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Case Reports

Abstract

Hidradenoma papilliferum (HP) is a benign, slow-growing adnexal tumor originating from apocrine or anogenital mammary-like glands, most commonly seen in the vulvar and perianal regions of adult females. HP usually presents as a well-circumscribed, asymptomatic dermal nodule, but unusual features such as ulceration and epidermal connection can mimic squamous cell carcinoma (SCC) or pyogenic granuloma, making clinical diagnosis challenging. We report a 43-year-old female with a solitary, ulcerated, pink, pearlescent papule measuring 9 × 9 mm in the midline inferior intergluteal cleft. Clinical differential diagnoses included pyogenic granuloma, SCC, and condyloma. The lesion was completely excised. Histopathological examination revealed a benign, well-circumscribed adnexal neoplasm with apocrine differentiation, composed of papillary projections into cystic epithelial-lined spaces. A unique finding was the ulcerated epidermal connection, which is atypical for hidradenoma papilliferum (HP), raising potential concern for SCC or pyogenic granuloma. No cytologic atypia, increased mitotic activity, or invasive growth was identified. Complete excision was curative, with no recurrence at 12 months. This case emphasizes the importance of recognizing atypical presentations of HP, especially in rare locations and when ulceration and epidermal involvement are present, and highlights the critical role of histopathological evaluation in distinguishing this benign tumor from malignancy to prevent unnecessary aggressive treatment.