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Gidradenoma

Gidradenoma — the rare benign, multilobular tumor of a sweat gland which is localized in a derma, gistogenetichesk having both an ekkrinny, and apocrenic differentiation.

Epidemiology

The rare tumor which is equally often found at men and women; 80% of patients are more senior than 40 years.

Classification

Histologically allocate 2 main forms gidradeny:
• poroidny (5%) with an ekkriny differentiation;
• clear cell (95%) with an apocrenic differentiation.

Etiology and pathogeny

Histochemical and electronic and microscopic methods revealed signs of secretion of apocrenic type.
Ultrastructural researches revealed the expressed Golgi's complex and electronic and dense educations from "otshnurovky" apical part of cells (secretory granules) in a channel gleam.

Clinical signs and symptoms

In 50% of cases of a gidradenom it is localized on face skin and pilar part of the head, in 21% — on skin of extremities, in 20% — on a trunk. Contrary to the standard opinion, only in 6 supervision the tumor was localized in skin of a mammary gland and any case of its localization on a vulva and perianal area is not registered.
As a rule, the gidradenoma represents the kistozopodobny, accurately delimited skin and/or intradermal small knot, a grayish-bluish shade with a diameter of 1 — 3 cm from which light or sanious liquid is sometimes emitted; in 15% of cases education ulcerates.

The diagnosis and the recommended clinical trials

The diagnosis is made on the basis of clinical signs and cytologic research of a smear-skarifikata or punctate.
Poroidny form of a gidradenoma: at lupny increase multilobular with various ratio of a solid and cystous component. The tumor more often cystous, is localized in deep departments of a derma, is surrounded with a fibrous capsule, is not connected with the epidermis covering it. Walls of a cyst are covered by the keratinized epithelium, in a gleam find tubular structures, papillary outgrowths. Cytologic are defined poroidny (like ekkrinny ferries) and kutikulyarny cells, the necrosis centers, nuclear polymorphism, sometimes multinuclear macrophages. Poroidny cells — small dark with scanty cytoplasm, kutikulyarny cells — larger with light cytoplasm and intercellular bridges, remind kutikulyarny cells of a normal channel of an ekkrinny sweat gland.
Clear cell form of a gidradenoma: allocate solid, cystous and solid and cystous options. On cellular structure they may contain light cells, squamoid (eosinophilic, granular, polygonal) the cells, mucinous cells and cells of apocrenic type covering tubular structures. The last are present practically at any option of a gidradenoma. The tumor usually is located in a derma, but continuous communication with hyperplastic epidermis and a funnel of a follicle is sometimes noted. In cytoplasm of light cells the high  content of a glycogen which is removed when processing by a diastase. Squamoid cells have a roundish or oval kernel, hardly noticeable kernels and finely divided chromatin. In cytoplasm there are a lot of tonofilaments. Mucinous cells are difficult defined in hydroadenoma, they usually cover cystous cavities and are characterized by the ballonovidny cytoplasm rich with mucin. The cells covering tubula can be 2 types — prismatic and cylindrical. The first cover protokopodobny structures (a sign of a pro-current differentiation), the second cover zhelezistopodobny structures and to some extent reflect a differentiation towards secretory part of apocrenic gland.

Differential diagnosis

The Poroidny option of a gidradenoma needs to be differentiated about idle time of gidrakantomy, ekkrinny poromy; in both cases of a gidradenom it is not connected with epidermis.
Besides, to gidradeny differentiate with bazaliomy, a metastasis of nephrocellular cancer, a trichilemmoma.

General principles of treatment of a gidradenoma

Surgical excision, electroexcision are shown.

Forecast

Favorable

 
"Hemoblastoses   Histiocytoses of X"