Background: Fine-needle aspiration (FNA) is well-established as an accurate technique for the diagnosis of palpable breast masses. While the differential diagnosis of such lesions usually focuses on benign or malignant mammary proliferations, a subset of breast neoplasms arises from skin and soft tissue. Skin adnexal neoplasms such as hidradenoma can pose a particular pitfall on breast FNA cytology (FNAC) as epithelial proliferations that are not of ductal or lobular origin. Case: A 59-year-old female presented with a superficial breast mass. FNAC revealed a hypercellular lesion with marked nuclear atypia that was highly suspicious for carcinoma. However, at partial mastectomy, the histological features of the tumor were consistent with atypical hidradenoma. Negativity for estrogen receptor (ER) and progesterone receptor (PR) confirmed the diagnosis. Eighteen years later, the patient remains free of recurrence or metastasis. Conclusions: This report offers the first description of findings of atypical hidradenoma on FNAC. In the breast, its high cellularity and nuclear atypia can mimic a primary mammary carcinoma on FNAC. Although breast and skin adnexal tumors show a immunohistochemical overlap, negative ER and PR stains in a low-grade tumor can suggest a nonmammary lesion. Skin adnexal neoplasms should be considered in the differential diagnosis of superficial breast tumors.

Keywords:
Hidradenoma, Breast, Fine-needle aspiration cytology
1.
Akçil M, Karaağaoğlu E, Demirhan B: Diagnostic accuracy of fine-needle aspiration cytology of palpable breast masses: an SROC curve with fixed and random effects linear meta-regression models. Diagn Cytopathol 2008;36:303-310.
2.
Yu YH, Wei W, Liu JL: Diagnostic value of fine-needle aspiration biopsy for breast mass: a systematic review and meta-analysis. BMC Cancer 2012;12:41.
3.
Aker F, Gümrükçü G, Onomay B, Erkan M, Gürleyik G, Kiliçoğlu G, Karagüllü H: Accuracy of fine-needle aspiration cytology in the diagnosis of breast cancer. A single-center retrospective study from Turkey with cytohistological correlation in 733 cases. Diagn Cytopathol 2015;43:978-986.
4.
Rosa M, Mohammadi A, Masood S: The value of fine needle aspiration biopsy in the diagnosis and prognostic assessment of palpable breast lesions. Diagn Cytopathol 2012;40:26-34.
5.
Wai CJ, Al-Mubarak G, Homer MJ, Goldkamp A, Samenfeld-Specht M, Lee Y, Logvinenko T, Rothschild JG, Graham RA: A modified triple test for palpable breast masses: the value of ultrasound and core needle biopsy. Ann Surg Oncol 2013;20:850-855.
6.
Nagar S, Iacco A, Riggs T, Kestenberg W, Keidan R: An analysis of fine needle aspiration versus core needle biopsy in clinically palpable breast lesions: a report on the predictive values and a cost comparison. Am J Surg 2012;204:193-198.
7.
O'Donnell ME, McCavert M, Carson J, Mullan FJ, Whiteside MW, Garstin WI: Non-epithelial malignancies and metastatic tumours of the breast. Ulster Med J 2009;78:105-112.
8.
Young JL, Ward KC, Wingo PA, Howe HL: The incidence of malignant non-carcinomas of the female breast. Cancer Causes Control 2004;15:313-319.
9.
Cho KE, Son EJ, Kim JA, Youk JH, Kim EK, Kwak JY, Jeong J: Clear cell hidradenoma of the axilla: a case report with literature review. Korean J Radiol 2010;11:490-492.
10.
Domoto H, Terahata S, Sato K, Tamai S: Nodular hidradenoma of the breast: Report of two cases with literature review. Pathol Int 1998;48:907-911.
11.
Grampurohit VU, Dinesh U, Rao R: Nodular hidradenoma of male breast: cytohistological correlation. J Cytol 2011;28:235-237.
12.
Ives CL, Donnelly PK, Ryley N, Green R, Bliss P, Ellis I: Benign hidradenoma masquerading as ductal breast cancer-a rare case of false-positive recurrence in cancer follow-up. Breast J 2013;19:670-671.
13.
Kumar N, Verma K: Clear cell hidradenoma simulating breast carcinoma: a diagnostic pitfall in fine-needle aspiration of breast. Diagn Cytopathol 1996;15:70-72.
14.
Mote DG, Ramamurti T, Naveen Babu B: Nodular hidradenoma of the breast: a case report with literature review. Indian J Surg 2009;71:43-45.
15.
Ohi Y, Umekita Y, Rai Y, Kukita T, Sagara Y, Takahama T, Andou M, Yoshida A, Yoshida H: Clear cell hidradenoma of the breast: a case report with review of the literature. Breast Cancer 2007;14:307-311.
16.
Pandey P, Dixit A, Chandra S, Tanwar A: Cytological features of malignant eccrine acrospiroma presenting as a soft tissue mass axilla: a rare sweat gland tumor with histologic correlation. Int J Appl Basic Med Res 2015;5:145-148.
17.
Vasconcelos I, Radke C, Tellechea Ó, Schoenegg W: Hidradenoma of the breast: a source of diagnostic confusion. Breast J 2015;21:681-682.
18.
