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Papillary Hidradenoma: Immunohistochemical J Clin Pathol: First Published As 10.1136/Jcp.52.11.829 on 1 November 1999

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Papillary Hidradenoma: Immunohistochemical J Clin Pathol: First Published As 10.1136/Jcp.52.11.829 on 1 November 1999 J Clin Pathol 1999;52:829–832 829 Papillary hidradenoma: immunohistochemical J Clin Pathol: first published as 10.1136/jcp.52.11.829 on 1 November 1999. Downloaded from analysis of steroid receptor profile with a focus on apocrine diVerentiation Annamaria OYdani, Anna Campanati Abstract sometimes been shown to express oestrogen Aim—To make a quantitative evaluation receptors and progesterone receptors.1–3 How- by image analysis of oestrogen receptors, ever, there have been few reports on the steroid progesterone receptors, and androgen re- receptor profile of papillary hidradenoma, ceptors in papillary hidradenomas and which has unique clinicopathological features anogenital sweat glands. as it develops only in postpuberal and post- Methods—20 papillary hidradenomas and menopausal women and is localised almost the anogenital sweat glands detected in exclusively to vulvar, perineal, and perianal surgical specimens selected from 10 vul- skin.45 Moreover in recent years several vectomies for squamous carcinoma, eight histological studies of the female anogenital haemorrhoidectomies, and one anal region have carefully examined a new variant of polypectomy, all from female patients, cutaneous glands, the so called “anogenital were investigated by the avidin– sweat glands,” which are considered the most streptavidin peroxidase testing system. likely source of papillary hidradenomas.6 Our Results—90% of papillary hidradenomas objective in this immunohistochemical study and almost all the anogenital sweat glands was to make a quantitative evaluation of showed immunoreactivity for oestrogen oestrogen receptors, progesterone receptors, receptor and, more weakly, for progester- and androgen receptors. By focusing attention one receptor, with immunolabelled nu- on the apocrine diVerentiation of papillary epi- clear area ranging from 10% to 90%. thelium, we aimed to provide further immuno- Conversely conventional sweat glands did histochemical evidence for the supposed his- not show any nuclear staining. Overex- togenetic linkage of papillary hidradenoma pression of androgen receptors occurred with anogenital sweat glands, as well its steroid in 20% of papillary hidradenomas, with hormone dependence. nuclear staining strictly bordering papil- lary epithelium with apocrine diVerentia- tion. There was no immunoreactivity for Methods http://jcp.bmj.com/ androgen receptors in anogenital sweat The patient data and specimens used in this glands. study were retrieved by AC from the files of the Conclusions—Oestrogen and progesterone department of pathology and the dermatology receptors seem to represent reliable mark- clinic of the University of Ancona from 1986 to ers for diVerentiating between anogenital 1997. The investigation was performed on 19 sweat glands and conventional sweat excisional biopsies, including 20 papillary hid- glands, and a further link to explain why radenomas. In addition, anogenital sweat papillary hidradenomas occur almost ex- glands were analysed in the specimens from 10 on September 28, 2021 by guest. Protected copyright. clusively in the female anogenital region. vulvectomies performed for squamous carci- Positivity for oestrogen/progesterone re- noma, eight hemorrhoidectomies, and one anal ceptors suggests that epithelia either of polypectomy, all from female patients. Sections anogenital sweat glands or of papillary hid- from archival formalin fixed, paraYn embed- radenomas are controlled by ovarian ster- ded tissues were stained using conventional oid hormones. Androgen receptor nuclear procedures, and by the alcian blue (pH 2.5) staining of the epithelium with apocrine and periodic acid–SchiV (PAS) methods for diVerentiation in vulvar papillary hidrad- mucins. Serial sections were also incubated enoma strengthens its homology with with a panel of primary antibodies, all known breast duct papilloma. to react with formaldehyde fixed, paraYn (J Clin Pathol 1999;52:829–832) embedded tissue, against the following: low molecular weight keratins (CAM 5.2; Becton Keywords: steroid receptors; anogenital sweat glands; Dickinson), high molecular weight keratins Dermatology Clinic, papillary hidradenomas; apocrine diVerentiation University of Ancona, (AE 1–3; Diagnostic Products Corporation), Ospedale Umberto 1, carcinoembrionic antigen (anti-CEA; Ylem), Largo Cappelli I, 60123 Oestrogen and progesterone receptors have human milk fat globule protein (anti-HMFG 1 Ancona, Italy AOYdani recently been carefully investigated in both and 2; Oxoid), S 100 (anti-S protein; Dako- A Campanati benign and malignant eccrine sweat gland patts), actin (HHF 35; Dakopatts), vimentin tumours, primarily