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Background: Nodular hidradenocarcinoma (NHAC), an eccrine carcinoma, has been reported in the dermatology and pathology literature, but few references have been made in the otolaryngology literature even though the head and neck is a common site of occurrence., Methods: A case report of a 37-year-old Hispanic man with a right-sided neck mass diagnosed preoperatively as a parotid mass by imaging and fine-needle aspiration is presented. After presentation at our multidisciplinary tumor board, excision of the mass was undertaken., Results: Final pathology revealed a NHAC, which is presented in our report., Conclusion: NHAC is an aggressive malignant tumor that is often misdiagnosed preoperatively and that must be treated with aggressive multimodality therapy for increased survival.

Orbital tumors are very differential group of lesions. The most common symptoms are ophthalmology dysfunction as: exophthalmus, eye movement dysfunction and visual loss. More often a benign lesions is found than malignant. They are originated mostly from lacrimal glands. We present a case of 62 years old man with large expansion of benign tumor of the orbit with exophthalmus, eye movement disability and complete blindness. The authors performed radical surgery with removing of the orbit content. Histopathology described a very rare tumor of the orbit-hidradenoma.

A 44-year-old man was referred for a right chest nodule of 3 months duration. A 'benign' nodule had been excised from this location 8 years prior. On examination, palpable nodes were noted in the right axilla. Radiographic studies were significant only for right axillary lymphadenopathy. Histologically, a nodular dermal proliferation composed of poorly differentiated epithelioid cells in nests and focally forming ducts with pseudopapillary architecture comprised the primary tumor. Features of a clear cell hidradenoma were noted focally. Immunohistochemical (IHC) analysis revealed reactivity for HMW cytokeratins, CK5 and CK7, p53, p63, CEA (focal), androgen receptor, EGFR, estrogen receptor (ER), MUC5AC, and strong/diffuse membranous staining for Her-2/neu. Negative stains included villin, TTF-1, CDX2, S-100 protein, vimentin, gross cystic disease fluid protein 15 (GCDFP-15), mammoglobulin, and MUC2. A wide local excision and axillary node dissection was performed. Metastatic tumor involved nine of 28 nodes. Interphase fluorescence in situ hybridization (FISH) demonstrated chromosomal amplification of the Her-2/neu locus within the tumor and a nodal metastasis. The patient has completed adjuvant and radiotherapy, including trastuzumab, and is asymptomatic. We believe this to be the first demonstration of Her-2/neu amplification in a malignant skin adnexal tumor. In analogy to breast carcinoma, these findings suggest the applicability of trastuzumab for patients with metastatic adnexal carcinomas demonstrating Her-2/neu amplification.

We report a case of a 26-year-old woman with an 8.0-cm tumor of the left breast. The tumor was clinically and radiologically suspicious for malignancy. The pathologic evaluation of the core biopsy and the subsequent excision specimen revealed a benign sclerosing, cystic, and papillary adnexal tumor with apocrine and clear cell morphology. The immunohistochemical staining for p63 was positive. Estrogen, progesterone, and Her-2 receptor immunohistochemical stains were negative. The cytogenetic analysis revealed 46, XX t(11:19) (q21;q13.1) balanced translocation. The final diagnosis was apocrine hidradenoma.

Syringocystoadenoma papilliferum is benign adnexal tumor derived from the sweat glands that is located in the head and neck in 70-80% of patients, and commonly presents as a papule or a solitary nodule. We report a case of syringocystoadenoma papilliferum with an atypical presentation given its location in the thigh and the peculiar histologic features, unrepresentative of this entity.

Syringocystadenoma papilliferum of the breast is extremely rare in children. However, some occasional cases have been diagnosed in females. This report documents a case of syringocystadenoma papilliferum occurring in a healthy 4-year-old male. Histopathologically, this tumor, located deep in the dermis, was characterized by the presence of papillary projections extending into the lumen of epithelial cystic invaginations in a background of dense fibrous tissue. The papillary projections and the duct-like structures were lined by an inner columnar epithelium, which demonstrated luminal apical decapitation secretion, and had an outer layer of smaller cuboidal cells. These findings support apocrine differentiation in this case. A fairly dense mononuclear infiltrate in the stroma of the tumor, especially in the papillary projections, was also present. Although syringocystadenoma papilliferum is rare in children, it should not be summarily ruled out during examinations of masses found in the pediatric male breast. It is important to recognize this unusual location of the tumor so that a prompt diagnosis, based on histopathology and surgical excision, can be proposed.

