Hidrocystomas - A Brief Review

Khashayar Sarabi, BS, MSIV; Amor Khachemoune, MD, CWS

September 06, 2006

Histology and Pathogenesis

Eccrine hidrocystomas usually result from dilation of cystic excretory eccrine glands due to retention of sweat and dilation or blockage of the sweat duct. Under the microscope, eccrine hidrocystomas appear as unilocular cysts, which usually contain a single cystic cavity composed of 1 or 2 layers of cuboidal cells. They are located within the mid-dermal to superficial layers of the skin, especially around the eyes. Unlike their apocrine counterpart, there are no secretory cells seen and decapitation of cells is not viewed under the microscope.^[1] Histochemically, they stain positive for S100 protein (solitary type), whereas apocrine hidrocystomas do not. The cyst and epidermis do not communicate, and the periodic acid-Schiff (PAS)-positive granules are not observed.^[1]

Apocrine hidrocystomas appear as unilocular or multilocular under the microscope. The cyst wall is composed of an inner layer of secretory columnar epithelium. The epithelium is either a single or double layer of cuboidal-columnar epithelium, which lies above an outer myoepithelial cell layer. PAS- positive granules are observed in the presence of lipofuscin granules. Apocrine hidrocystomas also encompass papillary projections, which are not usually seen in the eccrine hidrocystomas. These projections are vascular connective tissue, covered by the secretory epithelium. Papillary projections then appear on the lumen of the cysts as an outgrowth extension from the wall of the cyst.^[2]

References

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Cite this: Hidrocystomas - A Brief Review - Medscape - Sep 05, 2006.

Table. Differentiation Between Eccrine and Apocrine Hidrocystomas
	Eccrine Hidrocystomas	Apocrine Hidrocystomas
No. of lesions	Solitary or multiple	Primarily solitary (but occasionally manifesting as multiple lesions)
Color	Ranges from flesh-colored to light-blue tint	Ranges from dark-blue tint to black
Size	1 to 6 mm in diameter	3 to 15 mm in diameter
Age group affected	30-75 years	30-75 years
Gender distribution	More prevalent among females than among males	Females and males are affected in equal numbers
Epithelium types	1-2 layers of cuboidal epithelium	Single/double cuboidal-columnar epithelium
Stains	S-100 positive (solitary type), PAS negative	S-100 negative, PAS positive
Special cellular features	No decapitation of cells, no secretory cells	Decapitation of secretory cells, papillary projections seen under microscope
Body location	Malar, periorbital, chest, axilla, neck	Face, ears, head, chest, shoulders
Possible treatments	Puncture and drainage, electrodessication, carbon dioxide laser, anticholinergic topical creams; placement in cold temperature	Puncture and drainage, electrodessication, carbon dioxide laser, anticholinergic topical creams
Special features	Worse in hot, humid weather	No change with temperature

PAS = periodic acid-Schiff

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Hidrocystomas - A Brief Review

Histology and Pathogenesis

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References

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