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Caltabiano DC, Raciti MV, Reali L, Mannino G, Poidomani S, Mangiameli A, Basile A, Galvano G. Apocrine hydroadenoma mimicking a Morton's neuroma: a rare differential diagnosis. J Ultrasound 2024:10.1007/s40477-024-00911-x. [PMID: 38900364 DOI: 10.1007/s40477-024-00911-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/24/2024] [Indexed: 06/21/2024] Open
Abstract
A 62-year-old woman, with neuropathic pain and paresthesia in her right forefoot, showed a circumscribed soft tissue swelling on the sole between the second and third metatarsal. Ultrasound (US) imaging showed a well-defined lesion in the second intermetatarsal space, without vascularization sign at Power Doppler (PD). In the first hypothesis, these findings led to Morton's neuroma. Magnetic Resonance Imaging (MRI), demonstrated a dumbbell-shaped lesion between the II and the III metatarsal heads; it extended cranially to the subcutaneous fat of the dorsal slope. The MRI findings weren't compatible with a classic Morton's neuroma and were radiologically undetectable. The patient had a sub-total excisional biopsy. The anatomopathological features were specific to an apocrine hydroadenoma from an ectopic sweat gland. This rare pathology has not been previously described in the literature and it must be considered as a differential diagnosis due to the clinical presentation and the US appearance mimicking Morton's neuroma.
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Affiliation(s)
- Daniele Carmelo Caltabiano
- Azienda Ospedaliera Di Rilievo Nazionale E Di Alta Specializzazione Garibaldi (U.O.C. Diagnostica Per Immagini, Radiologia Interventistica e Neuroradiologia Garibaldi Centro), Piazza Santa Maria Di Gesù 5, Catania, Italy
| | - Maria Vittoria Raciti
- Azienda Ospedaliera Di Rilievo Nazionale E Di Alta Specializzazione Garibaldi (U.O.C. Diagnostica Per Immagini, Radiologia Interventistica e Neuroradiologia Garibaldi Centro), Piazza Santa Maria Di Gesù 5, Catania, Italy.
| | - Linda Reali
- Azienda Ospedaliero Universitaria Policlinico "G. Rodolico - San Marco (U.O.C. Radiologia 1), Via Santa Sofia 78, Catania, Italy
| | - Giuliana Mannino
- Azienda Ospedaliero Universitaria Policlinico "G. Rodolico - San Marco (U.O.C. Radiologia 1), Via Santa Sofia 78, Catania, Italy
| | - Simone Poidomani
- Azienda Ospedaliero Universitaria Policlinico "G. Rodolico - San Marco, (U.O.C. Anatomia Patologica), Via Santa Sofia 78, Catania, Italy
| | - Adriana Mangiameli
- Azienda Ospedaliera Di Rilievo Nazionale E Di Alta Specializzazione Garibaldi (U.O.C. Diagnostica Per Immagini, Radiologia Interventistica e Neuroradiologia Garibaldi Centro), Piazza Santa Maria Di Gesù 5, Catania, Italy
| | - Antonio Basile
- Azienda Ospedaliero Universitaria Policlinico "G. Rodolico - San Marco (U.O.C. Radiologia 1), Via Santa Sofia 78, Catania, Italy
| | - Gianluca Galvano
- Azienda Ospedaliera Di Rilievo Nazionale E Di Alta Specializzazione Garibaldi (U.O.C. Diagnostica Per Immagini, Radiologia Interventistica e Neuroradiologia Garibaldi Centro), Piazza Santa Maria Di Gesù 5, Catania, Italy
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2
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Wei S. Update on selective special types of breast neoplasms: Focusing on controversies, differential diagnosis, and molecular genetic advances. Semin Diagn Pathol 2022; 39:367-379. [DOI: 10.1053/j.semdp.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 11/11/2022]
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Baněčková M, Kazakov DV, Skálová A, Michal M. MAML2-Rearranged Tumors of the Breast: A Diagnostic Dilemma. Int J Surg Pathol 2020; 29:343-345. [PMID: 33325304 DOI: 10.1177/1066896920981634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Martina Baněčková
- 60569Charles University, Plzen, Czech Republic.,Bioptic Laboratory Ltd, Plzen, Czech Republic
| | - Dmitry V Kazakov
- 60569Charles University, Plzen, Czech Republic.,Bioptic Laboratory Ltd, Plzen, Czech Republic
| | - Alena Skálová
- 60569Charles University, Plzen, Czech Republic.,Bioptic Laboratory Ltd, Plzen, Czech Republic
| | - Michal Michal
- 60569Charles University, Plzen, Czech Republic.,Bioptic Laboratory Ltd, Plzen, Czech Republic
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Clear cell papillary neoplasm of the breast with MAML2 gene rearrangement: Clear cell hidradenoma or low-grade mucoepidermoid carcinoma? Pathol Res Pract 2020; 216:153140. [PMID: 32853960 DOI: 10.1016/j.prp.2020.153140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/08/2020] [Accepted: 07/24/2020] [Indexed: 12/14/2022]
Abstract
Clear cell hidradenoma (CCH) is an uncommon adnexal tumor usually arising from eccrine glands and commonly seen on the face and the upper extremities. CCH occurring in the breast is extremely rare. Herein we report a case of MAML2-rearranged CCH of breast with a papillary architecture closely mimicking intraductal papilloma, adenomyoepithelioma and low-grade mucoepidermoid carcinoma, thus representing a source of diagnostic confusion. An overview of salient histologic features and immunophenotypes to distinguish CCH and low-grade mucoepidermoid carcinoma is also integrated into the report.
