ABSTRACT
SUMMARY: Apocrine glands are sweat glands that are located in the skin of the dog. Anal sac apocrine, circunanal apocrine, and mammary glands are considered modified apocrine structures, and there are about nine possible types of neoplasms and other tumors in the apocrine glands of the dog and cat, including cysts, adenoma, carcinoma, and adenocarcinoma. Thus, it is important to provide new markers to characterize these glands to improve the histopathological diagnosis. In this article, we describe the distribution of kallikrein- related peptidases 5, 7, 8, and 10 in the normal apocrine glands of the dog's skin. These proteases have been shown to play a fundamental role in the homeostasis of the human skin barrier but have been scarcely studied in canine skin.
Las glándulas apocrinas son glándulas sudoríparas que se encuentran en la piel del perro. Las glándulas apocrinas del saco anal, apocrinas circunanales y mamarias se consideran estructuras apocrinas modificadas, y existen alrededor de nueve tipos posibles de neoplasias y otros tumores en las glándulas apocrinas del perro y el gato, incluidos quistes, adenoma, carcinoma y adenocarcinoma. Por lo tanto, es importante proporcionar nuevos marcadores para caracterizar estas glándulas para mejorar el diagnóstico histopatológico. En este artículo, describimos la distribución de las peptidasas 5, 7, 8 y 10 relacionadas con la calicreína en las glándulas apocrinas normales de la piel del perro. Se ha demostrado que estas proteasas desempeñan un papel fundamental en la homeostasis de la barrera de la piel humana, pero apenas se han estudiado en la piel canina.
Subject(s)
Animals , Dogs , Apocrine Glands/metabolism , Apocrine Glands/chemistry , Kallikreins/analysis , Kallikreins/metabolism , Skin , ImmunohistochemistryABSTRACT
Los nevus apocrinos puros son hamartomas de las unidades pilosebáceas caracterizadas por proliferaciones benignas de glándulas apocrinas maduras, la cual es una descripción microscópica realizada en los reportes de patología sin que se nombre el diagnóstico exacto. Considerando además, los diagnósticos diferenciales clínicos y la baja frecuencia de este diagnóstico, presentamos un caso clínico y una revisión del tema
Pure apocrine nevi are hamartomas of the pilosebaceous units characterized by benign proliferations of mature apocrine glands, which is a microscopic description made in pathology reports without the exact diagnosis being named. Considering the clinical differential diagnoses and its low frequency, we present a case report and a review of the literature on this topic
Subject(s)
Humans , Female , Adolescent , Apocrine Glands , Sweat Gland Diseases/diagnosis , Hamartoma/diagnosis , Apocrine Glands/pathology , Sweat Gland Diseases/pathology , Hamartoma/pathology , NevusABSTRACT
Resumen El carcinoma apocrino primario de glándula sudorípara es una neoplasia con una muy baja incidencia, que puede representar un reto diagnóstico, clínico e histológico, y un reto terapéutico local, adyuvante y de la enfermedad avanzada. La edad media de los pacientes es de alrededor de 67 años, y no se ha observado preferencia según el sexo. Se presenta con mayor frecuencia en las axilas y en el cuero cabelludo. Se caracteriza clínicamente por un lento crecimiento, aunque puede progresar agresivamente, con compromiso local, ganglionar y metastásico, principalmente, pulmonar, hepático y óseo. El tratamiento recomendado -una vez establecida la histología- consiste en una resección local amplia con un margen claro de 1 a 2 cm y linfadenectomía regional si se detectan ganglios clínicamente positivos. El tratamiento adyuvante (radioterapia o quimioterapia) y de la enfermedad avanzada no está claramente establecido. Se presentan dos pacientes de sexo femenino con sospecha inicial de cáncer de mama, en quienes se diagnosticó finalmente un carcinoma apocrino de glándula sudorípara.
