What’s_your_diagnosis?

A pinkish nodule on the vertex: What’s your diagnosis?

Mohamed Ben Rejeb1, Yosra Soua1, Nouha Abdejlil2, Monia Youssef1

1Department of Dermatology, Fattouma Bourguiba University Hospital, Monastir-Tunisia; 2Department of Anapathology, Fattouma Bourguiba University Hospital, Monastir-Tunisia

Corresponding author: Dr. Mohamed Ben Rejeb, E-mail: med.benrejeb@gmail.com

Submission: 29.12.2019; Acceptance: 10.01.2020

DOI: 10.7241/ourd.2020e.5

Cite this article: Rejeb MB, Soua Y, Abdejlil N, Youssef M. A pinkish nodule on the vertex: What’s your diagnosis? Our Dermatol Online. 2020;11(e):e5.1-e5.2.

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CASE REPORT

A 71-year-old man presented to our dermatology department with a slightly painful nodular lesion over the scalp for 1 year. The size of the nodule had gradually increased recently. He had no personal or family history of skin disease or other systemic disorders. Cutaneous examination showed well-circumscribed and tender sessile pinkish nodule measuring 2 cm over the vertex of the scalp (Fig. 1). It was firm in consistency and we noticed an infiltrated area surrounding the lesion. Dermoscopic examination showed a well-defined nodule composed of white structures, pinkish and yellowish homogeneous areas, linear irregular vessels and arborizing telangiectasias (Figs. 2 and 3). The lesion was completely excised.

Figure 1. A well-demarked and firm, exophytic pinkish nodule measuring 2 cm over the vertex of the scalp.
Figure 2. Dermoscopy image of nodular hidradenoma. Note white structures(*), pinkish and yellowish homogeneous areas(#), linear irregular vessels and arborizing telangiectasias (◊).
Figure 3. Dermoscopy image of nodular hidradenoma. Note white structures(*), pinkish and yellowish homogeneous areas(#), linear irregular vessels and arborizing telangiectasias (◊).

HISTOLPATHOLOGY

Histopathological examination showed well-circumscribed intradermal tumor with a lobular arrangement of uniform and clear cells, ductal structures, and cystic spaces (Figs. 4 and 5).

Figure 4. Low-power view of a circumscribed dermal tumor nodule Hex40.
Figure 5. High-power view showing uniform cells with eosinophilic cytoplasm admixed with few clear cells HEx100.

WHAT’S YOUR DIAGNOSIS?

Answer: Nodular Hidradenoma

Nodular Hidradenoma (NH) is a rare benign adnexal neoplasm of either eccrine or apocrine differentiation from sweat glands that is commoner in adults than in children [1,2]. It’s a challenging diagnosis because of clinical heterogeneity. NH is more commonly seen in women with an average age of 30 to 40 years. The most common site is the head [3]. Clinically, NH usually presents as a solitary slow-growing pinkish nodule which is well-circumscribed, firm, non-tender and involving the scalp, neck, trunk, and extremities [4]. Dermoscopy can be useful. Dermoscopic features include pinkish or bluish homogeneous areas with vascular and white structures [5]. Histological examination confirmed the diagnosis by showing a circumscribed but unencapsulated tumor composed of lobulated and cystic masses of cells mainly located in the upper or mid dermis [3]. The best treatment for NH is surgical excision. Although NH is a benign skin lesion, long term follow-up of patients is required to detect possible recurrence that may be transformed to malignant NH [6].

References

1. Juan Carlos RM, Sylvia Aide MC, Alejandra VM, Ana Sof?a AC, Ivette MM, et al. Nodular hidradenoma: Dermoscopic presentation. J Am Acad Dermatol. 2017;76:S46-8.

2. Nasit JG, Dhruva G. Nodular hidradenoma of the scalp: A cytomorphologicalevaluation on fine needle aspiration cytology. Indian J Dermatol Venereol Leprol. 2014;80:569-72.

3. Abdulla AB, Suresh SR and Maragaret AR. Malignant nodular hidradenoma of the eyelid: a rare sweat gland tumor. Middle East Afr J Ophthalmol. 2010;17:374–6.

4. Kataria SP, Singh G, Batra A, Kumar S, Kumar V, Singh P. Nodular hidradenoma: aseries of five cases in male subjects and review of literature. Adv Cytol Pathol. 2018;3:46-7.

5. Patricia S, Aimilios L, Luis Javier DP, Isil K, Carolina M, et al. Dermoscopy of nodular hidradenoma, a great masquerader: a morphologicalstudy of 28 cases. Dermatology. 2016;232:78-82.

6. Nhuan N, Michiro S, Takahiro N, Yo K, Chiaki S, et al. Malignant transformation of nodular hidradenoma in the lower leg. Case Rep Oncol. 2018;11:298-304.

Notes

Source of Support: Nil

Conflict of Interest: None

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