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.