Introduction: Malignant tumors of the sweat glands are very rare. Clear cell hidradenoma is a lesion with histopathological features resembling those of eccrine poroma and eccrine spiradenoma. The biological behavior of the tumor is aggressive, with local recurrences reported in more than 50% of the surgically-treated cases., Materials and Methods: Two patients are presented, the first with tumor in the right axillary region, the second with a recurrent tumor of the abdominal wall. The first patient underwent wide excision with clear margins and axillary lymph node dissection and the second patient underwent wide excision of the primary lesion and bilateral inguinal node dissection due to palpable nodes., Results: The patients had uneventful postoperative courses. No additional treatment was administered. However, sixteen months after surgery, patient 2 developed extensive and massive recurrence involving almost the whole abdominal wall. Although he had received several chemotherapeutic agents, the disease had a relentless course and the patient succumbed two and a half years following surgery., Conclusion: Malignant tumors of the sweat glands are very rare neoplasms with no discrete clinical characteristics. It is necessary to suspect any lesion which shows evidence of enlargement and to verify its status by histological evaluation. Additional resection is generally required, with at least 2-cm clear margins, since surgery is the only effective treatment.

We treated a 5-year-old boy with clear-cell hidradenoma of the forearm. Our literature search found only one previous report of this disease occurring during the first decade of life, and the present patient is the first with involvement of the limbs. This presentation demonstrates that clear-cell hidradenoma needs to be considered in the differential diagnosis of cutaneous tumors even in young children, which is of interest because malignant transformation can occur.

Clear cell hidradenoma is a benign skin appendage tumor that may mimic conventional-type renal cell carcinoma. Histologically, clear cell hidradenoma contains small ductular lumens, focal apocrine and squamoid change, and a less prominent vascular pattern than renal cell carcinoma. Furthermore, immunohistochemical studies can aid in distinguishing the 2 tumors. Knowing the cytologic features of primary skin adnexal neoplasms helps distinguish them from cutaneous metastases, which are more commonly referred for fine-needle aspiration biopsy evaluation. Detailed clinical history, physical findings, and ancillary studies are essential for correct diagnosis and categorization of these tumors. We report the rare case of a patient with renal cell carcinoma who underwent excision of an axillary clear cell hidradenoma, which was clinically suggestive of cutaneous metastatic disease.

Brooke-Spiegler syndrome is an autosomal dominantly inherited disease with predisposition to cutaneous adnexal neoplasms, most commonly cylindromas and trichoepitheliomas. We report a patient in whom 11 lesions were removed from the scalp and face for various reasons over a period of 3 years. The histopathological survey revealed a plethora of benign adnexal neoplasms showing apocrine, follicular, and sebaceous differentiation occurring independently and conjointly. The histopathological spectrum in our patient included cylindromas, spiradenomas, trichoepitheliomas, small nodular trichoblastomas, and lymphadenomas. Many lesions had hybrid features of two or more neoplasms. By far the most common composite tumor was spiradenocylindroma. Some spiradenocylindromas demonstrated prominent sebaceous or trichoblastomatous differentiation or both. We suggest the terms "sebaceous spiradenocylindroma" and "trichospiradenocylindroma" for these lesions. The occurrence of sebaceous and trichoblastic differentiation in spiradenocylindromas is a further proof that spiradenoma and cylindroma are not eccrine tumors but neoplasms of the folliculosebaceousapocrine unit.

Background: Nevus sebaceus has a well-documented potential to develop a wide variety of neoplasms of both epidermal and adnexal origins. It is highly unusual for more than three tumors to arise simultaneously within a single nevus sebaceus. Sebaceous carcinoma arising within a nevus sebaceus is a rare occurrence., Objective: The objective was to report the case of a patient with a nevus sebaceus that simultaneously developed five distinct neoplasms of epidermal and various adnexal origins and to report the fourth case of sebaceous carcinoma arising within a nevus sebaceus., Methods: A 45-year-old woman presented with a nevus sebaceus that contained five separate neoplasms, including sebaceous carcinoma, basal cell carcinoma, trichoadenoma, trichoblastoma, and syringocystadenoma papilliferum., Results: Complete excision of the nevus sebaceus and the five tumors was performed. Systemic work-up showed no evidence of metastatic disease or association with Muir-Torre syndrome., Conclusion: This case report highlights the diverse neoplastic potential of nevus sebaceus and demonstrates the capacity of this hamartoma to develop aggressive tumors, such as sebaceous carcinoma. Prophylactic excision or at least close clinical surveillance for sudden development of new growths is warranted in all cases of nevus sebaceus.