Abstract Primary apocrine carcinoma of the sweat gland is a neoplasm with a very low incidence that may represent a clinical and histological diagnostic challenge, as well as for adequate local, adjuvant, and advanced disease management. The average age of patients is around 67 years with no gender preference. This cancer develops primarily at the axillary and scalp levels and is clinically characterized by slow growth, but can progress aggressively with local, nodal, and metastatic involvement (primarily lung, liver, and bone). The recommended management, once the histology is established, consists of a wide local resection with a clear margin of 1 to 2 cm and regional lymphadenectomy if clinically positive nodes are detected. The adjuvant treatment (radiotherapy or chemotherapy) and for the advanced disease is not established. We report here the cases of two female patients initially diagnosed with breast cancer who were finally diagnosed with apocrine carcinoma of the sweat gland.
Subject(s)
Apocrine Glands , Breast Neoplasms , Pathology , Skin Neoplasms , Case ReportsABSTRACT
O presente estudo objetivou caracterizar os aspectos anatomopatológicos e imuno-histoquímicos dos tumores das glândulas cutâneas em cães. A caracterização morfológica seguiu a classificação atualizada da Organização Mundial de Saúde. Para a caracterização imuno-histoquímica, utilizaram-se anticorpos monoclonais primários anti-citoqueratina 14 (CK14), vimentina, p63, calponina, EGFR e Ki-67. Dos animais examinados, 66,67% (18/27) eram machos e 33,33% (9/27) fêmeas, 21 tinham raça definida e seis eram sem raça definida (SRD), com idade variando entre sete e 15 anos. Dos tumores caracterizados, 40,74% eram hepatoides (11/27), 29,63% sebáceos (8/27), 25,92% apócrinos (7/27) e 3,70% meibômio (1/27). Os tumores malignos representaram 55,56%, e os benignos 44,44%. Com esses resultados, foi possível demonstrar que os tumores das glândulas cutâneas em cães são frequentes, sem predileção por raça, sexo e com idade superior ou igual a sete anos. Os anticorpos CK 14, p63, vimentina e EGFR foram imunoexpressos nas células basais, células de diferenciação sebácea dos tumores hepatoides e de meibômio e células mioepiteliais. Entretanto, a vimentina e o EGFR não demonstraram imunomarcação para os tumores sebáceos. A calponina foi um bom marcador para as células mioepiteliais. O índice de Ki-67 foi mais acentuado nos tumores malignos em relação aos benignos. No entanto, estudos futuros utilizando maior número de casos se fazem necessários.(AU)
The present study aimed to characterize the anatomopathological and immunohistochemical aspects of cutaneous glandular tumors in dogs. Tumours were diagnosed according to the WHO criteria for canine skin neoplasms. For the immunohistochemical characterization, the primary monoclonal antibodies anti-cytokeratin 14 (CK14), vimentin, p63, calponin, EGFR and Ki-67 were used. Males were 66.67% (18/27) and females 33.33% (9/27), 21 had a defined race and 6 were mixed breed, with ages varying from 7 to 15 years. The tumors characterized were 40.74% hepatoid (11/27), 29.63% sebaceous (8/27), 25.92% apocrine (7/27) and 3.70% Meibômio (1/27). Malignant tumors accounted for 55.56% and benign tumors 44.44%. With these results it was possible to demonstrate that tumors of cutaneous glands in dogs are frequent, with no predilection for race, sex and with an age ≥ seven years. The CK 14 antibodies, p63, vimentin, and EGFR were imunoexpressed in the basal cells of the sebaceous cell differentiation and Meibomian hepatoides tumors and myoepithelial to cells. However, vimentin and EGFR did not demonstrate immunostaining for sebaceous tumors. Calponin was a good marker for myoepithelial cells. The Ki-67 index was more pronounced in malignant tumors compared to benign tumors. However, more studies are needed mainly using a higher number of tumors.(AU)
Subject(s)
Animals , Dogs , Sebaceous Gland Neoplasms/pathology , Sebaceous Gland Neoplasms/veterinary , Skin Neoplasms/pathology , Skin Neoplasms/veterinary , Dog Diseases , Anal Gland Neoplasms/pathology , Apocrine GlandsABSTRACT
Apocrine hidrocystoma, also called apocrine cystadenoma, is a benign cystic tumor-like lesion that arises from the proliferation of apocrine glands. Clinically, it usually occurs singly as a unilocular or multilocular, dome-shaped translucent cyst. Histologically, it appears as unilocular or multilocular cysts composed of an inner layer of single or double layer of secretory columnar epithelium with decapitation secretion lying above an outer myoepithelial cell layer. Apocrine hidrocystomas mostly occur within the head and neck region and involvement of genitalia is extremely rare. This paper emphasizes the importance of considering the differential diagnosis of a genital cystic lesion. Herein, we report a case of apocrine hidrocystoma occurring in the penis and compare the clinicopathological characteristics of apocrine hidrocystoma in genitalia with the previous cases.
