Skin adnexal neoplasm can occur in the breast, and the other benign skin adnexal tumors reported in the breast are eccrine spiradenoma, syringoma, papillary syringocystadenoma, and cylindroma. After searching on Google Scholar and PubMed using the keywords “nodular hidradenoma breast” and “eccrine acrospiroma breast”, we retrieved 33 cases of nodular hidradenoma of the breast reported in the indexed English literature. (Table 1)
Table 1
Review of Clinicopathological Features of Nodular Hidradenoma Cases
| First author/ Year of publication | Age (years)/sex | Clinical Presentation | Laterality | Duration | Size of lump | Cystic area |
1 | Fink et al. / 1968 | 46 / Female | Nipple discharge with breast mass present in the upper inner quadrant | Not mentioned | 17 years | 10 cm | Present |
2 | Fink et al. / 1968 | 61 / Female | Breast lump in the upper outer quadrant | Right | Three years | 3 cm | Present |
3 | Fink et al. / 1968 | 42 / Male | Asymmetry of nipples, the tumor is a subareolar region. | Left | Not mention clearly (Many years) | 2 cm | Not mention |
4 | Fink et al. / 1968 | 45 / Female | Serous nipple discharge | Left | 8 Months | 0.7 cm | Not mention |
5 | Fink et al. / 1968 | 60 / Female | Lump in the subareolar region | Not mentioned | 15 Years | Not mention | Not mention |
6 | Fink et al. / 1968 | 30 / Female | Lump in the subareolar region | Right | Not mention | 1 cm | Not mention |
7 | Hertel et al. / 1976 | 57 / Female | subareolar mass | Not mentioned | Two weeks | 2 cm | Not mention |
8 | Ilie B / 1986 | 73 / Male | Lump in Breast | Left | Several months | 2. cm | Present |
9 | Kobayashi et al. / 1994 | 63 / Male | Bloody Nipple discharge and mass | Left | Not mention | 3 cm | Present |
10 | Cyrlak et al. / 1995 | 21 / Female | Mass in inner quadrant | Right | One year | 7 cm | Present |
11 | Kaise et al. / 1996 | 52 / Female | Lump in upper inner quadrant | Left | NA | ---- | Article not retrieved |
12 | Kumar et al. / 1996 | 75 / Female | Lump in breast upper, inner quadrant | Left | Six weeks | 3 cm | Not mention |
13 | Domoto et al. / 1998 | 58 / Female | Fluctuating nodule without tenderness | Left | One year | 3 cm | Present |
14 | Domoto et al. / 1998 | 44/ Male | Nodule, nipple, discharge | Left | One year | 2 cm | Not Mentioned |
15 | Shimizu et al. / 1999 | 60 / Male | Lump in the subareolar area | Right | Not mentioned | 3.5 cm | Present |
16 | Yamada et al. / 2001 | 41 / Female | Lump in upper outer | Left | Not mentioned | 2.0 cm | Present |
17 | Honma et al. / 2002 | 77 / Male | Nodule beneath in nipple | Not mentioned | Not mentioned | Not Mentioned | Article not retrieved |
18 | Kim et al. / 2005 | 41 / Female | Lump in upper inner | Right | One month | 1.5 cm | Not Mentioned |
19 | Girish et al. / 2006 | 49 / Female | Lump in the subareolar area | Left | Three years Recurrent | 3 cm | Present |
20 | Dhingra et al. / 2007 | 60 / Female | Lump in upper outer | Right | One year | 5.5 cm | Present |
21 | Kazakov et al. / 2007 | 55 / Female | Nodule in upper outer | Left | Six months | 2.2 cm | Present |
22 | Ohi et al. / 2007 | 55 / Female | Lump in Upper Inner Quadrant | Right | Not mentioned | 0.8 cm | Present |
23 | Mote et al. / 2009 | 40 / Female | Lump in upper outer | Left | Two years | 5 cm | Present |
24 | Grampurohit et al. / 2011 | 18 / /Male | Painful lump subareolar area, Nipple discharge | Left | Two months | 4 cm | Present |
25 | Ives et al. / 2013 | 67 / Female | Nodule near scar | Right | One year | 1 cm | Present |
26 | Orsaria M / 2013 | 39/Male | Recurrent Nodule | Left | Recurrent | 1 cm | Not Mentioned |
27 | Sehgal et al. / 2014 | 30 / Female | Lump in upper outer | Left | 10 Months | 3 cm | Present |
28 | Vasconcelos et al. / 2015 | 40/ Female | Lump in the subareolar area | Right | Five years | 5 cm | Present |
29 | Sharma et al. / 2016 | 50/ Female | Lump in Breast | Left | Not mentioned | 3.4 cm | Present |
30 | Hsieh et al / 2017 | 50/ Female | Lump in upper outer | Left | 15 years | 3 cm | Present |
31 | Yılmaz/2017 | 38 /Female | Lump in the subareolar region | Left | Not mentioned | 3cm | Present |
32 | Tynski et al / 2018 | 51/ Female | Lump in Breast | Left | Two years | 2.3 cm | Present |
33 | Choi/2019 | 66 /Female | Lump in Breast | Right | Two years | 2.2cm | Present |
34 | Jaitly V/2019 | 20/Female | Breast mass | Right | 1 Year | 4cm | Present |
The published data in indexed English literature shows female preponderance accounting76% of the cases. Very few cases of male breast have been reported. [1, 3, 4, 8, 9, 11, 18, 20] The most common presentation is breast lump (97%) and nipple discharge (15%). One case presented with only nipple discharge. [1] Left predominance was seen over the right breast in females (56%).[1,3,4,6,7,8,10,13,15,17,18,20,21,23−26] The duration of complaints was more than one year in 26% of the cases,[1, 13, 17, 22, 24, 26, 27] while it was unknown in (29.4%) of cases. The size of the lump ranged from 0.7 to 10cm. One patient complaint of 10cm lump for 17 years. 1 The imaging showed cystic component in (67.6%) of cases,[1,3,4,5,8,9,10,13–19,21−25] while it was unknown in (32.3%) of the cases. Only two cases had a recurrence.[13, 20] NH can arise from skin adnexal structure if located superficially and from mammary ducts if located deep in location.8 Finck et al.,[1] in their series, described NH arising in deep parenchyma and nipple region with no connection to the overlying skin, as seen in the present case. Histomorphology showed the dual type of cell population. One was a polygonal cell with clear cytoplasm, and the other was cuboidal cells with eosinophilic cytoplasm. These neoplasms rarely show mitosis and necrosis. The lack of cytological atypia and monomorphic appearance helps to distinguish it from ductal carcinoma in situ. However, it is not easy to distinguish it from ductal carcinoma in situ in frozen sections.[16] One of the common differential diagnoses for NH is adenomyoepithelioma, which shows two cell patterns. The tumor cells are immunoreactive to myoepithelial markers like SMA, Muscle-specific actin, P63, and CD10. While tumor cells in clear cell hidradenoma are positive for p63 and negative for muscle actin, CD10, and SMA.[16] Malignant transformation has been noted only in 5% of cases of NH [17] The treatment of choice is surgical excision with clean margins and regular follow-up. [21]