Adult-onset eccrine angiomatous hamartoma treated with excis
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A 45-year-old lady came to dermatology OPD with complaints of single raised lesion over left retro auricular area for 12 years. It was associated with on and off pain for 6 months. There was no history of trauma/surgery prior to the onset of lesion. No history of bleeding or discharge from the lesion. No history of hyperhidrosis over the lesion. Her past medical history was not significant.

Cutaneous examination showed a solitary, erythematous, tender plaque, approximately measuring 6x4 cm in size present over the left retro-auricular area. Its margins were well defined, consistency was soft and surface was lobulated. Hypertrichosis and hyperhidrosis were absent. Bruit was not heard over the lesion.

Ultrasound revealed an iso to hypoechoic soft tissue lesion measuring 6 mm in its maximum thickness involving cutaneous and subcutaneous plane of left post auricular region with no evidence of calcification, extension into deeper planes or underlying bony cortical irregularity and on colour doppler showed minimal vascularity.

MRI revealed a well-defined T1 isointense and T2/flair hyperintense signal lesion measuring approximately 3.1x2.8x4.5 (APxTRxCC) involving subcutaneous plane of left mastoid region. Post contrast study showed significant enhancement.

Histopathological examination revealed parakeratosis, granulosis, acanthosis and elongation of rete ridges in epidermis. Proliferation of eccrine sweat glands and blood vessels which were thin walled, dilated and filled with RBCs were seen in dermis and subcutaneous tissue. The blood vessels were seen adjacent to the eccrine glands and were arranged in clusters. Superficial dermis showed lymphocytes and plasma cell infiltrate. Since the lesion was large and involving the scalp, patient was referred to plastic surgery department, who performed excision of the tumour.

Eccrine angiomatous hamartoma is an uncommon entity. Lesions usually occur in the extremities.

However, in this patient the lesion was on the scalp which is an uncommon site of involvement. The lesion was successfully excised and skin grafting was done. Hence, authors report this case for its rarity and peculiar site of involvement.