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Hidradenoma of The Vulva
HIDRADENOMA
OF THE
LOUIS C. BRUNO, M.D., AND ELIZABETH (From
the Rhode
VULVA
MEYER,
Island
XD.,
PROVIDENCE,
R. 1.
Hospital)
H
IDRADENOMA is a growth, almost invariably benign, originating in sweat glands, and is synonymous with terms such as syringocystadenoma, sweat gland adenoma, and adenoma hidradenoides. This is considered a relatively rare tumor of the vulva, undoubtedly a conclusion derived from the fact that approximately only sixty eases have been reported in the literature since the original communication by Pick in 19041 The authors feel, however, that this entity occurs far more frequently, hut is seldom reported and at times not recognized. CASE I.-A GO-year-old white woman had a pedunculated, hard mass attached to the right labium for “the last few years” prior to hospital admission. It was not painful, but seemed to have increased in size during the last few months. The tumor, which measured 10 by 4 cm. in size, was believed to be a fibroid and was excised under local anesthesia. Pathological examination showed an adenoma of sweat glands measuring 4.5 by 3 by 2 cm. CASE 2.*-On routine examination of a 63-year-old white woman, a rauliflower-like nodule about 1 cm. in diameter was found on the right labium, which bled easily with even very gentle manipulation. A basal-cell carcinoma was diagnosed clinically and a hemivulveetomy performed. Pathological examination revealed two hidradenomas, one measuring 6.5 cm. and the other 1.0 cm. in diameter. CASE 3.-For five to six years prior to seeking medical advice, this 64.year-old white woman noticed a hard, nontender mass the size of a Li walnut” at the superior end of the right labium. It was asymptomatic, except for possibly a slight inrrease in size. A hard, bluish nodule measuring 2 cm. in diameter was excised under local anesthesia. Pathological examination established the diagnosis of papillary syringocystadenoma or hidradenoma. CASE 4.-A 62.year-old white woman was admitted to the hospital because of a symptom less growth of the right vulva of “years’ ” duration. No clinical features of the lesion in situ were available. Simple excision under local anesthesia was effected. Pathological examination described a nodule measuring 2 by 2 by 1 cm. which was called “adenoma of the vulva, papillary cystic type. ’ ’ However, the histological description fitted diagnosis of hidradenoma. Review of the slide reclassified it as such. CASE B.-Routine examination of a 60.year-old white woman revealed a papillomatous growth of the right labium the size of a cherry. Therapy consisted of simple excision under local anesthesia. Pathological examination described a tumor with dimensions of 1.4 by 1.2 by 0.4 cm. diagnosed as an “adenoma of the vulva. ” ,%gain, the microscopic description typical of hidradenoma of the vulva prompted review and reclassification of the slide. The true nature of the lesion in t,his series was not suspected prior to histological examination. The failure to diagnose the cases properly is attributed to the wide range of gross, clinical manifestations of the tumor. No set of characteristic features can be outlined. The size of the lesion may vary from 1 to 10 cm. in its greatest diameter; the color may not be constantly that of normal skin, as in one of our cases it had a bluish pigmentation; the base may be sessile or pedunculated; the configuration ranges anywhere between a rough papillomatous to a smooth nodular appearance; the consistency is variable and, finally, the growth may present as a freely moveable, well-defined entity, or as a fixed, ulcerated, slightly raised, easily bleeding structure that is readily mistaken for a dermal carcinoma,
Reference 1. Novak, E.: Gynecological and Obstetrical Pathology, Philadelphia, 1947, W. B. Saunders Company, p. 39. *Case 2 was taken from the surgical pathology material in the Rhode Island State Hospital, the remaining four ca8es from the Rhode Island Hospital. 922
OF THE
LOUIS C. BRUNO, M.D., AND ELIZABETH (From
the Rhode
VULVA
MEYER,
Island
XD.,
PROVIDENCE,
R. 1.
Hospital)
H
IDRADENOMA is a growth, almost invariably benign, originating in sweat glands, and is synonymous with terms such as syringocystadenoma, sweat gland adenoma, and adenoma hidradenoides. This is considered a relatively rare tumor of the vulva, undoubtedly a conclusion derived from the fact that approximately only sixty eases have been reported in the literature since the original communication by Pick in 19041 The authors feel, however, that this entity occurs far more frequently, hut is seldom reported and at times not recognized. CASE I.-A GO-year-old white woman had a pedunculated, hard mass attached to the right labium for “the last few years” prior to hospital admission. It was not painful, but seemed to have increased in size during the last few months. The tumor, which measured 10 by 4 cm. in size, was believed to be a fibroid and was excised under local anesthesia. Pathological examination showed an adenoma of sweat glands measuring 4.5 by 3 by 2 cm. CASE 2.*-On routine examination of a 63-year-old white woman, a rauliflower-like nodule about 1 cm. in diameter was found on the right labium, which bled easily with even very gentle manipulation. A basal-cell carcinoma was diagnosed clinically and a hemivulveetomy performed. Pathological examination revealed two hidradenomas, one measuring 6.5 cm. and the other 1.0 cm. in diameter. CASE 3.-For five to six years prior to seeking medical advice, this 64.year-old white woman noticed a hard, nontender mass the size of a Li walnut” at the superior end of the right labium. It was asymptomatic, except for possibly a slight inrrease in size. A hard, bluish nodule measuring 2 cm. in diameter was excised under local anesthesia. Pathological examination established the diagnosis of papillary syringocystadenoma or hidradenoma. CASE 4.-A 62.year-old white woman was admitted to the hospital because of a symptom less growth of the right vulva of “years’ ” duration. No clinical features of the lesion in situ were available. Simple excision under local anesthesia was effected. Pathological examination described a nodule measuring 2 by 2 by 1 cm. which was called “adenoma of the vulva, papillary cystic type. ’ ’ However, the histological description fitted diagnosis of hidradenoma. Review of the slide reclassified it as such. CASE B.-Routine examination of a 60.year-old white woman revealed a papillomatous growth of the right labium the size of a cherry. Therapy consisted of simple excision under local anesthesia. Pathological examination described a tumor with dimensions of 1.4 by 1.2 by 0.4 cm. diagnosed as an “adenoma of the vulva. ” ,%gain, the microscopic description typical of hidradenoma of the vulva prompted review and reclassification of the slide. The true nature of the lesion in t,his series was not suspected prior to histological examination. The failure to diagnose the cases properly is attributed to the wide range of gross, clinical manifestations of the tumor. No set of characteristic features can be outlined. The size of the lesion may vary from 1 to 10 cm. in its greatest diameter; the color may not be constantly that of normal skin, as in one of our cases it had a bluish pigmentation; the base may be sessile or pedunculated; the configuration ranges anywhere between a rough papillomatous to a smooth nodular appearance; the consistency is variable and, finally, the growth may present as a freely moveable, well-defined entity, or as a fixed, ulcerated, slightly raised, easily bleeding structure that is readily mistaken for a dermal carcinoma,
Reference 1. Novak, E.: Gynecological and Obstetrical Pathology, Philadelphia, 1947, W. B. Saunders Company, p. 39. *Case 2 was taken from the surgical pathology material in the Rhode Island State Hospital, the remaining four ca8es from the Rhode Island Hospital. 922