A case of hidradenoma papilliferum with mixed features of syringocystadenoma papilliferum (SCAP) and anogenital mammary-like glands is reported. A single, fresh red-colored nodule developed in the sulcus between the labia majora and minora of a 49-year-old Japanese woman. Histopathologically, the tumor showed epithelial lining with apocrine secretion and slight connective tissues characteristics. Our case was unique because, like SCAP, the tumor was connected to the epidermis and cystic invaginations extended downward into the deep dermis. In addition, beneath the tumor, tubular structures that resembled normal mammary tissue were present in the subcutaneous fatty tissue. In this study, it has been suggested that this tumor might have been developed from these mammary-like glands.

The embryologic origin of the breast is related to salivary and sweats glands. Thus, breast neoplasms may show differentiation toward these tissues, although this is a rare event in humans. We report the clinicopathologic and immunohistochemical features of a 57-year-old woman presenting with a spiradenoma that originated in breast tissue and became malignant 40 years later. Some histogenetic concepts relevant to this case are discussed, along with a brief review of this neoplasm.

Background: Syringocystadenocarcinoma papilliferum, a rare sweat gland carcinoma, is the malignant counterpart of syringocystadenoma papilliferum., Objective: To demonstrate a rare case of syringocystadenocarcinoma papilliferum successfully treated with Mohs micrographic surgery., Methods: A 60-year-old male presented with two verrucous plaques on his right auricle since childhood. These two plaques became ulcerated, more painful, and pruritic in 1 year. Histopathologic examination revealed syringocystadenocarcinoma papilliferum., Results: Mohs micrographic surgery with reconstruction of right auricle was performed subsequently. There are no signs of recurrence or metastasis 6 years after operation., Conclusion: Syringocystadenocarcinoma papilliferum can be successfully treated with Mohs micrographic surgery.

The authors present a rare case of hidradenoma of the external ear and discussed the clinical picture, as well as diagnostic and therapeutic procedures.

A case of eccrine spiradenoma of the left pinna is described. To the best of our knowledge, this is the first report regarding this site. The treatment was a surgical excision in safe margins. This rare benign tumour should be considered for the differential diagnosis of solitary or multiple soft tissue lesions of the head and neck.

Background: Hidroacanthoma simplex (HAS) is an uncommon eccrine neoplasm of the skin. It is a benign neoplasm, but some cases of malignant change were reported in the literature., Objective: To describe a rare case of porocarcinoma in a relatively short period from pre-existing HAS on the abdomen., Methods: Wide local excision was performed on this neoplasm., Results: There was no recurrence for 72 months after wide excision. CONCLUSION. : We recommend an early excision and careful attention in the case of HAS because of its potential malignant change.

Background: Hidradenoma papilliferum is an uncommon benign tumor that is located almost exclusively in the vulvar and anal areas. It is usually very small and asymptomatic, and to make a correct diagnosis is clinically very difficult. Occasionally the tumor becomes elevated to form a reddish brown papillary mass, and the surface ulcerates, which may erroneously suggest malignancy., Objective: We report a case of a large, perianal hidradenoma papilliferum with suspected malignancy in a young Japanese female., Results: A 22-year-old female had been aware of a perianal nodule for approximately 1 year. Examination of the perianal area revealed a wide pedunculated, reddish nodule with several white maculae. It was ulcerated and bleeding, 2.0 x 1.2 x 0.8 cm in size, and located in the 3 o'clock position. The nodule was totally excised with a narrow margin. The histopathologic diagnosis was hidradenoma papilliferum. No recurrence was observed for 23 months., Conclusion: When dermatologists encounter tumors of the anogenital area of adult females, it is important to keep hidradenoma papilliferum in mind as the differential diagnosis. Dermatologists should recognize that the tumor is benign, eliminating the need for wide resection.

