Apocrine Hidrocystoma Workup

Author: Jesse M Olmedo, MD; Chief Editor: Dirk M Elston, MD more...

Updated: Jul 22, 2011

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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 the image below). Apocrine hidrocystomas are more likely to be multilocular than the closely related eccrine hidrocystoma.

Histology of apocrine hidrocystoma. Cystic spaces appear empty because sweat is removed during processing. Decapitation secretion often is seen in the lining.

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.

Proceed to Treatment & Management

Contributor Information and Disclosures

Author

Jesse M Olmedo, MD Staff Physician, Department of Dermatology, Beatrice Keller Clinic

Disclosure: Nothing to disclose.

Coauthor(s)

Ronald P Rapini, MD Josey Professor and Chair, Department of Dermatology, Professor of Pathology, University of Texas Medical School at Houston and MD Anderson Cancer Center

Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Society for Investigative Dermatology, and Texas Medical Association

Disclosure: Elsevier publishers Royalty Independent contractor

Specialty Editor Board

Carrie L Kovarik, MD Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

References

Alessi E, Gianotti R, Coggi A. Multiple apocrine hidrocystomas of the eyelids. Br J Dermatol. Oct 1997;137(4):642-5. [Medline].
Combemale P, Kanitakis J, Dupin N, Parraud C, Guigon M. Multiple Moll's gland cysts (apocrine hidrocystomas) of the eyelids. Dermatology. 1997;194(2):195-6. [Medline].
de Eusebio E, Lopez-Bran E, Rojo S, Suarez R, Sanchez Yus E, Robledo A. Multiple hidrocystomas. Dermatology. 1996;193(2):152-3. [Medline].
Ter Poorten HJ. Apocrine hidrocystoma of the right scapula. Arch Dermatol. Dec 1977;113(12):1730. [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].
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].
Woolery-Lloyd H, Rajpara V, Nijhawan RI. Treatment for multiple periorbital eccrine hidrocystomas: botulinum toxin A. J Drugs Dermatol. Jan 2009;8(1):71-3. [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.

Clinical example of apocrine hidrocystoma.

Histology of apocrine hidrocystoma. Cystic spaces appear empty because sweat is removed during processing. Decapitation secretion often is seen in the lining.

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