PERIANAL PAPILLARY HIDRADENOMA

Case Presentation The patient is a 56-year-old white woman who presented with a painless nodule in the perianal region, which had been slowly growing for 6 months. She denies any comorbidities or family history of neoplasms. Upon examination, a cystic nodule measuring 10 × 20 mm was observed 3 cm from the anal margin. The patient underwent excisional biopsy of the lesion under local anesthesia, and the histological diagnosis was papillary hidradenoma.

Discussion Papillary hidradenoma is a rare, benign cystic tumor of apocrine glands. It typically presents as an anogenital nodule in women, most commonly between the ages of 30 and 50. Its most common location is the vulva, with rare occurrences in other regions. Perianal involvement is rare, with only around 20 reported cases in the past 20 years. Literature describes this lesion as a tumor that predominantly affects post-pubertal white women. Clinically, the tumor appears as a single, painless, small (<2 cm) unilateral nodule with intact overlying skin, fibroelastic consistency, well-defined borders, and mobility; it can also be polypoid, vegetative, or cystic in nature. Symptoms in the perianal region are rare, but some cases may present with pain, burning sensation, discharge, bleeding, or pruritus. Histologically, the tumor is located in the dermis, separated from the epidermis by fibrous connective tissue. There is controversy in the literature regarding the tumor's potential to evolve into cancer. Some authors consider malignancy a possibility, while others do not. Adenomatous hyperplasia with cellular pleomorphism and irregular papillary acinar patterns without lumen formation raise speculations about its malignant potential; sometimes, this lesion is misdiagnosed as adenocarcinoma. The differential diagnosis is broad, including benign lesions such as hemorrhoidal disease, anorectal abscess, viral warts, sebaceous cysts, lipomas, and neurofibromas, as well as malignant lesions such as metastatic papillary carcinoma and squamous cell carcinoma. Excisional biopsy with margins is sufficient for diagnosis, treatment, and cure.

Conclusion Considering the histological diversity of the anal region, biopsy is essential for diagnostic clarification of all unusual lesions in the perianal area.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025