Christine J. Ko, MD

David Cassarino, MD, PhD

Low magnification of a hidradenocarcinoma shows a dermal-based, atypical, multilobular neoplasm with clear cell features image and cystic spaces image containing mucinous material and cellular debris.

Areas of squamous differentiation image and prominent tumoral cell necrosis image are present in this example of hidradenocarcinoma. Squamous differentiation is much less common than in porocarcinoma.



  • Malignant acrospiroma, malignant hidradenoma


  • Malignant adnexal tumor arising from, or showing areas similar to, a hidradenoma



  • Most frequently in head and neck region


  • Nodule or mass


  • Surgical approaches

    • Wide, local excision of tumor

    • Mohs micrographic surgery may be best option to ensure clear margins

  • Drugs

    • For metastatic hidradenocarcinoma, if surgery is not an option

      • Various chemotherapeutic regimens reported

      • Case reports of sunitinib and capecitabine treatment

  • Radiation

    • Variable response


  • Excision is sometimes curative

  • Course can be aggressive

    • Local recurrences

    • Metastatic disease

      • Lymph nodes, distant skin, internal organs


Histologic Features

  • Epithelial islands with interspersed glands/ducts

  • Architecture may be predominantly solid islands; sometimes cystic areas present

    • Cells composing the islands are variable

      • Clear, poroid, less commonly squamoid, rarely mucinous

  • Hyalinized stroma

  • Infiltrative growth pattern; not well-circumscribed

  • Deep extension

  • Necrosis may be evident

  • Nuclear pleomorphism may be present

  • Mitoses often present

    • May be > 4 per 10 high-power fields

  • Perineural or vascular invasion may be identified

  • Area of tumor compatible with benign hidradenoma may be seen

Cytologic Features

  • May show high-grade cytologic atypia

  • Some cases may be composed of relatively bland cells without prominent cytologic atypia

  • Mitoses may be few or many

  • Varying proportions of clear, poroid, and squamoid cells

    • Poroid cells have dark blue nuclear outline with finely granular nucleoplasm



  • Positive with p63, cytokeratin 5/6, consistent with a primary cutaneous tumor

  • Carcino-embryonic antigen (CEA) and EMA highlight glandular/ductal foci

  • p53 positive, and Ki-67 generally shows a high proliferative index

  • Generally negative with Her2/neu

Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Hidradenocarcinoma

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