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Apocrine Hydrocysadenoma of the Ear
Otolaryngology–Head and Neck Surgery (2005) 133, 981-982
CLINICAL PHOTOGRAPH
Apocrine Hydrocysadenoma of the Ear P. J. Anderson, MD, FDSRCS(Ed), FRCS(Plast), Adelaide, South Australia
A
57-year-old housewife presented with a painless blue swelling on the scaphoid fossa of her left pinna (Fig 1). This had increased slowly in size, without any discharge, since she first had noticed it 9 months previously. Results of further examination of the patient were unremarkable. The lesion was treated by excision, including the underlying cartilage. The resulting defect was reconstructed by using an islanded postauricular skin flap. Histologic examination showed the lesion to be an apocrine hydrocystadenoma.
DISCUSSION Apocrine hydrocystadenoma is an uncommon benign tumor, originating in the apocrine sweat glands. The apocrine glands are located mainly in the axilla, perineum, and nipples; and few are found around the face (apart from the ear canal).1 It is surprising in view of this that most apocrine hydroscystadenomas occur within the head and neck region, with an incidence of 40 of 42 in 1 series.2 The tumor in this case was benign, in keeping with the case of the majority of sweat gland tumors; the incidence of benign sweat gland tumors of all types has been reported to be 85% to 90%. Finally, whereas most patients with this tumor type present with a single lesion, it is recognized that lesions can occur at multiple sites in the same patient. Differential diagnosis includes melanoma as well as tumors of eccrine sweat glands. The distinction between apocrine and eccrine tumors can be difficult on both histologic and clinical examination. However, the site of the tumor may provide a clue. For example, a periorbital tumor (Fig 2) is more likely to be an eccrine hydrocvstadenoma.1 In addition, the color also may be helpful in distinguishing between the two tumor types because the dark blue color is highly suggestive of an apocrine tumor, as in this case. The cause of the curious blue coloration has been the subject of
some debate. It has been suggested that the color of the tumor is caused by dark-colored fluid in the cyst or is caused by non–melanin secretory granules.3 Another more recent view is that the color is due to the Tyndall phenomenon, in
From the Australian Craniofacial Unit, Women’s and Children’s Hospital. Reprint requests: P. J. Anderson, MD, FDSRCS(Ed), FRCS(Plast),
Australian Craniofacial Unit, Women’s and Children’s Hospital, 72, King William Street, Adelaide, South Australia, SA5006. E-mail address: [email protected].
Figure 1 The patient’s left pinna, demonstrating the apocrine hydrocystadenoma with its distinctive blue coloration.
0194-5998/$30.00 © 2005 American Academy of Otolaryngology–Head and Neck Surgery Foundation, Inc. All rights reserved. doi:10.1016/j.otohns.2005.07.034
982
Otolaryngology–Head and Neck Surgery, Vol 133, No 6, December 2005 which the blue hue is produced as a result of the cyst fluid acting as a colloidal system, in which light scattering occurs.4 The treatment is by simple excision with narrow margins because of the benign nature of the lesion. Accurate preoperative diagnosis may prevent an unnecessarily large defect in a site for which it may be difficult to produce a good cosmetic reconstruction, such as the pinna in this case.
REFERENCES
Figure 2 An eccrine hydrocystadenoma in a characteristic (periorbital) position.
1. Crabbe EB. Eccrine sweat gland tumour of the lip. Plast Reconstr Surg 1982;69:521–3. 2. Tulenko JR, Cartwright H. An analysis of sweat gland tumours. Surg Gynaecol Obstet 1965;121:345–7. 3. Mehragen AH. Apocrine cystadenoma. Arch Dermatol 1974;80:274 –9. 4. Sauer GC, Hall JC, editors. Manual of skin diseases, 7th ed. Philadelphia: Lippincott-Raven;1998:599 – 601.
CLINICAL PHOTOGRAPH
Apocrine Hydrocysadenoma of the Ear P. J. Anderson, MD, FDSRCS(Ed), FRCS(Plast), Adelaide, South Australia
A
57-year-old housewife presented with a painless blue swelling on the scaphoid fossa of her left pinna (Fig 1). This had increased slowly in size, without any discharge, since she first had noticed it 9 months previously. Results of further examination of the patient were unremarkable. The lesion was treated by excision, including the underlying cartilage. The resulting defect was reconstructed by using an islanded postauricular skin flap. Histologic examination showed the lesion to be an apocrine hydrocystadenoma.
DISCUSSION Apocrine hydrocystadenoma is an uncommon benign tumor, originating in the apocrine sweat glands. The apocrine glands are located mainly in the axilla, perineum, and nipples; and few are found around the face (apart from the ear canal).1 It is surprising in view of this that most apocrine hydroscystadenomas occur within the head and neck region, with an incidence of 40 of 42 in 1 series.2 The tumor in this case was benign, in keeping with the case of the majority of sweat gland tumors; the incidence of benign sweat gland tumors of all types has been reported to be 85% to 90%. Finally, whereas most patients with this tumor type present with a single lesion, it is recognized that lesions can occur at multiple sites in the same patient. Differential diagnosis includes melanoma as well as tumors of eccrine sweat glands. The distinction between apocrine and eccrine tumors can be difficult on both histologic and clinical examination. However, the site of the tumor may provide a clue. For example, a periorbital tumor (Fig 2) is more likely to be an eccrine hydrocvstadenoma.1 In addition, the color also may be helpful in distinguishing between the two tumor types because the dark blue color is highly suggestive of an apocrine tumor, as in this case. The cause of the curious blue coloration has been the subject of
some debate. It has been suggested that the color of the tumor is caused by dark-colored fluid in the cyst or is caused by non–melanin secretory granules.3 Another more recent view is that the color is due to the Tyndall phenomenon, in
From the Australian Craniofacial Unit, Women’s and Children’s Hospital. Reprint requests: P. J. Anderson, MD, FDSRCS(Ed), FRCS(Plast),
Australian Craniofacial Unit, Women’s and Children’s Hospital, 72, King William Street, Adelaide, South Australia, SA5006. E-mail address: [email protected].
Figure 1 The patient’s left pinna, demonstrating the apocrine hydrocystadenoma with its distinctive blue coloration.
0194-5998/$30.00 © 2005 American Academy of Otolaryngology–Head and Neck Surgery Foundation, Inc. All rights reserved. doi:10.1016/j.otohns.2005.07.034
982
Otolaryngology–Head and Neck Surgery, Vol 133, No 6, December 2005 which the blue hue is produced as a result of the cyst fluid acting as a colloidal system, in which light scattering occurs.4 The treatment is by simple excision with narrow margins because of the benign nature of the lesion. Accurate preoperative diagnosis may prevent an unnecessarily large defect in a site for which it may be difficult to produce a good cosmetic reconstruction, such as the pinna in this case.
REFERENCES
Figure 2 An eccrine hydrocystadenoma in a characteristic (periorbital) position.
1. Crabbe EB. Eccrine sweat gland tumour of the lip. Plast Reconstr Surg 1982;69:521–3. 2. Tulenko JR, Cartwright H. An analysis of sweat gland tumours. Surg Gynaecol Obstet 1965;121:345–7. 3. Mehragen AH. Apocrine cystadenoma. Arch Dermatol 1974;80:274 –9. 4. Sauer GC, Hall JC, editors. Manual of skin diseases, 7th ed. Philadelphia: Lippincott-Raven;1998:599 – 601.