Subject(s)
Male , Apocrine Glands , Cystadenoma , Decapitation , Deception , Diagnosis, Differential , Epithelium , Genitalia , Head , Hidrocystoma , Neck , PenisABSTRACT
Hidradenoma papilliferum is a rare benign cystic tumor that originates from apocrine glands or anogenital mammary glands. Here, we describe 2 cases of hidradenoma papilliferum of the anus. Two female patients aged 39 and 35 presented with perianal masses with hemorrhoids. The patients underwent hemorrhoidectomy and excision of the lesion. Histopathology confirmed the masses as hidradenoma papilliferum. The postoperative course was uneventful for both patients, and there were no recurrences after 18 and 12 months of follow-up, respectively. Proctologists should consider hidradenoma papilliferum in their differential diagnosis of benign anal tumors. Surgical excision is necessary for diagnosis and treatment of hidradenoma papilliferum.
Subject(s)
Female , Humans , Acrospiroma , Anal Canal , Apocrine Glands , Diagnosis , Diagnosis, Differential , Follow-Up Studies , Hemorrhoidectomy , Hemorrhoids , Mammary Glands, Human , RecurrenceABSTRACT
Los hidrocistomas apocrinos son lesiones quísticas benignas. Clínicamente se caracterizan por ser nódulos quísticos claros o traslucidos, solitarios, en forma de cúpula, con superficie lisa. En la mayoría de los casos la localización suele ser alrededor del ojo, particularmente lateral al canto externo. Suelen ser asintomáticos, de crecimiento lento pudiendo llegar a 10 mm de diámetro o más. Presentamos un caso de un paciente con un hidrocistoma apocrino variante pigmentada.
Apocrine hydrocystomas are benign cystic lesions, clinically characterized by being clear or translucent cystic nodules, solitary, domeshaped, with a smooth surface. In most cases the location is usually around the eye, particularly lateral to the outer edge. They are usually asymptomatic, slow growing and can reach 10 mm in diameter or more. We present a case of a patient with a pigmented variant apocrine hydrocystom
Subject(s)
Humans , Middle Aged , Sweat Gland Neoplasms/diagnosis , Hidrocystoma/diagnosis , Dermoscopy/methods , Apocrine Glands , Sweat Gland Neoplasms/pathology , Hidrocystoma/pathologyABSTRACT
Hidradenitis suppurativa (HS) is a disorder of the apocrine gland causing a chronic, recurrent and painful inflammation. It is a disabilitating condition and, though many therapeutic options are available, the response is often ineffective in most cases and patients can present many recurrences with physical and psychological sequelae. Recent data had shown increased interleukin (IL)-17 serum levels in patients with HS. Psoriasis is a chronic immune-mediated inflammatory disorder and new evidences have shown the role of Th17 cells in its pathogenesis and the therapeutic efficacy of anti-IL-17 antibodies. We present a case of a patient suffering from psoriasis and HS successfully treated with anti-IL-17 antibodies for both conditions. This is the first case report of HS treated with secukinumab.
Subject(s)
Humans , Antibodies , Apocrine Glands , Hidradenitis Suppurativa , Hidradenitis , Inflammation , Interleukin-17 , Interleukins , Psoriasis , Recurrence , Th17 CellsABSTRACT
Apocrine encapsulated papillary carcinoma (EPC) of the breast is a rare neoplasm, and only 10 cases have been reported in the literature to date. Although EPC by definition lacks a peripheral myoepithelial layer, all previously published apocrine EPC cases were clinically indolent and lacked a conventional invasive component. Herein, we report the 11th case of apocrine EPC, which had a conventional invasive carcinoma component and provides evidence of the malignant potential of this entity. We postulate that apocrine EPC is most likely a morphological variant of conventional EPC, with the same unpredictable malignant potential as non-apocrine cases.
