Hidrocystoma (apocrine hidrocystoma, eccrine hidrocystoma, cystadenoma) is a benign tumor of the apocrine or eccrine sweat glands. ICD-10 Code: D23
Eccrine hidrocystomas are common benign tumors of the sweat glands. They are thought to develop due to obstruction of the eccrine sweat gland, causing retention of secretions and the appearance of a dilated cystic structure.
Multiple eccrine hidrocystomas (Robinson type) are more common in women (ratio 6.5:1 compared to men) between the ages of 20 and 90 and are associated with occupational factors such as increased humidity and air temperature (cooks, laundry workers, etc.). They also show a seasonal variation with an increase in the number and size of tumors during hot periods of the year.
Solitary eccrine hidrocystomas (Smith type) do not show seasonal variations and are observed equally in men and women.
Apocrine hidrocystomas are thought to develop due to occlusion of the ductal apparatus of the glands. They occur between the ages of 20 and 70 and very rarely in children and adolescents. There is no seasonal variation in these cases.
Hidrocystomas are associated with genetic disorders such as Schöpf-Schulz-Passarge syndrome, Gorlin-Goltz syndrome, and may develop in Graves' disease. Two cases of malignant transformation of hidrocystomas have been reported, one with adenocarcinoma from an apocrine hidrocystoma and the other with squamous cell carcinoma from an eccrine hidrocystoma.
Eccrine Hidrocystomas
The main localization is on the face, often periorbital (especially lower eyelids) and lateral canthus (lid margins are not involved), as well as on the nose and cheeks. The tumors appear as semi-translucent, dome-shaped nodules with a smooth surface and rarely exceed 10 mm in diameter. Their color varies from flesh-colored to various shades of blue. When punctured with a needle, they release a watery fluid (which distinguishes them from apocrine hidrocystomas, in which an oily fluid is found).
The most common type (70%) is solitary (Smith type). They do not differ in appearance from multiple hidrocystomas, but they are larger (up to 1.5 cm in diameter) and sometimes giant. In addition to the usual location around the periorbital area and cheeks, hidrocystomas may also occur on the trunk, lips, scrotum, vulva, and popliteal fossa. Cases of pigmented (up to black color) and pedunculated elements have been described. Giant hidrocystomas located on the eyelids may contribute to ptosis and epiphora.
Apocrine Hidrocystomas
Dome-shaped, translucent cystic formations ranging in size from 3 to 15 mm in diameter, which may be multiple or more commonly solitary, with a flesh-colored or dark blue color. Variations in color are associated with the Tyndall effect and the presence of colloidal solutions of lipofuscin pigment. Occasionally, pigmented tumors (brown or black) are seen, and melanin may be seen in the cytoplasm of the lining cells. The cyst contents are oily and foamy.
Localization: face (60%), trunk (14%), scalp and extremities (12%), axillary and inguinal regions (9%). On the face, they are most commonly found along the lid margins, near the inner canthus, sometimes in the caruncle area, and on the conjunctiva. Cases of intrabulbar occurrence with painless eyelid edema without skin color changes and displacement of the eyeball have been described. Localizations on the palms, penis, and the cartilaginous part of the external auditory canal have been reported, with the development of secondary otitis and deafness.The diagnosis of basal cell carcinoma (BCC) is based on the clinical presentation and histological findings.
- Epidermoid cysts
- Molluscum contagiosum
- Basal cell carcinoma
- Blue nevus
- Melanoma
- Syringoma
- Milium
- Hemangioma
- Lymphangioma
- Mucoid cysts