PAPILLARY HIDRADENOMA IN THE PERIANAL REGION IN A MALE PATIENT: A CASE REPORT

Case Presentation Patient, E.G.S., male, 46 years old, was referred by dermatology for a right perianal nodule present for 5 months, with associated inflammatory process. He denies fever, weight loss, or pain upon palpation. On physical examination, a 1 cm verrucous nodular lesion was found, with no signs of inflammation or fistulous tract. He denies comorbidities and a history of perianal diseases. Pelvic MRI showed a 1 cm perianal nodular image with no lymphadenopathy. He underwent excision of the lesion with margins. The histopathology report confirmed papillary hidradenoma in the right perianal region, with complete excision of the lesion.

Discussion Papillary hidradenoma is a rare and benign cystic tumor originating from apocrine sweat glands in the anogenital region. This tumor is more commonly found in women, with fewer occurrences in men between 30 and 45 years old. The vulva and labia majora are the most frequent sites, while it is less common in the labia minora, perineum, anal region, and extragenital areas. The vulvar occurrence is four times more frequent than perianal. It typically presents as a small, painless, mobile tumor with fibroelastic consistency. It can be vegetative, polypoid, or cystic in nature. Symptoms in the perianal region may include pain, burning, and itching, often related to concomitant fecal passage. Histologically, it shows a hyperplastic adenomatous pattern with clusters of glandular acini, cysts, and tubules, covered by a double layer of columnar and myoepithelial cells in the dermis. Malignant transformation is rare, and the tumor has a benign behavior with no recurrence or metastasis. Differential diagnoses include external hemorrhoids, anal abscess, viral warts, and squamous cell carcinoma. It is less commonly confused with neurofibroma, sebaceous cysts, lipomas, or melanoma.

Conclusion Anogenital papillary hidradenomas are uncommon tumors, and their histological and molecular profiles have been little studied. Dermatoscopic analysis of the lesion does not provide an accurate diagnosis, making proctological evaluation necessary. Local excision is the treatment of choice, and recurrence is rare, typically due to incomplete excision of the primary tumor. The limited number of reports in the literature regarding male involvement, coupled with the difficulty in suspicion, makes this issue challenging. Due to the wide range of differential diagnoses, including both malignant and benign conditions, biopsy and histopathological examination are essential for lesions in the perianal region, enabling diagnosis and treatment.

 

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

Publication History

Article published online:
25 April 2025