Subject(s)
Apocrine Glands , Breast Neoplasms , Breast , Carcinoma, PapillaryABSTRACT
A cistomatose de glândula apócrina é uma condição rara e não-neoplásica, que tem sido relatada em cães e gatos, e caracterizada por vários grupos de glândulas sudoríparas dilatadas, cuja distribuição generalizada raramente é observada. Uma fêmea de onça-pintada melânica (Panthera onca), com idade estimada de 16 anos e mantida em cativeiro, apresentou aumento de volume abdominal. Ao exame físico foram observados vários nódulos de consistência macia e flutuante, não aderidos, com tamanho de 2 a 15cm de diâmetro, na região ventral abdominal. Outras massas de menor diâmetro (0,5-1,0cm) estavam presentes na região cervical e no dorso do animal. Estas massas foram removidas em um procedimento cirúrgico. Dentro deste cisto havia conteúdo líquido, inodoro e translúcido. Microscopicamente, observou-se entre a derme média e profunda a formação de múltiplos cistos de tamanho variável. Esses cistos eram revestidos por uma única camada de células predominantemente cubóides. Em alguns focos eram observadas raras projeções papiliformes de epitélio glandular. O citoplasma estava levemente eosinofílico e com raras imagens de decapitação do ápice. O diagnóstico de cistomatose de glândulas apócrinas foi realizado através dos achados macroscópicos e microscópicos.(AU)
Cystomatosis of the apocrine gland is a rare condition reported in dogs and cats. It is a non-neoplastic condition, characterized by several groups of dilated cystic sweat glands. Rarely a more widespread distribution can be observed. A captive female about 16 year-old melanic jaguar (Panthera onca) presented increased abdominal volume. Physical examination showed multiple floating nodular masses ranging from to 2 to 15cm in diameter located in the ventral abdomen. Other masses of smaller diameter (0.5-1.0cm) were present in the cervical region and in the back of the jaguar. These masses were surgically removed. Within this cyst had a odorless translucent content. Microscopically, between the mid and deep dermis there existed multiple cysts of different sizes, coated with a single layer of cuboidal cells. In some foci, there were rare papilliform projections of glandular epithelium. The cytoplasm was slightly eosinophilic with rare images of decapitation of the apex. The diagnostic of apocrine cystomatosis was performed through macroscopic and microscopic findings.(AU)
Subject(s)
Animals , Female , Apocrine Glands/pathology , Sweat Gland Diseases/veterinary , Panthera/surgery , Hamartoma/veterinary , Animals, WildABSTRACT
Ceruminous glands are specialized apocrine glands located in the external auditory canal (EAC). Pleomorphic adenoma (PA) of the EAC is derived from these ceruminous glands. Tumors arising from these ceruminous glands are rare. Furthermore, ceruminous PA of the EAC is extremely rare. About 35 cases have been reported to date in the English literature, and only 4 cases have been reported in Korea. There are several controversial issues about these rare tumors such as nomenclature, histogenesis and classification. We report here on two cases of ceruminous PA and review the cases in the Korean literature.
Subject(s)
Adenoma , Adenoma, Pleomorphic , Apocrine Glands , Classification , Ear Canal , KoreaABSTRACT
A patient with nevus sebaceous showing linear or wide distribution can present with a triad of nevus sebaceous, seizures, and mental retardation. Most of those cases are classified as sebaceous nevus syndrome. Ophthalmological, skeletal, and other abnormalities may also be present. A male weighing 3,580 g was born at the gestational age of 38 weeks after a normal pregnancy. He was referred to the dermatologic department on the first day of life. He presented with yellow-orange and verrucous plaques on both sides of the temporal areas, face, neck, upper and lower extremities, and trunk. Skin biopsy specimens were taken from the scalp and right lower leg. Histologically, both specimens showed sebaceous gland hyperplasia, absence of mature hair follicles, infundibular cystic structures, and apocrine glands. Brain magnetic resonance imaging, transthoracic echocardiography, abdomen ultrasonography, and routine laboratory investigations were performed and showed nonspecific findings. The patient did not show seizure activity at 19 days of observation, and he is now on close observation. We herein report a very rare case of systematized nevus sebaceous presenting at birth.