Background: In the literature, there are some reports of cases interpreted as carcinomatous transformation in eccrine syringofibroadenoma (ESFA)., Results: We have studied five cases with a histological mixture of ESFA and carcinoma. The carcinoma had a partial squamous cell cytology in all cases. In two of them, there was partial poroma and porocarcinoma picture. However, the squamous cell parts had some features of porocarcinoma such as retiform configuration and funnel-like cavities with luminal carcinoembryonic antigen (CEA) positivity. Also, there was strong epithelial membrane antigen (EMA) positivity. Therefore, we interpret the cases as porocarcinomas with extensive squamous metaplasia. One case had a life-long precursor lesion with a histologic picture interpreted as ESFA, with progressing cytologic atypia. Another case had ectodermal dysplasia, a condition known to predispose to ESFA and a precursor lesion of long-standing, probably benign ESFA. In these two cases, we interpret the carcinoma as a secondary development in a benign ESFA. Three cases were otherwise healthy people with precursor lesions of 10-, 5-, and 2-year duration. We do not know for certain if the ESFA preceded the carcinoma in these cases but we think that it probably did., Conclusions: We recommend that diagnosed ESFA shall be completely excised or followed, in view of the risk of developing carcinoma.

Malignant eccrine spiradenoma (MES) is a very rare tumor. Tumors can be low grade or high grade. There are nine cases in the literature with systemic metastases. Of these, only one was low grade; the others had obvious features of high-grade malignancy such as pleomorphism, increased mitoses, and abnormal mitoses. Low grade MESs are more difficult to diagnose and are said to have a better prognosis. We report an additional case of low-grade MES with systemic metastases. It had a monotonous appearance with few mitotic figures and minimal pleomorphism. Vascular invasion was seen in both cases of low-grade MES and may be an important prognostic feature.

Malignant spiradenoma is an exceedingly rare adnexal tumour clinically characterized by rapid enlargement of a pre-existing, long-standing benign spiradenoma. Microscopic examination typically reveals a continuum between benign spiradenoma and areas of malignant transformation. Biological behaviour is unpredictable and it should be regarded as a potentially lethal neoplasm. Treatment recommendations require radical surgical excision. The reported case of a 23-year-old female illustrates the malignant transformation of a 1.5 cm nodule within a large linear spiradenoma almost covering the frontal aspect of the lower leg. In reviewing the literature, malignant transformation seems to occur slightly more often in multiple than in solitary spiradenomas. It is unclear whether excision restricted to the malignant area is an advisable treatment option in comparison to total excision of all spiradenoma nodules. In the presented case, the transformed area was excised. The patient is free of recurrence after 2 years.

Background: Familial eccrine spiradenoma is a rare autosomal dominant condition that is characterized by slow-growing, benign adnexal tumors., Objective: We investigated a case of familial eccrine spiradenoma displaying an autosomal dominant inheritance pattern. To our knowledge, only two previously reported cases of familial eccrine spiradenoma exist in the literature., Methods: A case report and review of the literature are given., Results: We report a case of familial eccrine spiradenoma in a mother and daughter and present successful treatment using surgical extirpation and CO2 laser ablation., Conclusion: Familial eccrine spiradenoma is a benign autosomal dominantly inherited condition that is characterized by tender, slow-growing, adnexal tumors of the head and neck. Surgical tumor extirpation and CO2 laser ablation offer both an effective symptomatic and cosmetically elegant treatment option.

Tubulopapillary hidradenoma (TPH)1 is a term proposed to describe morphological dermal ductal tumors with both eccrine and apocrine differentiation. The term TPH encompasses a spectrum of lesions that includes tubular apocrine adenoma (TAA) and papillary eccrine adenoma (PEA):2 PEA and TAA can be indistinguishable both clinically and histologically. We described a case of TPH with both prominent eccrine and apocrine differentiation combined with syringocystadenoma papilliferum (SCAP) over the distal extremity. This rarely encountered dermatopathological phenomenon is the sixth reported case from the literature in which PEA or TAA and SCAP were present in the same lesion.3-7 Furthermore, the tumor had a warty surface, which is histologically consistent with a typical viral verruca. Although PCR and DNA probe hybridization for human papilloma virus (HPV) types 2, 6/11, 16 and 18 failed to reveal positive results, the location and clinicopathologic correlation convinced us that superimposed HPV could not be excluded.

