Sir,

A 63-year-old woman presented to an eye department with a lower lid cutaneous lesion present for a period of 6 months. She previously had a lesion excised from the same site 2 years before, for which no, histopathological records were available. The present lesion, which measured 6 mm in diameter, was not adherent to deeper structures and was not associated with regional lymphadenopathy. The lesion was excised (with a 2 mm margin of normal skin) with preservation of underlying orbicularis oculi muscle. Histopathological examination of the excised lesion demonstrated a benign skin adnexal neoplasm. It contained gland-like structures with a predominantly tubular pattern and a fibrous stroma (Figure 1). Columnar cells lined the ductal system with an outer cuboidal layer. There was also evidence of decapitation secretion in the columnar cells lining the ducts (Figure 2). Immunohistochemical studies (Figure 3) revealed an epithelial phenotype consistent with apocrine differentiation (EMA and cytokeratin 7 immunoreactive), and peripheral myoepithelial cells were demonstrated by smooth muscle actin immunoreactivity. In addition, the tumour cells were oestrogen receptor positive (Figure 3). Proliferation index was assessed with Ki67 immunoreactivity and was very low. These features are consistent with a tubular apocrine adenoma.

Figure 1
figure 1

Tubular structures diffusely infiltrating stroma (H+E x40).

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Figure 2
figure 2

Decapitation secretion seen within the tubular structures (H+E x400).

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Figure 3
figure 3

Immunohistochemical profile. The lining epithelial cells were both cytokeratin 7 (a) and EMA (b) immunoreactive. Peripheral myoepithelial cells were highlighted by smooth muscle actin (c) and there was variable nuclear oestrogen receptor immunoreactivity (d). A, B and C x200, D x400.

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Tubular apocrine adenoma is a rare apocrine neoplasm first described by Landry and Winkelmann.1 They are nodular, frequently large, slow growing, and are found most commonly on the scalp. Histologically, the tumour is characterised by lobules of well-differentiated tubular structures located in the dermis. The tubules are lined by an inner layer of tall columnar cells, which show decapitation secretion, and frequently show an outer layer of cuboidal cells. Comedo-like channels that extend into the epidermis and connect with some of the tubular structures are occasionally seen.1 The stroma is composed of fibrous tissue with few inflammatory cells. This is in contrast to syringocystadenoma papilliferum, which contains numerous inflammatory cells in the stroma.2 While it is most commonly seen in the scalp region tubular apocrine adenomas have been described in other areas such as the skin of the chest.3

This tumour has also been reported to occur within a mammary adenoid cystic carcinoma.4 A number of reports have described tubular apocrine adenoma, with areas within the tumour showing features of syringocystadenoma papilliferum.3, 5

Immunoperoxidase studies have shown that the tumour cells contain cytokeratin. Human milk protein and carcinoembryonic antigen have been localised to the apical region of the cell.5 Oestrogen receptor immunoreactivity is, not unsurprisingly, seen in benign apocrine tumours.

Electron microscopic studies of these tumours have shown luminal cells to have vacuoles and lipid granules and microvilli that project into the lumen of the tubules.6

We have presented a case of tubular apocrine adenoma, a rare tumour with a predilection for the scalp region, on the eyelid margin, which recurred following initial excision. To our knowledge, this tumour has not previously been reported in the eyelid skin.