Subject(s)
Humans , Male , Pregnancy , Abdomen , Apocrine Glands , Biopsy , Brain , Echocardiography , Gestational Age , Hair Follicle , Hyperplasia , Intellectual Disability , Leg , Lower Extremity , Magnetic Resonance Imaging , Neck , Nevus , Parturition , Scalp , Sebaceous Glands , Seizures , Skin , UltrasonographyABSTRACT
Nevus sebaceous is a common congenital cutaneous hamartoma occurring mainly on the face and scalp. It is well known that secondary neoplasms can be easily observed in the primary lesion. However, a case of trichoblastoma and compound nevus concurrently arising from nevus sebaceous has not been previously reported. A 26-year-old woman presented with a well-demarcated atrophic skin-colored plaque on her scalp from birth. On the plaque, a black dome-shaped round nodule and a brownish nodule with irregular margins were found one week previously without subjective symptoms. Histopathological examination of the central plaque lesion revealed epidermal hyperplasia and hyperplasia of the sebaceous glands and eccrine glands. In addition, ectopic, dilated apocrine glands were revealed in the lower dermis, and the hair follicles remained small and primordial, consistent with nevus sebaceous. A section of the black nodule showed palisading basaloid cells surrounded by abundant fibrous stroma. Nests of nevus cells were found at the dermo-epidermal junction and dermis in the brownish nodule. Based on these findings, the black nodule and brownish nodule were diagnosed as trichoblastoma and compound nevus, respectively. Herein, we report an interesting case of trichoblastoma and compound nevus concurrently arising from nevus sebaceous, which is, to our knowledge, the first such report in the dermatologic literature.
Subject(s)
Adult , Female , Humans , Apocrine Glands , Dermis , Eccrine Glands , Hair Follicle , Hamartoma , Hyperplasia , Nevus , Parturition , Scalp , Sebaceous GlandsABSTRACT
Metronomic chemotherapy consists of an anticancer modality treatment. It is applicable in patients at an advanced stage, with the objective of increasing overall survival. The aim of this study was to report an anal sac apocrine carcinoma case in a dog with lymph node metastasis treated with metronomic chemotherapy sequential to surgery and conventional chemotherapy using gemcitabine and carboplatin. Metronomic chemotherapy was associated with cyclooxygenase-2 (COX-2) inhibitors, due to strong tumor COX-2 immunohistochemistry expression. Metronomic chemotherapy was initiated with cyclophosphamide, but it was replaced by lomustine, also in metronomic dosage, due to adverse effects. Treatment showed effectiveness, since the patient's overall survival exceeded 1095 days (36 months), considerably higher than the mean overall survival expected for this pathology.(AU)
Quimioterapia metronômica consiste em uma modalidade de tratamento anticancerígeno, aplicável a pacientes em estadiamento avançado, com o objetivo de aumentar a sobrevida global. O objetivo deste trabalho foi relatar um caso de carcinoma apócrino do saco anal, em uma cadela, com metástase em linfonodo tratado com quimioterapia metronômica sequencial à cirurgia e quimioterapia convencional utilizando-se gencitabina e carboplatina. O tratamento metronômico foi associado ao uso de inibidores de ciclo-oxigenase-2 (COX-2), baseando-se na constatação de sua expressão tumoral. A terapia metronômica iniciou-se com ciclofosfamida, mas houve necessidade de substituição pela lomustina, também em dose metronômica, devido à ocorrência de efeitos adversos. O tratamento mostrou ser eficaz, pois a sobrevida do paciente ultrapassa 1095 dias (36 meses) desde a cirurgia, sendo consideravelmente maior que a média relatada para essa patologia.(AU)
Subject(s)
Animals , Female , Dogs , Angiogenesis Inhibitors , Apocrine Glands/ultrastructure , Carcinoma/drug therapy , Carcinoma/veterinary , Cyclophosphamide/therapeutic use , Lomustine/therapeutic use , Lymphatic MetastasisABSTRACT
ABSTRACT The authors report the first case in Brazilian literature of orbital apocrine hidrocystoma with immunohistochemistry confirmation. The tumor had been growing slowly and progressively, there was no history of impaired vision, diplopia, watering, discharge, or prior trauma. There was no proptosis and extraocular mobility was normal. The radiologic study by orbital computerized tomography revealed an extraconal nodule, with partially defined limits, with cystic and solid areas in the superomedial right orbit. An anterior orbitotomy, with full excision of the tumor was performed. A histopathology examination revealed apocrine hidrocystoma and immunohistochemistry confirmed the diagnosis. After surgery, the patient had total remission of symptoms.
