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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 849 - 18th September Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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44 year-old female with a left labial mass.

Case posted by Dr. Hafeez Diwan.


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Tubular structures wit decapitation secretion. Tubular apocrine adenoma.

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Guest Romualdo

Posted

Mammary-like gland adenoma of the vulva somewhat resembling a sclerosing adenosis.

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Robledo F. Rocha

Posted

[color="#292526"][font="Palatino Linotype, serif"][size="4"]Topped by epidermal hyperplasia and embedded in a hyaline stroma, an intradermal proliferation of tubules with an outer layer of myoepithelial cells and an inner layer of cuboidal to low columnar cells that show decapitation secretion.[/size][/font][/color]
[color="#292526"][font="Palatino Linotype, serif"][size="4"]I would call this tubular adenoma.[/size][/font][/color]
[color="#292526"][font="Palatino Linotype, serif"][size="4"]I prefer not use the [color="#333333"]adjective [/color]“apocrine” once I believe there are many shared characteristics with so-called papillary eccrine adenoma to admit that both are nothing more than expressions of the same entity. Furthermore, the classification according to sweat gland line of differentiation is of little importance and sometimes impossible to ascertain.[/size][/font][/color]

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Guest Jim Davie MD

Posted

[size=3]Hidradenoma papilliferum (favored), vs. apocrine adenoma.

The peripheries of hidradenomas can occasionally show a deceptive tubular and/or nested architecture, rather than the expected papillary architecture.
[i] With a bit of digging on the web, I found an example image set:[/i]
[i] Low power: [url="http://www.webpathology.com/image.asp?n=2&Case=542"]Hidradenoma with tubular architecture at periphery ([/url][/i][url="http://www.webpathology.com/image.asp?n=2&Case=542"]www.webpathology.com/image.asp?n=2&Case=542)[/url]
[/size][size=3][i]High power: [url="http://www.webpathology.com/image.asp?n=4&Case=542"]Hidradenoma with tubular architecture at periphery ([/url][/i][url="http://www.webpathology.com/image.asp?n=4&Case=542"]www.webpathology.com/image.asp?n=4&Case=542)[/url][/size]

[size=3]As we are only seeing the superficial aspect of this apocrine neoplasm in these images, I will opine this is actually the superficial aspect of hidradenoma papilliferum. I would want to see the entire lesion (excision) before rendering a final decision.

Clinical location in vulva favors hidradenoma.[/size]
[size=3]Apocrine adenoma, in contrast, is more often found in axillary or scalp locations.[/size]

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Dr. Hafeez Diwan

Posted

Good discussion above. I went with hidradenoma papilliferum.

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Robledo F. Rocha

Posted

Jim’s well-aimed opinion serve as a wake-up call for mistrusting every superficial sampling, mainly if the clinical presentation is not typical.

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