to identify a marker for dif- (anti-vimentin; Dakopatts), lysozyme (anti- Correspondence to: ferentiating breast cancer metastases from lysozyme; Dakopatts), EMA (anti-EMA; Da- Professor OYdani eccrine neoplasms. Syringoma, chondroid sy- kopatts), and receptors for oestrogen (oestro- Accepted for publication ringoma, eccrine hidradenoma, eccrine carci- gen receptor ID5; BioGenex), progesterone 6 July 1999 noma, and microcystic adnexal carcinoma have (PGR-1A6; BioGenex), and androgen 830 OYdani, Campanati (F39.4.1; BioGenex). The avidin-streptavidin- tin, human milk fat globules (HMFG), and J Clin Pathol: first published as 10.1136/jcp.52.11.829 on 1 November 1999. Downloaded from peroxidase testing system was employed. All lysozyme but not for those against carcinoem- preparations of papillary hidradenomas were brionic antigen (CEA). The cells with apocrine briefly counterstained with ethyl green and diVerentiation were distinctly immunoreactive those of anogenital sweat glands with haema- to epithelial membrane antigen, keratin, and toxylin. Non-immune mouse and rabbit sera lysozyme, but not to carcinoembrionic antigen. were substituted as negative controls. Appro- priate positive controls were run concurrently RECEPTORS for all the antibodies tested. Tissue samples Anogenital sweat glands reacted strongly with from breast and prostate cancers, known to antibodies to oestrogen receptor and moder- bear oestrogen/progesterone receptors and ately to progesterone receptor, whereas there androgen receptors, acted as external controls. was no immunoreactivity to androgen recep- Stromal vimentin staining (fibroblasts, en- tor. Interestingly, in glands with an intermedi- dothelium) was used as an internal control of ate morphology encompassing anogenital antigenicity as its epitope shows a vulnerability sweat glands with “a small segment of typical to fixation or processing comparable to that eccrine epithelium”,6 only nuclei of anogenital 7 shown by steroid receptor antigens. The epithelium stained with oestrogen receptor and oestrogen and progesterone receptors were progesterone receptor antibodies. quantified on slides with the Cell Analysis Sys- Eighteen papillary hidradenomas (90%) 8 tem 200 instrument (CAS 200). Information showed immunoreactivity for oestrogen/pro- concerning clinical presentation, treatment, gesterone receptor which was scored according and outcome was sought for all patients. Com- to per cent positive nuclear surface11: 0, negative plete excision of hidradenomas was easily (two cases); 1, less than 1–10% positive (no accomplished and postoperative course was cases); 2, 1–10% positive (no cases); 3, 10–33% uneventful. positive (five cases); 4, 34–66% positive (seven cases); 5, 67–100% positive (sic cases). We chose Results a score of 10% as the cut oV to include border- CLINICAL FEATURES line positive cases in the positive category. The All patients were in postpuberal and postmeno- staining intensity was calculated on the basis of pausal age groups: the youngest was 26 years 1, weak; 2, moderate; and 3, intense nuclear old and the oldest 92 (mean 51 years). One staining. The oestrogen receptor score staining patient had two hidradenomas. Nine of the 19 was 3 in all positive cases, whereas progesterone patients were asymptomatic; in three, the receptor staining score was 2 in 13 cases and 1 in tumour was a fortuitous finding in specimens five cases. There was no relation between stain- from haemorrhoidectomies. Bleeding and ul- ing degree and the age of the patients. No cerated lesions had occurred in three patients. immunostaining was obtained for oestrogen and Four patients reported fluctuation in size of the progesterone receptors in epithelium with apo- tumor with the menstrual cycle. The clinical crine diVerentiation; in contrast, it showed over- diagnosis of the lesion was correct in five cases; expression of androgen receptors as almost all http://jcp.bmj.com/ misdiagnoses included cysts in nine, haemor- the nuclei were immunolabelled. Two papillary rhoids in three, and melanoma and carcinoma hidradenomas did not show any staining for in one case each. Tumour sizes ranged from 0.3 either steroid receptors or vimentin filaments. cm to 4 cm (mean: 1.2 cm) HISTOPATHOLOGY Discussion All 20 tumours fulfilled the diagnostic criteria Although an unusual lesion, papillary hidrad- of papillary hidradenoma, as reported in enoma represents the most common benign on September 28, 2021 by guest. Protected copyright. standard textbooks of dermatopathology.910In adnexal tumour of vulvar skin.12 The hypoth- five cases we detected areas of apocrine diVer- esis that this tumour originates directly from entiation of papillary epithelium where lining apocrine sweat glands conflicts with its main cells appeared columnar, cuboidal, or flat- clinicopathological features: it has not been tened, depending entirely on the location of the reported in men,
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