RESUMO Os autores relatam o primeiro caso de hidrocistoma apócrino orbitário com confirmação imunohistoquímica. O tumor apresentou crescimento lento e progressivo, sem relato de baixa de acuidade visual, diplopia, epífora, secreção ou trauma prévio. Não houve proptose ou alteração da motilidade extraocular. O exame de imagem por tomografia computadorizada da órbita revelou uma lesão nodular, extraconal, de limites imprecisos, com áreas císticas e sólidas no seu interior, na região súpero-medial de órbita direita. O paciente foi submetido à orbitotomia por via anterior, com exérese integral da tumoração. O exame histopatológico revelou o diagnóstico de hidrocistoma apócrino e a imunohistoquímica confirmou o diagnóstico. Após a cirurgia, o paciente teve regressão total dos sintomas.
Subject(s)
Humans , Female , Middle Aged , Sweat Gland Neoplasms/diagnosis , Orbital Neoplasms/diagnosis , Immunohistochemistry/methods , Hidrocystoma/diagnosis , Apocrine Glands/pathology , Sweat Gland Neoplasms/surgery , Sweat Gland Neoplasms/pathology , Biopsy , Orbital Neoplasms/surgery , Orbital Neoplasms/pathology , Biomarkers, Tumor , Tomography, X-Ray Computed , Hidrocystoma/surgery , Hidrocystoma/pathology , Eyelids/pathologyABSTRACT
El tumor mixto cutáneo es una neoplasia se aparición inusual al que se ha denominado también siringoma condroide. Se reporta un caso de Tumor mixto benigno apocrino en una paciente de 63 años. Paciente mujer de 63 años, con lesión tumoral de un año de evolución en zona frontal, asintomática. La ecografía de partes blandas fue compatible con lesión quística y el estudio histológico mostró la presencia de una neoplasia mixta benigna epitelial estromal, correspondiente a un tumor mixto benigno apocrino. Los tumores mixtos benignos apocrinos son neoplasias poco frecuentes, localizadas en las glándulas sudoríparas. Se caracterizan por presentarse como un nódulo subcutáneo o intradérmico, solitario, que puede alcanzar hasta 3 cm. de diámetro. Son asintomáticos y de crecimiento lento. Su principal ubicación corresponde a la cabeza y cuello y predominan en pacientes de sexo masculino, de edad media. El diagnóstico de certeza es histopatológico, encontrándose a la microscopía un patrón epitelial compuesto por estructuras tubulares, ductales, túbulo-alveolares o áreas sólidas con diferenciación pilo-sebácea focal, en un estroma que puede ser mixoide o condroide Se presenta este caso por ser un tumor de baja frecuencia, cuyo diagnóstico es esencialmente histopatológico y cuya terapia resolutiva es la extirpación quirúrgica completa.
Apocrine mixed tumor of the skin: a diagnosis challenge to consider. Cutaneous mixed tumor is an uncommon, benign adnexal neoplasm arising from apocrine or eccrine glands of the dermis. Apocrine mixed tumors often exhibit decapitation secretion, a feature of apocrine epithelium, but they may exhibit a wide range of metaplastic changes and differentiation in the epithelial, the myoepithelial, and the stromal components. We present two clinical cases of Apocrine mixed tumour of the skin in two different patients who have seen in our Department.
