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Dermatology > BENIGN NEOPLASMS
Apocrine Hidrocystoma
Article Last Updated: Feb 16, 2007
AUTHOR AND EDITOR INFORMATION
Section 1 of 10  
Author: Jesse M Olmedo, MD, Staff Physician, Department of Dermatology, Beatrice Keller Clinic
Jesse M Olmedo is a member of the following medical societies: Texas Medical Association
Coauthor(s):
Ronald P Rapini, MD, Professor and Chair, Department of Dermatology, Professor of Pathology, University of Texas Medical School, MD Anderson Cancer Center
Editors: Carrie L Kovarik, MD, Assistant Professor, Department of Dermatology and Dermatopathology, University of Pennsylvania School of Medicine; Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA; Rosalie Elenitsas, MD, Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System; Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University; William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
Author and Editor Disclosure
Synonyms and related keywords:
apocrine cystadenoma, apocrine retention cyst, benign cystic proliferation, benign cyst
Background
Apocrine hidrocystomas are benign cystic proliferations of the apocrine secretory glands. These cysts most commonly appear as solitary, soft, dome-shaped, translucent papules or nodules and most frequently are located on the eyelids, especially the inner canthus. Apocrine hidrocystomas grow slowly and usually persist indefinitely.
Pathophysiology
The exact stimulus for the development of an apocrine hidrocystoma is unknown. Plausible causes of the closely related eccrine hidrocystoma include occlusion or blockage of the sweat duct apparatus, which results in the retention of sweat and a dilated cystic structure.
Frequency
United States
The lesion is relatively common in the United States.
Mortality/Morbidity
Cysts are entirely benign and seldom recur after removal. Cysts may annoy patients; however, symptoms usually are mild or absent. Vision usually is not affected.
Race
No predilection for race or geographic region is recognized.
Sex
No sex predilection is described.
Age
Cysts occur in adulthood, although in no particular age group.
History
Apocrine hidrocystomas usually are asymptomatic. No seasonal variation or familial tendencies have been identified. Cysts tend to appear during adulthood, grow slowly, and persist indefinitely.
Physical
- The tumors usually occur as solitary translucent papules or nodules.
- Consistency is fluctuant and cystic.
- Size varies from a few millimeters to approximately 1.5 cm.
- Tumors occasionally manifest as multiple lesions, especially when of the eccrine hidrocystoma type.
- Cysts often appear tense and shiny. The coloration varies from flesh-colored to blue or black (see Image 1).
- Tumors have a predilection for the eyelid, particularly the inner canthus.
- Tumors may arise on other areas of the head, neck, and trunk.
- Tumors also have been reported to occur on the penis, in the axillae, and in the anal region.
- Lesion edges are not well delineated but blend gradually into adjacent skin.
- Walls, although translucent, are sufficiently thick that they seldom rupture spontaneously.
- When incised, the cyst collapses and a thin, clear, brownish or blackish fluid is released.
- Cysts are mobile with palpation and transilluminate.
- The fluid color of an apocrine hidrocystoma does not result from the presence of melanin or hemosiderin but may result either from the Tyndall phenomenon or the presence of lipofuscin pigment.
- Apocrine hidrocystomas are not affected by variation in temperature (unlike eccrine hidrocystomas).
Causes
Although the origin of apocrine hidrocystomas is not known entirely, they are believed to be adenomatous cystic proliferations of the apocrine glands.
Basal Cell Carcinoma
Blue Nevi
Malignant Melanoma
Milia
Syringoma
Other Problems to be Considered
Eccrine cystadenoma
Follicular cyst
Procedures
- Diagnosis is made easily by biopsy.
Histologic Findings
The clinical appearance of a pea-sized cyst near the inner canthus of the eye, which contains a thin clear or pigmented fluid, suggests an apocrine hidrocystoma; however, histologic examination often is required to establish a specific and definitive diagnosis. Upon histologic examination, apocrine hidrocystomas show large unilocular or multilocular cystic spaces within the dermis (see Image 2). Apocrine hidrocystomas are more likely to be multilocular than the closely related eccrine hidrocystoma. The cyst wall is lined by apocrine-type secretory epithelium. The innermost layer of the wall is composed of a single (occasionally double) layer of cuboidal-to columnar-shaped cells. The nuclei of these cells are positioned basally. The outer layer of cells composing the cyst wall is formed by myoepithelial cells in which the long axes run parallel to the cyst wall. Well-organized fibrous tissue surrounds the cyst. Papillary projections extend from the secretory layer into the cyst cavity, depicting decapitation secretion. The secretory cells contain periodic acid-Schiff–positive, diastase-resistant granules and occasionally contain pigment granules, which provide the brown color of the cystic fluid. This pigment is neither melanin nor hemosiderin. On electron microscopy, secretory cells have numerous, dense, lysosomal-type secretory granules typical of apocrine gland cells. They also have an increased number of annulate lamellae, which are unusual in normal apocrine cells.
