.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
Acknowledgements
References
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