Subject(s)
Humans , Female , Middle Aged , Skin Neoplasms/diagnosis , Salivary Gland Neoplasms/diagnosis , Neoplasms, Complex and Mixed/diagnosis , Apocrine Glands/pathology , Skin Neoplasms/pathology , Salivary Gland Neoplasms/pathology , Neoplasms, Complex and Mixed/pathology , Diagnosis, DifferentialABSTRACT
AbstractA 43-year-old Chinese man presented with generalized hypohidrosis, which he had had since birth, without obvious abnormalities of other skin appendages except a sparse beard and axillary hairs. The sweat test revealed localized sweating on the face, axillae and palms. Histopathologic examination showed that the sweat glands were absent in the forearm and thigh, but some eccrine and apocrine sweat glands were present in the right axilla. S-100 was expressed in the nerve terminals surrounding the acini and ducts of the eccrine sweat glands, while PGP9.5 was positive in the acini of apocrine glands and the nerve terminals surrounding the eccrine glands in the axilla. To our knowledge, this is the first case of congenital idiopathic hypohidrosis in China.
Subject(s)
Adult , Humans , Male , Apocrine Glands/abnormalities , Eccrine Glands/abnormalities , Hypohidrosis/congenital , Hypohidrosis/pathology , Axilla , Apocrine Glands/pathology , China , Eccrine Glands/pathology , ImmunohistochemistryABSTRACT
A Hidradenite Supurativa é uma doença crônica debilitante, estigmatizante e de difícil tratamento. A doença apresenta várias características clínicas, podendo ocorrer isolada ou simultaneamente em diversas localizações, geralmente simétricas, distribuídas na "linha do leite". Afeta a pele onde há maior quantidade de glândulas apócrinas intertriginosas, em ordem decrescente: axilas, região ano-genital, aréolas e sulco inframamário. Seu curso insidioso inicia com nódulos subcutâneos que se rompem e/ou coalescem, formando abscessos na derme profunda, extremamente doloridos. As lesões frequentemente drenam exudato purulento fétido, com importante prejuízo à qualidade de vida. Com a progressão da doença, ocorre formação de fistulas, comedões, fibrose, contraturas dérmicas e endurecimento da pele. Suas maiores chances de cura estão no diagnóstico precoce e tratamento individualizado, que abrange medidas farmacológicas, comportamentais e cirúrgicas. O tratamento cirúrgico tem sido considerado a medida curativa mais efetiva. A decisão entre as diversas modalidades vai depender do estágio, apresentação e comprometimento local e incluem incisão e drenagem dos abscessos, deroofing, marsupialização, eletrocirurgia, laser Nd:YAG, laser de CO2 e excisão cirúrgica extensa. As opções de reconstrução incluem cicatrização por segunda intenção, enxerto de pele total imediato ou tardio, fechamento primário e retalhos. O caso relatado de lesões préesternais apresentava características clínicas e histológicas compatíveis com HS, sendo esta uma localização incomum na Literatura. O resultado pós-operatório da ressecção de toda a lesão com fechamento primário mostrou-se resolutivo após longo tempo de seguimento. Mais ensaios clínicos randomizados são necessários para estipular o melhor manejo na HS.
Hidradenitis suppurativa is a chronic debilitating and stigmatizing disease that is difficult to treat. The disease presents several clinical characteristics, which may occur alone or simultaneously in various locations, generally symmetrical and distributed in the "milk line". It affects the following areas of the skin where intertriginous apocrine glands are numerous, in the descending order: axilla, anogenital region, areolas, and inframammary crease. Its insidious progression begins with formation of subcutaneous nodules that rupture and/or coalesce, forming extremely painful abscesses in the deep dermis. The lesions often drain foul purulent exudate, with significant damage to quality of life. As the disease progresses, formation of fistulas, comedones, fibrosis, dermal contractures, and hardening of the skin occur. The highest chances of cure are lie in early diagnosis and individualized treatment, which covers pharmacological, behavioral, and surgical measures. Surgical treatment has been considered a more effective curative measure. The decision between the different modalities will depend on the stage, presentation, and local commitment and include incision and drainage of abscesses, deroofing, marsupialization, electrosurgery, Nd:YAG laser, CO2 laser, and extensive surgical excision. The reconstruction options include healing by second intention, immediate or delayed full-thickness skin graft, primary closure, and flaps. The reported case of presternal injuries presented clinical and histological characteristics compatible with hidradenitis suppurativa; this location has been rarely reported in the literature. The postoperative results of complete resection of the lesion with primary closure indicated resolution over a long follow-up period. More randomized clinical trials are needed to determine the best management strategy for hidradenitis suppurativa.