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Jaitly V, Jahan-Tigh R, Belousova T, Zhu H, Brown R, Saluja K. Case Report and Literature Review of Nodular Hiradenoma, a Rare Adnexal Tumor That Mimics Breast Carcinoma, in a 20-Year-Old Woman. Lab Med 2019; 50:320-325. [PMID: 30722042 DOI: 10.1093/labmed/lmy084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 11/05/2018] [Accepted: 01/03/2019] [Indexed: 12/29/2022] Open
Abstract
Nodular hidradenoma is an uncommon cutaneous adnexal tumor arising from sweat glands. In the skin, it usually presents as a solitary dermal nodule; excision is curative in most cases. In rare instances, it may present as a breast mass and can mimic breast carcinoma clinically and radiologically, causing diagnostic dilemmas for the treating physician and pathologist. Herein, we discuss a case of nodular hidradenoma in a 20-year-old Hispanic woman as a rapidly growing mass in the breast that mimicked breast carcinoma. We discuss the rare presentation of this uncommon tumor and the differential diagnosis of this entity, as well as the results of our literature review on the topic.
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Affiliation(s)
- Vanya Jaitly
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center McGovern Medical School, Houston, Texas
| | - Richard Jahan-Tigh
- Department of Dermatology, The University of Texas Health Science Center McGovern Medical School, Houston, Texas
| | - Tatiana Belousova
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center McGovern Medical School, Houston, Texas
| | - Hui Zhu
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center McGovern Medical School, Houston, Texas
| | - Robert Brown
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center McGovern Medical School, Houston, Texas
| | - Karan Saluja
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center McGovern Medical School, Houston, Texas
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Arai M, Nozaki T, Matsusako M, Zenke Y, Arai S, Matsui M, Suzuki K, Jinzaki M, Kurihara Y. MR Imaging of Mushroom-like Skin Adnexal Tumors in the Scalp: A Report of Two Cases. Magn Reson Med Sci 2019; 19:282-285. [PMID: 31292324 PMCID: PMC7553803 DOI: 10.2463/mrms.cr.2019-0051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Few studies had been published regarding imaging findings of skin adnexal tumors. We experienced two giant cases of them with a characteristic mushroom-like growth pattern. MRI showed a circumscribed mushroom-like shaped mass extruding from the subcutaneous tissue with microcystic lesions. Although differentiation between benignancy and malignancy may be difficult by radiological examinations, MRI may be helpful to identify its origin and differentiate soft tissue tumors with skin adnexal tumors in having these imaging findings.
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Affiliation(s)
- Manabu Arai
- Department of Radiology, St. Luke's International Hospital.,Department of Radiology, Keio University School of Medicine
| | - Taiki Nozaki
- Department of Radiology, St. Luke's International Hospital
| | | | - Yukari Zenke
- Department of Dermatology, St. Luke's International Hospital
| | - Satoru Arai
- Department of Dermatology, St. Luke's International Hospital
| | - Mizuko Matsui
- Department of Plastic Surgery, St. Luke's International Hospital
| | - Koyu Suzuki
- Department of Pathology, St. Luke's International Hospital
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Lee JY, Kang BS, Shim HS, Song IH, Kim M, Lee SH, Chung HW, Lee MH, Shin MJ. Clear Cell Hidradenoma: Characteristic Imaging Features on Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1993-2001. [PMID: 29388236 DOI: 10.1002/jum.14552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/01/2017] [Accepted: 11/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the imaging features of clear cell hidradenoma on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). METHODS The radiologic and pathologic databases at 2 medical institutions were searched retrospectively from 2004 to 2016 to identify patients with a diagnosis of clear cell hidradenoma. Ultrasonographic, CT, and MRI features were described, and pathologic specimens were reviewed. RESULTS There were 5 female and 4 male patients. The mean patient age was 48.9 years (range, 28-70 years). Five patients underwent only US; 2 patients underwent only CT; 1 patient underwent both US and CT; and 1 patient underwent US and MRI. Most of the tumors were located primarily in the subcutaneous fat layer. The mean tumor size was 18.4 mm. On US, 6 masses had a heterogeneous echo texture, including an anechoic portion with protruding echogenic portions. Two masses had multiple septa in the anechoic portion. On color Doppler US, blood flow was both central and peripheral in 5 patients. All 3 cases seen on CT presented as a low-attenuation mass with an enhanced solid internal nodule. On MRI, the mass showed heterogeneous signal intensity on T2-weighted images and enhancement of the peripheral wall and internal solid component on contrast-enhanced T1-weighted images. CONCLUSIONS Clear cell hidradenoma is usually located in the subcutaneous fat layer, has a well-defined margin, appears as a cystic mass with an internal solid nodule, and occasionally has multiple septa on US, CT, and MRI.