Sehgal S, Goyal P, Ghosh S, Mittal D, Kumar A, Singh S: Clear cell hidradenoma of breast mimicking atypical breast lesion: a diagnostic pitfall in breast cytology. Rare Tumors 2014;6:5343.
19.
Kazakov DV, Ivan D, Kutzner H, Spagnolo DV, Grossmann P, Vanecek T, Sima R, Kacerovska D, Shelekhova KV, Denisjuk N, Hillen U, Kuroda N, Mukensnabl P, Danis D, Michal M: 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;31:236-247.
20.
Gauerke S, Driscoll JJ: Hidradenocarcinomas: a brief review and future directions. Arch Pathol Lab Med 2010;134:781-785.
21.
Ko CJ, Cochran AJ, Eng W, Binder SW: Hidradenocarcinoma: a histological and immunohistochemical study. J Cutan Pathol 2006;33:726-730.
22.
Nazarian RM, Kapur P, Rakheja D, Piris A, Duncan LM, Mihm MC, Hoang MP: Atypical and malignant hidradenomas: a histological and immunohistochemical study. Mod Pathol 2009;22:600-610.
23.
Souvatzidis P, Sbano P, Mandato F, Fimiani M, Castelli A: Malignant nodular hidradenoma of the skin: report of seven cases. J Eur Acad Dermatol Venereol 2008;22:549-554.
24.
Mambo NC: The significance of atypical nuclear changes in benign eccrine acrospiromas: a clinical and pathological study of 18 cases. J Cutan Pathol 1984;11:35-44.
25.
Piris A, Scopsi L, Clemente C, Cetti Serbelloni F, Mihm MC, Jr., Hoang MP: Epidermal growth factor receptor gene status by fluorescence in situ hybridization in malignant, atypical, and benign hidradenomas. Am J Dermatopathol 2010;32:586-592.
26.
Hernández-Pérez E, Cestoni-Parducci R: Nodular hidradenoma and hidradenocarcinoma. A 10-year review. J Am Acad Dermatol 1985;12:15-20.
27.
Dey P, Das A, Radhika S, Nijhawan R: Cytology of primary skin tumors. Acta Cytol 1996;40:708-713.
28.
Dubb M, Michelow P: Cytologic features of hidradenoma in fine needle aspiration biopsies. Acta Cytol 2009;53:179-182.
29.
Gangane N, Joshi D, Sharma SM: Cytomorphological diagnosis of malignant eccrine tumors: report of two cases. Diagn Cytopathol 2008;36:801-804.
30.
Garcia-Bonafe MM, Campins MM, Redecilla PH: Malignant nodular hidradenoma on the scalp: report of a case with fine needle aspiration cytology features and histologic correlation. Acta Cytol 2009;53:576-580.
31.
Ray R, Dey P: Fine needle aspiration cytology of malignant hidradenoma. Acta Cytol 1993;37:842-843.
32.
Cibas ES, Dominiczak MH: Cytology. Elsevier, 2014.
33.
DeMay RM: The Art & Science of Cytopathology. Chicago, American Society for Clinical Pathology, 2012.
34.
Mertens RB, de Peralta-Venturina MN, Balzer BL, Frishberg DP: Gata3 expression in normal skin and in benign and malignant epidermal and cutaneous adnexal neoplasms. Am J Dermatopathol 2015;37:885-891.
35.
Miettinen M, McCue PA, Sarlomo-Rikala M, Rys J, Czapiewski P, Wazny K, Langfort R, Waloszczyk P, Biernat W, Lasota J, Wang Z: Gata3: a multispecific but potentially useful marker in surgical pathology. A systematic analysis of 2500 epithelial and nonepithelial tumors. Am J Surg Pathol 2014;38:13-22.
36.
Rollins-Raval M, Chivukula M, Tseng GC, Jukic D, Dabbs DJ: An immunohistochemical panel to differentiate metastatic breast carcinoma to skin from primary sweat gland carcinomas with a review of the literature. Arch Pathol Lab Med 2011;135:975-983.
37.
Swanson PE, Mazoujian G, Mills SE, Campbell RJ, Wick MR: Immunoreactivity for estrogen receptor protein in sweat gland tumors. Am J Surg Pathol 1991;15:835-841.
38.
Istvanic S, Fischer AH, Banner BF, Eaton DM, Larkin AC, Khan A: Cell blocks of breast FNAs frequently allow diagnosis of invasion or histological classification of proliferative changes. Diagn Cytopathol 2007;35:263-269.
39.
Mahalingam M, Nguyen LP, Richards JE, Muzikansky A, Hoang MP: The diagnostic utility of immunohistochemistry in distinguishing primary skin adnexal carcinomas from metastatic adenocarcinoma to skin: an immunohistochemical reappraisal using cytokeratin 15, nestin, p63, d2-40, and calretinin. Mod Pathol 2010;23:713-719.
40.
Mentrikoski MJ, Wick MR: Immunohistochemical distinction of primary sweat gland carcinoma and metastatic breast carcinoma: can it always be accomplished reliably? Am J Clin Pathol 2015;143:430-436.
41.
Plaza JA, Ortega PF, Stockman DL, Suster S: Value of p63 and podoplanin (d2-40) immunoreactivity in the distinction between primary cutaneous tumors and adenocarcinomas metastatic to the skin: a clinicopathologic and immunohistochemical study of 79 cases. J Cutan Pathol 2010;37:403-410.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.