Dong Bin, Xia Hongsheng, Liu Ying, Wang Su, Ye Zhubiao
Department of Ultrasound, Hangzhou Third People's Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, People's Republic of China.
Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, People's Republic of China.
Int J Gen Med. 2025 Sep 4;18:5127-5135. doi: 10.2147/IJGM.S534241. eCollection 2025.
Nodular hidradenoma (NH) is a rare benign adnexal tumor originating from sweat glands, often misdiagnosed due to nonspecific clinical manifestations. Ultrasonography (US) plays a critical role in the diagnosis of skin tumors, yet systematic descriptions of its sonographic features remain limited.
This study aims to investigate the very-high-frequency (VHF) characteristics of eccrine nodular hidradenoma (ENH) and establish key imaging criteria to differentiate it from other cutaneous/subcutaneous lesions.
A retrospective analysis was conducted on 32 histopathologically confirmed ENH cases between November 2018 and December 2024. The VHF ultrasound evaluated ENH location, size, shape, margin, boundary, echogenicity, calcification, blood supply, and so on.
The VHF features of ENH showed that the maximum diameter of the lesions was about 12.42 ± 7.66 mm. Most lesions revealed predominant craniofacial/limb involvement (62.5%) and almost all lesions (96.9%) demonstrated transdermal extension into subcutaneous tissue. Lesion morphology varied from geometric regularity (87.5%) to irregular lobulation (12.5%), reflecting ENH's structural diversity. Echogenicity patterns were classified as: homogeneous solid hypoechoic architecture (6.2%, 2/32), heterogeneous solid-dominant hypoechogenicity (40.6%, 13/32), mixed echogenicity with solid-cystic components (31.3%, 10/32, solid:cystic ≈1:1), mixed cystic-dominant echogenicity (21.9%, 7/32). Notably, the ultrasound features of inner septa, "snow falling" or "fluid-fluid level" were observed in some lesions. Additionally, 9.4% (3/32) showed intralesional calcifications and all lesions exhibited posterior acoustic enhancement. Doppler analysis highlighted vascular heterogeneity, with 87.5% (28/32) classified as Adler grade 2-3, correlating histopathologically with vascularized stromal septa.
The VHF ultrasound demonstrates characteristic diagnostic features of ENH, including its anatomical predilection, the involved skin layers, heterogeneous internal echogenicity, and distinctive blood flow patterns. These features provide critical indicators for differential diagnosis, establishing VHF ultrasound as a pivotal imaging modality to enhance diagnostic precision and optimize clinical decision-making in dermatologic oncology.
结节性汗腺瘤（NH）是一种罕见的起源于汗腺的良性附属器肿瘤，常因临床表现不具特异性而被误诊。超声检查（US）在皮肤肿瘤的诊断中起着关键作用，但其超声特征的系统描述仍然有限。
本研究旨在探讨小汗腺结节性汗腺瘤（ENH）的超高频（VHF）特征，并建立关键成像标准以将其与其他皮肤/皮下病变区分开来。
对2018年11月至2024年12月期间32例经组织病理学确诊的ENH病例进行回顾性分析。VHF超声评估ENH的位置、大小、形状、边缘、边界、回声性、钙化、血供等情况。
ENH的VHF特征显示，病变的最大直径约为12.42±7.66mm。大多数病变主要累及头面部/肢体（62.5%），几乎所有病变（96.9%）均表现为经皮延伸至皮下组织。病变形态从几何规则（87.5%）到不规则分叶（12.5%）不等，反映了ENH的结构多样性。回声模式分为：均匀实性低回声结构（6.2%，2/32）、以实性为主的不均匀低回声（40.6%，13/32）、具有实性-囊性成分的混合回声（31.3%，10/32，实性：囊性≈1:1）、以囊性为主的混合回声（21.9%，7/32）。值得注意的是，在一些病变中观察到内部间隔、“落雪”或“液-液平面”的超声特征。此外，9.4%（3/32）显示病灶内钙化，所有病变均表现为后方回声增强。多普勒分析突出了血管的异质性，87.5%（28/32）被归类为Adler 2-3级，在组织病理学上与血管化的间质间隔相关。
VHF超声显示了ENH的特征性诊断特征，包括其解剖学偏好、累及的皮肤层、内部回声不均匀以及独特的血流模式。这些特征为鉴别诊断提供了关键指标，确立了VHF超声作为一种关键的成像方式，可提高诊断准确性并优化皮肤肿瘤学的临床决策。