Pathologic examination of an excisional biopsy specimen of a subepidermal nodule from the nasal tip of a 37-year-old black man demonstrated papillae covered by eosinophilic columnar epithelial cells, suggesting cylindric cell papilloma or well-differentiated papillary adenocarcinoma of nasal mucosa. The patient did not submit to further investigation of the sinonasal tract but sought attention 15 months later because of local recurrence of the lesion. A protuberant, 3-cm, cystic nodule of the subcutis over the left nasal ala and tip was excised completely and found to have characteristics of hidradenoma papilliferum, an apocrine gland neoplasm most commonly occurring in the anogenital skin of white women. This case demonstrates how easily an apocrine neoplasm arising near a mucocutaneous junction can be confused with a mucosal tumor, potentially leading to inappropriate treatment.

Eccrine syringofibroadenoma (ESFA) is a benign neoplasm arising from the intraepidermal portion of eccrine ducts. It is characterized by a distinctive histologic pattern of epithelial cells arranged in anastomosing cords surrounded by a fibrovascular stroma. Approximately 50 cases of ESFA have been reported, and in recent years the lesion has been described occurring in association with other skin conditions. We report 2 cases of ESFA arising in abdominal skin adjacent to enterostomy sites.

Malignant transformation of eccrine spiradenoma is extremely rare. We describe the case of a 70-year-old man with malignant eccrine spiradenoma of the forearm and metastases to the axillary lymph nodes. Surgical excision with adequate margins and lymph node dissection was performed. Tamoxifen therapy was instituted after obtaining positive immunostaining results for estrogen receptor. After 41 months of follow-up, there has been no recurrence or distant metastases. Wide local excision and close follow-up are crucial in the management of malignant eccrine spiradenoma. The role of other therapeutic modalities, including hormonal therapy, remains to be determined.

The first case of multifocal eccrine spiradenomas on the hand, forearm and scalp is described. This case is unusual in that the tumors located on the little finger included the nail matrix and occurred in a linear/zosteriform distribution, resulting in a nail deformity. The nodules on the forearm and scalp were in a random distribution. Histologically, each tumor was highly cellular and composed of two cell types: small darkly staining basaloid cells and larger, pale cells. Ultrastructural observations often showed an intracellular lumen with numerous microvilli in larger pale-staining cells., (Copyright 2002 S. Karger AG, Basel)

Brooke-Spiegler syndrome is a rare autosomal-dominant inherited disease, characterized by the development of multiple cylindromas and trichoepitheliomas. We report a case in which tumors were found on the head showing histological features of both cylindromas and spiradenomas. These changes were in continuity within the same lesions. Since cylindromas are thought to be apocrine in nature, whereas spiradenomas are eccrine, a contiguous growth within the same neoplasm indicates a conflict concerning their histogenesis. The available histological, ultrastructural and immunohistochemical studies have not produced any criteria to allow an unequivocal classification, suggesting instead that both tumors arise from similarly differentiated cells, perhaps from pluripotent epithelial cells. In our opinion, it seems impractical to strictly classify cylindromas and spiradenomas into tumors of apocrine or eccrine differentiation. Moreover, at least for those cases of Brooke-Spiegler syndrome, where both tumors are found in immediate vicinity to each other, we propose the term cylindrospiradenoma.

Eccrine spiradenoma (ES) is a benign tumor of the skin adnexal origin. It is often seen in the head and neck region of young adults and may be present for years. While there have been numerous case reports of malignant degeneration within ES, they have been mostly carcinomatous dedifferentiation and rarely carcinosarcomas. A malignant mixed tumor is a neoplasm with a malignant epithelial component and areas of chondroid and myxoid differentiation within the malignant epithelial proliferation. While the epithelial component is malignant, the mesenchymal component is felt to represent a benign, metaplastic response of the stroma. While the malignant mixed tumor has a benign counterpart, the benign mixed tumor, the former is usually not seen in continuity with the latter. We describe a case of ES with malignant degeneration and demonstrate the transformation from benign to malignant. The histology and immunohistochemistry of the neoplasm supports a malignant mixed tumor, an extremely unusual neoplasm to see in association with ES or any benign adnexal neoplasm.

Background: Reports in the literature reveal that malignant eccrine spiradenomas (MES) are exceedingly rare, and represent aggressive tumors arising in long-standing benign eccrine spiradenomas (ES)., Objective: We present a de novo case of MES of the nose, in contrast to reports in the literature of progression from long-standing benign lesions., Methods: Case report and brief review of the literature., Results: Our case was accepted as de novo MES because there was no evidence of ES on pathologic examination. It was treated by surgical excision with 1 cm tumor-free margins. No recurrence or complications were observed for 2 months, but long-term follow-up could not be performed because the patient died of adenocarcinoma of the colon., Conclusion: Although previously reported lesions have arisen in long-standing benign ESs, usually on the trunk or extremities, this report shows that MES may occur as a primary malignant tumor and may occur in unusual locations such as the nose.

