Hidradenoma papilliferum of the vulva.

Sir,

Hidradenoma papilliferum is a rare benign tumor of apocrine glands. It usually presents as an asymptomatic flesh-colored nodule in the anogenital area of women.[1]

A 32-year-old female patient presented with an asymptomatic nodule of 4 months duration in the vulva. On examination, a well-circumscribed red nodule of size 1 × 1 cm was seen on inner aspect of right labium majus [Figure 1]. The nodule was firm and nontender and the surface slightly eroded. Differential diagnoses considered were hidradenoma papilliferum or some other adnexal tumor, pyogenic granuloma, and a remote possibility of donovaniosis. Excision biopsy of the nodule was done and sent for histopathological examination, which showed a dermal tumor with cells in papillary folds, tubules, and cystically dilated spaces [Figure 2]. The lumen was lined by columnar cells with oval staining nucleus located near base and faintly eosinophilic cytoplasm. Decapitation secretion was seen inside the lumen [Figure 3]. These findings were suggestive of hidradenoma papilliferum.

Figure 1

Well-circumscribed red eroded nodule on the vulva

Figure 2

Histopathology showing dermal tumor with cells in papillary folds, tubules, and cystically dilated spaces. (H and E, ×100)

Figure 3

Histopathology showing lumen lined by columnar cells with decapitation secretion. (H and E, ×400)

Hidradenoma papilliferum is an uncommon benign neoplasm arising from apocrine glands, seen in middle-aged females, commonly between the ages of 30-49 years. It usually presents as a firm, flesh to red-colored nodule in the anogenital area. Rarely, it can be seen over the head and neck, and over modified apocrine gland areas such as breast, external ear canal, and eyelid. It is then referred to as ectopic hidradenoma papilliferum.[2] Histopathology shows a partly solid or solid-cystic dermal lesion with anastomosing papillary structures and tubules as well as some glandular areas. The epithelial lining consists of an inner layer of columnar cells with decapitation secretion in the lumen and frequently an outer myoepithelial layer. The tumor has got a good prognosis and malignant transformation is extremely rare.[3]

When an adult female presents with a nodular lesion in the anogenital area, hidradenoma papilliferum should be kept in mind along with other conditons such as sexually transmitted diseases and other benign and malignant tumors.