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Affiliation(s)
- Joo Yeon Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byeong Seong Kang
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Hyun Seok Shim
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - In Hye Song
- Department of Pathology , University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Misung Kim
- Department of Pathology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Sang Hoon Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Myung Jin Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Abstract
A 58-year-old female had a mass in the right breast palpable beneath the areola. A mammogram revealed a 1.5-centimeter soft tissue density that was confirmed with a subsequent ultrasound. The patient underwent a core needle biopsy which was initially reported as a moderately differentiated invasive ductal carcinoma. Immunohistochemical analysis revealed negative staining for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor (HER2), mammaglobin, and gross cystic disease fluid protein 15 (GCDFP-15). A wide local excision of the mass was performed. The pathology report stated the tumor had an infiltrative growth pattern with a desmoplastic stromal response with enhanced epithelial atypia consistent with malignant transformation of a nodular clear cell hidradenoma. Clear cell hidradenoma is a very rare tumor originating from the sweat gland and has a propensity for the face and extremities. The malignant variant of this tumor is extremely rare and has been reported to originate from the breast in few cases. This case represents the difficulty in diagnosing this tumor along with the radiographic and histologic features that can distinguish this malignancy from other entities.
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Affiliation(s)
- Isaac Chambers
- Internal Medicine, University of Kansas School of Medicine-Wichita
| | | | - Pavan S Reddy
- Internal Medicine, University of Kansas School of Medicine-Wichita
| | - K James Kallail
- Internal Medicine, University of Kansas School of Medicine-Wichita
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Alhashim M, Lee A, Chuang GS. Rapidly proliferating apocrine hidradenoma treated using Mohs micrographic surgery. Dermatol Surg 2013; 39:1535-6. [PMID: 23895228 DOI: 10.1111/dsu.12278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Minhal Alhashim
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
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11
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Abstract
Epithelial-myoepithelial proliferations of the breast are a heterogeneous poorly defined group of lesions characterized morphologically by dual differentiation into ductal (luminal) and myoepithelial cells. They include neoplastic and non-neoplastic entities that have overlapping morphologic features that may give rise to diagnostic difficulty. Many of these entities are low grade or of uncertain malignant potential but the biology of some of these rare lesions remains to be elucidated. This article discusses the differential diagnosis of epithelial-myoepithelial lesions of the breast and highlights the morphologic features of some of these entities.
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Affiliation(s)
- Rola H Ali
- Department of Pathology, University of British Columbia and Consultant Pathologist, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Malcolm M Hayes
- Department of Pathology, University of British Columbia and Consultant Pathologist, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada.
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12
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Canedo T, de Almeida MP, Cuzzi T, Ramos-e-Silva M. Immunophenotypic aspects of cylindroma and nodular hidradenoma. J Eur Acad Dermatol Venereol 2010; 24:178-85. [DOI: 10.1111/j.1468-3083.2009.03398.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Yu G, Goodloe S, D'Angelis CA, McGrath BE, Chen F. Giant clear cell hidradenoma of the knee. J Cutan Pathol 2009; 37:e37-41. [PMID: 19615032 DOI: 10.1111/j.1600-0560.2009.01354.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hidradenomas, also referred to as nodular hidradenomas or clear cell hidradenomas (CCH), are benign cutaneous eccrine tumors usually 2-3 cm in dimension. Hidradenomas are relatively common; however, giant forms are rare. We report a case of an 8.0 x 6.0 x 3.0 cm clear cell hidradenoma of the left knee in a 43-year-old man. The tumor was mobile, located above the patellar tendon and was without bony involvement on imaging studies. Grossly, the resected tumor was unencapsulated and tan, with a solid and cystic cut surface showing papillary excrescences on the cyst wall. Microscopically, the tumor cells showed an infiltrative growth pattern at the periphery, however, the tumor cytology was bland and no necrosis or mitoses were identified. The overlying dermis contained hemosiderin pigment deposition and infiltration with eosinophils. Immunohistochemically, tumor cells were positive for cytokeratin, CAM5.2, p53, carcino-embryonic antigen (CEA) and epithelial membrane antigen (EMA), and negative for CD10 and Ki-67. The cytological features of hidradenomas can present diagnostic challenges, as other 'clear cell' tumors such as metastatic renal cell carcinoma should be considered. Immunohistochemical studies and differential diagnoses are discussed.
