|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 1 | Page : 26-27
Janardhan Bommakanti1, Mahjabeen Salma2
1 Department of Dermatology, Venereology and Leprosy (DVL), Mediciti Institute of Medical Sciences, Ranga Reddy District, Telangana, India
2 Department of Pathology, VRK Women's Medical College, Hyderabad, Telangana, India
|Date of Web Publication||16-Jul-2015|
Department of Dermatology, Venereology and Leprosy (DVL), Mediciti Institute of Medical Sciences, Ranga Reddy District, Telangana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bommakanti J, Salma M. Apocrine hidrocystoma. Indian J Dermatopathol Diagn Dermatol 2015;2:26-7
Apocrine hidrocystoma is cystic dilatation of apocrine secretory glands. It was first described by Mehregan in 1893. Commonly seen in adults, both sexes are equally affected. Skin lesions are asymptomatic, solitary or multiple, with size ranging from 10 mm or more. The lesions are well-defined, dome-shaped and translucent nodules. The surface is smooth and brown colored with interspersed grey or blue-black pigmentation (pigmentation in part of the cyst). The common sites are around the eyes i.e. lateral or outer canthus, penis, fingers and axillae. Multiple apocrine hidrocystomas are seen in Schopf Schulz Passarge syndrome. 
A 22-year-old unmarried man presented with asymptomatic elevated skin lesion over lateral aspect of left eye since 4 years. Initially he noticed a single, small skin-colored elevated lesion, which gradually increased in size with bluish-black pigmentation over next 2 years [Figure 1]. There was no history of seasonal change in size on exposure to hot or cold, any visual disturbance, discharge/bleeding or significant family history. Patient wanted removal of lesion for cosmetic reason. Routine investigations were normal. A punch biopsy was undertaken with a differential diagnosis of naevi/appendageal tumour/melanoma. Biopsy revealed a large cystic cavity lined by columnar cells with decapitation and peripheral layer of myoepithelial cells [Figure 2] and [Figure 3]. Decapitation secretions stained periodic acid schiff (PAS) positive with diastase resistance. It was diagnosed as apocrine hidrocystoma. The lesion was surgically excised.
|Figure 1: Bluish-black-colored nodular skin lesion on lateral aspect of left eye|
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|Figure 2: Columnar cells with decapitation secretion and peripheral layer of myoepithelial cells lining a cystic cavity (H and E, ×100)|
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|Figure 3: Histology showing cystic lesion lined by apocrine type epithelial cells with apocrine snouts (projections) and fringe (H and E, ×100)|
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Hidrocystomas are cystic dilatations of secretory glands. They are of two type depending on origin- apocrine or eccrine. Apocrine hidrocystomas are benign cystic dilatation of apocrine secretory glands whereas eccrine hidrocystomas are cystic dilatation of eccrine glands. The origin of apocrine hidrocystomas is not known, but believed to be adenomatous cystic proliferation of the apocrine glands. Clinically the lesions are usually solitary, skin-colored and dome-shaped nodules with bluish hue. Thye are commonly present on the face, neck and trunk, but also seen on penis, axillae and anal region.  Hidrocystomas although translucent, are thick and seldom rupture spontaneously. When incised, apocrine hidrocystomas collapse and a thin clear, brownish, or blackish fluid is released. The fluid color of an apocrine hidrocystoma does not result from the presence of melanin or hemosiderin but from either lipofuscin pigment or tyndall effect. The size of apocrine hidrocystomas is not influenced by variation in temperature (unlike eccrine hidrocystomas).
Multiple apocrine hidrocystomas are rarely encountered, are seen in Schopf Schulz Passarge syndrome (Ectodermal dysplasia syndrome, other components are Hypotrichosis, Hypodontia, Nail dystrophy, Palmoplantar keratoderma and periocular cysts).  Fakuda et al. reported five cases of multiple apocrine hidrocystadenomas from Japan  and Alessi et al. noticed multiple apocrine hidrocystadenomas over eyelids.  The diagnosis of apocrine hidrocystoma on clinical findings is difficult, hence clinico- pathological correlation is needed. Histologically epidermis is normal, large cystic cavities lined by cuboidal or columnar apocrine secretory cells with decapitation secretion and peripheral layer of myoepithelial cells extending as papillary projections in the dermis is characteristic and the cyst has no connection with the overlying epidermis.  All these characteristic histopathological features were seen in our case. Eccrine hidrocystomas differ from the apocrine one by absence of decapitation secretion, PAS-positive granules, unilocular cysts and myoepithelial cells. Apocrine hidrocystomas are incised and drained; however, electrosurgical destruction of the cyst wall is often recommended to prevent recurrence.  Apocrine hidrocystoma in our patient was removed by punch biopsy. They seldom recur after removal.
Finally dermatopathology plays an important role in planning treatment and follow-up of the patient. It is important to rule out malignancy, particularly when the presentation is unusual.
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[Figure 1], [Figure 2], [Figure 3]