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Presented by Dr. Pedram Argani and prepared by Dr. Katherine Fomchenko
This is an elderly male with a history of prostate cancer and an inguinal mass.
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Question 1 of 1
1. Question
This is an elderly male with a history of prostate cancer and an inguinal mass.
Correct
Answer: C. Clear cell hidradenoma
Histologic Description: This is a somewhat cystic lesion with solid and papillary architectures. The neoplastic cells closely resemble urothelium in that they have a transitional type appearance and are associated with flatted cells at the top which resemble urothelial umbrella cells. The stroma is hyalinized, and there is essentially no mitotic activity. These features are typical of clear cell hidradenoma, an adnexal neoplasm.
Differential Diagnosis: Metastatic urothelial carcinoma would have a similar pattern but would demonstrate greater cytologic atypia and mitotic activity. This would be extremely unusual in the absence of a history of urothelial carcinoma. Given the patient’s history of prostatic adenocarcinoma, a metastases from that tumor is a significant concern; however, the absence of immunoreactivity for prostatic markers like NKX3.1, as well as diffuse immunoreactivity for GATA3, excluded that possibility. Invasive squamous cell carcinoma would demonstrate keratinization as well as greater cytologic atypia and mitotic activity.
Recently, clear cell hidradenomas have been shown to have the same gene fusion has been identified in mucoepidermoid carcinoma of salivary glands (CRTC1/3-MAML2).
Incorrect
Answer: C. Clear cell hidradenoma
Histologic Description: This is a somewhat cystic lesion with solid and papillary architectures. The neoplastic cells closely resemble urothelium in that they have a transitional type appearance and are associated with flatted cells at the top which resemble urothelial umbrella cells. The stroma is hyalinized, and there is essentially no mitotic activity. These features are typical of clear cell hidradenoma, an adnexal neoplasm.
Differential Diagnosis: Metastatic urothelial carcinoma would have a similar pattern but would demonstrate greater cytologic atypia and mitotic activity. This would be extremely unusual in the absence of a history of urothelial carcinoma. Given the patient’s history of prostatic adenocarcinoma, a metastases from that tumor is a significant concern; however, the absence of immunoreactivity for prostatic markers like NKX3.1, as well as diffuse immunoreactivity for GATA3, excluded that possibility. Invasive squamous cell carcinoma would demonstrate keratinization as well as greater cytologic atypia and mitotic activity.
Recently, clear cell hidradenomas have been shown to have the same gene fusion has been identified in mucoepidermoid carcinoma of salivary glands (CRTC1/3-MAML2).