Background: Apocrine hidrocystomas are adenomatous cystic proliferations of the apocrine glands. They typically occur as solitary lesions, though rarely may occur as multiple lesions. Management of multiple hidrocystomas can be difficult, particularly if they are large. Surgical modalities may be required for effective therapy., Objective: To compare the results of electrosurgery and excision in treating multiple apocrine hidrocystomas., Methods: A 50-year-old man presented with multiple apocrine hidrocystomas ranging in size from 1 to 12 mm. The lesions were located over the periorbital skin, cheeks, and pinnae. Excision and electrodessication were utilized for therapy. At a 1-year follow-up, the patient was evaluated for recurrences and cosmetic result., Results: There were no recurrences until 1 year after surgery. In the areas treated with electrodessication, no visible scars were identified. In the areas treated with excision, localized scars were observed., Conclusions: Both electrodessiation and excision are effective therapies for multiple apocrine hidrocystomas. We suggest that tumors less than 1 cm be treated with electrodessication and lesions greater than 1 cm with excision.

Eccrine spiradenoma is an uncommon tumour of the sweat gland and usually occurs as a solitary small painful nodule. Very rarely, it may present as multiple tumours arranged in a linear/zosteriform fashion. We present the case of a 23-year-old female who had multiple spiradenomas arranged linearly from the midline of forehead to the left corner of the mouth and a few lesions also on the margin of the left eyelid. The lesions were probably along the Blaschko's lines. Tumours were excised surgically in stages. Literature search revealed only 13 reported cases of linear/zosteriform/naevoid multiple spiradenomas and only four cases of solitary spiradenoma of the eyelid. The review of reported cases suggests that arrangement of tumours in a linear/zosteriform pattern is an important diagnostic clue for multiple (naevoid) spiradenomas.

Eccrine syringofibroadenoma (ESFA) is a rare disorder that shows differentiation toward eccrine sweat apparatus. There is a controversy concerning the pathogenesis and differentiation of this tumour. We report a case of ESFA in a 63-year-old Japanese man. We review the literature presenting a classification, including a newly reported subtype. Clinically and pathogenically, ESFA is probably a group of heterogeneous disorders.

Successful reconstructive surgery with muscle flaps depends on adequate arterial supply and undisturbed venous drainage. Combining such surgery with reconstructive vascular surgery of a large-caliber vein that is responsible for the venous drainage of the flap poses an additional challenge--the repaired vein's susceptibility to thrombosis. Every attempt must be made to prevent venous outflow obstruction following muscle flap surgery. Data from the vascular surgery literature demonstrate a low success rate for subclavian vein repair. The success rate with venous reconstructive surgery has been greater when a distal arteriovenous fistula accompanied the repair. The present case described the use of a temporary distal cephalic-brachial arteriovenous fistula to maintain the patency of the venous drainage of a pedicled latissimus dorsi muscle flap, following subclavian vein repair, for one-stage coverage of a large chest wall defect.

Adenomas of the middle ear are rare benign glandular neoplasms arising from the middle ear mucosa. After previous operations 25 and 15 years before, a 67-year-old female complained about dizziness, tinnitus, and unilateral hearing loss on the left side. A tumor in the tympanum that was revealed by otoscopy could be removed completely. Histological examinations showed an adenoma of the middle ear with cholesteatoma. This was inconsistent with the histological result of the operation in 1983, which had described a hidradenoma. An exact analysis of the preparations confirmed that a middle ear adenoma had already been present in 1983. Hidradenoma is one of the most important differential diagnoses. The characteristic histological sign of middle ear adenomas in contrast to hidradenomas is the lack of myoepithelial cells. In addition, it is very difficult to differentiate middle ear adenoma and adenocarcinoma using histopathological and clinical methods. Therefore, thorough follow-up is mandatory for patients after surgical treatment of middle ear adenomas.

Objective: To analyze 10.5 years' experience with hidradenoma papilliferum in Ferrara, Italy., Study Design: Review of 8 cases plus 25 from other area clinicians., Results and Conclusion: The clinical aspects of hidradenoma papilliferum are confusing. The tumor is uncommon, so physicians do not gain enough experience to recognize it. Histology is diagnostic and simple excision curative.