Surgical Care
Apocrine hidrocystomas can be incised and drained; however, electrosurgical destruction of the cyst wall often is recommended to prevent recurrence. Punch, scissors, or elliptical excision also can remove tumors. Multiple apocrine hidrocystomas can be treated with carbon dioxide laser vaporization. Multiple apocrine hidrocystomas can also be effectively treated with trichloroacetic acid.
Prognosis
- Apocrine hidrocystomas grow gradually and persist indefinitely after attaining full size. They seldom recur after removal.
Patient Education
- Advise patients that these cysts are benign.
Medical/Legal Pitfalls
- Almost no medical legal pitfalls are associated with apocrine hidrocystoma.
- If the diagnosis is made clinically without biopsy, a cystic basal cell carcinoma of the eyelid may be missed. Incision to observe the egress of fluid or biopsy of suspicious lesions excludes the possibility.
- Avoid aggressive surgery of the eyelid for benign apocrine hidrocystomas. A simple excision with Gradle scissors suffices for most patients.
| Media file 2:
Histology of apocrine hidrocystoma. Cystic spaces appear empty because sweat is removed during processing. Decapitation secretion often is seen in the lining. |
 |  View Full Size Image | |
Media type: Photo
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- Alessi E, Gianotti R, Coggi A. Multiple apocrine hidrocystomas of the eyelids. Br J Dermatol. Oct 1997;137(4):642-5. [Medline].
- Bures FA, Kotynek J. Differentiating between apocrine and eccrine hidrocystoma. Cutis. Jun 1982;29(6):616, 619-20. [Medline].
- Combemale P, Kanitakis J, Dupin N, et al. Multiple Moll's gland cysts (apocrine hidrocystomas) of the eyelids. Dermatology. 1997;194(2):195-6. [Medline].
- Dailey RA, Saulny SM, Tower RN. Treatment of multiple apocrine hidrocystomas with trichloroacetic acid. Ophthal Plast Reconstr Surg. Mar 2005;21(2):148-50. [Medline].
- Hashimoto K, Lever WF. Tumors of skin appendages. In: Freedberg IM, Eisen AZ, Wolff K, eds. Fitzpatrick's Dermatology in General Medicine. Vol 1. McGraw-Hill Professional Publishing;1999:899.
- Mackie RM. Tumors of skin appendages. In: Champion RH, Wilkinson DS, Ebling FJG, eds. Rook/Wilkinson/Ebling: Textbook of Dermatology. Vol 2. Blackwell Science Inc;1998:1703-6.
- Milum EA. A solitary pigmented tumor of the face. Apocrine hidrocystoma. Arch Dermatol. Apr 1991;127(4):572, 575. [Medline].
- Schleicher SM. Multiple translucent facial papules. Apocrine hidrocystoma. Arch Dermatol. Dec 1998;134(12):1627-8, 1630-1. [Medline].
- Shields JA, Eagle RC, Shields CL, et al. Apocrine hidrocystoma of the eyelid. Arch Ophthalmol. Jun 1993;111(6):866-7. [Medline].
- Smith JD, Chernosky ME. Apocrine hidrocystoma (cystademnoma). Arch Dermatol. May 1974;109(5):700-2. [Medline].
- Ter Poorten HJ. Apocrine hidrocystoma of the right scapula. Arch Dermatol. Dec 1977;113(12):1730. [Medline].
- de Eusebio E, Lopez-Bran E, Rojo S, et al. Multiple hidrocystomas. Dermatology. 1996;193(2):152-3. [Medline].
- del Pozo J, Garcia-Silva J, Pena-Penabad C, Fonseca E. Multiple apocrine hidrocystomas: treatment with carbon dioxide laser vaporization. J Dermatolog Treat. Jun 2001;12(2):97-100. [Medline].
Apocrine Hidrocystoma excerpt Article Last Updated: Feb 16, 2007
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