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Affiliation(s)
- Gengsheng Yu
- Department of Pathology, Buffalo General Hospital/University at Buffalo, Buffalo, NY 14203, USA
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14
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Cutaneous hidradenocarcinoma: a clinicopathological, immunohistochemical, and molecular biologic study of 14 cases, including Her2/neu gene expression/amplification, TP53 gene mutation analysis, and t(11;19) translocation. Am J Dermatopathol 2009; 31:236-47. [PMID: 19384064 DOI: 10.1097/dad.0b013e3181984f10] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present a series of 14 cases of cutaneous hidradenocarcinomas. The patients included 6 women and 8 men ranging in age at diagnosis from 34 to 93 years. All but 1 patient presented with a solitary nodule. There was no predilection site. One patient presented with multiple lesions representing metastatic nodules. Of 12 patients with available follow-up, 2 died of disease, whereas the remaining 10 patients were alive but 3 of them experienced a local recurrence in the course of the disease. Grossly, the tumors ranged in size from 1.2 to 6 cm. Microscopically, of the 14 primary tumors, 9 showed low-grade cytomorphology, whereas the remaining 5 neoplasms were high-grade lesions. The residuum of a hidradenoma was present in 5 of the 14 primaries. The mitotic rate was highly variable, ranging from 2 to 64 mitoses per 10 high-power field. The cellular composition of the tumors varied slightly, with clear cells, epidermoid cells, and transitional forms being present in each case. In 1 case, there was metaplastic transformation into sarcomatoid carcinoma. Glandular differentiation varied from case to case and appeared most commonly as simple round glands or as cells with intracytoplasmic lumens. Necrosis en masse was detected in 8 specimens. One specimen represented a reexcision and was unusual as it showed a well-demarcated intradermal proliferation of relatively bland clear cells accompanied by an overlying intraepidermal growth of clear cells resembling hidradenoacanthoma simplex. Despite the bland appearance, the tumor metastasized to a lymph node. Immunohistochemically, 5 of the 8 specimens studied for Her2/neu expression were negative, whereas 3 specimens from 2 cases yielded score +2, but all the 3 specimens with score 2+ subsequently proved negative for Her2/neu gene amplification by fluorescence in situ hybridization. Of 10 primaries studied, 4 tumors showed positive p53 immunoreaction in more than 25% of the cells comprising the malignant portion of the lesions, in 2 cases, a minority of the neoplastic cells (10%-20%) demonstrated nuclear staining, whereas the remaining 4 cases were negative. Of 9 specimens of hidradenocarcinoma studied for TP53 mutations, 2 harbored mutations, whereas the remaining 7 specimens showed the wild-type sequence. Of 11 specimens studied for translocation t(11;19), 2 cases harbored the translocation. It is concluded that cutaneous hidradenocarcinomas show some microscopic heterogeneity and comprise both low- and high-grade lesions that cytologically are similar to their benign counterpart, the hidradenoma. Within the spectrum of low-grade lesions, there seem to exist tumors almost indistinguishable from hidradenomas but still being capable of regional or distant metastasis. Similar to hidradenomas, hidradenocarcinomas show a t(11;19) translocation, but it is a significantly rarer event. Even rarer is the amplification of the Her2/neu gene. Of note is the relatively low frequency of TP53 mutations despite a high rate of p53 protein expression at the immunohistochemical level.
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Mullaney PJ, Becker E, Graham B, Ghazarian D, Riddell RH, Salonen DC. Benign hidradenoma: magnetic resonance and ultrasound features of two cases. Skeletal Radiol 2007; 36:1185-90. [PMID: 17624528 DOI: 10.1007/s00256-007-0348-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Revised: 05/23/2007] [Accepted: 06/04/2007] [Indexed: 02/02/2023]
Abstract
Tumors of sweat gland origin are rare in the hand but should be considered in the differential diagnosis when certain imaging features are present. We present a case of nodular hidradenoma of the hand, with previously unreported magnetic resonance imaging features, and a further case in the thigh, both with ultrasound and histopathological correlation. The imaging literature of this tumor is reviewed, and its significance is discussed with respect to the current understanding of its malignant potential.
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Affiliation(s)
- P J Mullaney
- Department of Medical Imaging, Toronto Western Hospital, 399 Bathurst St, Toronto, ON, M5G 2C4, Canada.
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