Case Number : Case 1834 - 8 June - Dr Arti Bakshi Posted By: Guest

It is never too early to see a case from Dr Arti Bakshi.

Geoff Cross - DermpathPRO Projects

This is really interesting, and beautiful, I have only seen this once during my residency. This is lymph node compromise by nodular hidradenoma, probably just a deposit and therefore the patient has a great prognosis. Here a nice article by Dr. Calonje describing the phenomenon

Yes, I also perceived it as nodular hidradenoma in a LN !!! 

Beautiful :-) 

Thanks for the reference Raul 

Completely agree with Raul! Ductal differentiation and myoepithelial/basal layer support a primary axillary nature of the lesion, and there aren't worrisome features (maybe something stromal fibroplasia in fig, but not invasive desmoplastic changes ).

My spot is primary axillary clear cell adenoma, with nodal involvement. 

agree with colleagues.the lesion is  looks like a nodular hidradenoma to me,too. interesting case!

I came back after a long absence!

Agree. Thanks for the diagnosis and reference Raul.

It is my pleasure to share with colleagues and friends

Kudos for Raul! Fully agree.

Brilliant Raul!....yes this is a lymph node deposit of nodular hidradenoma.

The patient had a nodular hidradenoma excised from the axilla a few years back. The tumour was present at the margin, but no re-excision was done at the time. The lesion recurred a year later and was completely excised this time. Following the LN deposit, I reviewed the previous histology worried that I might have missed a malignancy. Even with the benefit of hindsight, I could not see any overtly concerning features. The tumour was well circumscribed, cytologically banal with very ocassional mitoses. I came across the same article which Raul has referenced and sent the case to Dr Calonje for a second opinion. He agreed that the case was in the same spectrum as the cases in their series. None of the cases from that series have had an aggressive course and since then he has seen 2 more such cases, also with a benign outcome. I do think this is a novel example of 'benign metastasis', and hopefully this patient will follow an indolent course as well. Nevertheless, I think all nodular hidradenomas should be completely excised in the first instance and one needs to be aware that a small subset with benign histology can show regional LN involvement.

Thanks for all your comments!