Case Report and Literature Review of Nodular Hiradenoma, a Rare Adnexal Tumor That Mimics Breast Carcinoma, in a 20-Year-Old Woman

Vanya Jaitly, MD; Richard Jahan-Tigh, MD, MS; Tatiana Belousova, MD; Hui Zhu, MD, PhD; Robert Brown, MD; Karan Saluja, MD


Lab Med. 2019;50(3):320-325. 

In This Article

Pathologic Findings

Needle core biopsy results from the breast mass at an outside hospital were reported as indicating a squamoid epithelial neoplasm with clear cell features. Due to clinical and radiologic concern for breast malignant neoplasm, the patient underwent right-breast segmental mastectomy for excision of the mass with wide margins. Also, she underwent sentinel node mapping with the excision of lymph nodes.

On gross examination, a 4.2 × 4.0 × 2.8–cm firm, white-tan, well circumscribed mass with pushing borders was noted within the breast; the overlying skin was ulcerated. Microscopic examination revealed a circumscribed and lobulated dermal mass, with solid-cystic areas that extended into the breast parenchyma. The neoplastic cells were squamoid, with some areas showing clear cell change (Image 2A). The background stroma showed areas of increased hyalinization and focal myxoid degeneration in fibrovascular cores. Small ducts were present throughout the lesion. Scattered mitotic figures were observed (Image 2B); however, no area of necrosis was identified. Focal skin ulceration was noted; however, no extension of the tumor to the epidermis was identified.

Image 2.

Magnified images and immunohistochemical stains of specimen tissue from the breast tissue of our patient, a 20-year-old Hispanic woman. A, Low-power magnification shows a circumscribed and lobulated dermal mass with extension into the breast parenchyma. No connection to the overlying epidermis is identified (hematoxylin-eosin [H&E] staining; original magnification ×2). B, High-power magnification shows neoplastic cells with squamoid features, and some areas show clear cell change. Focal areas show small ducts. A few scattered mitotic figures were noted (highlighted with a circle) with no overt cytologic atypia or areas of necrosis (hematoxylin-eosin [H&E] staining; original magnification ×20). C, Immunohistochemical staining revealed that tumor cells had tested positive for cytokeratin (CK)5/CK6 (original magnification ×10), p40 (part D; original magnification, ×10), GATA3 (part E; original magnification ×10), and low Ki67 labeling index of ~5% (part F; original magnification ×10).

A panel of immunohistochemical stains was performed, the results of which showed that neoplastic cells tested diffusely positive for cytokeratin (CK)5/6 (Image 2C), p40 (Image 2D), p63, and GATA3 (Image 2E), and tested negative on estrogen receptor (ER), progesterone receptor (PR), smooth muscle actin (SMA), carcinoembryonic antigen (CEA), mammoglobin, and gross cystic disease fluid protein 15 (GCDFP-15) stains. The Ki-67 labeling index was approximately 5% (Image 2F). The cytomorphologic features and immunohistochemical profile were consistent with nodular hidradenoma involving the breast. At 1 year and 3 months of follow-up, the patient had no evidence of relapse or recurrence of disease.