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Differential Diagnosis of Hidradenoma Papilliferum:

Infiltrating carcinoma: When there is prominent stromal sclerosis in a hidradenoma papilliferum, it may impart an infiltrative appearance to the glandular structures mimicking invasive carcinoma. Two-layered epithelium, including p63-positive myoepithelial cells supports the diagnosis of hidradenoma papilliferum and rules out malignancy.

Metastatic endometrioid adenocarcinoma: Cases with a prominent glandular component can resemble metastatic endometrioid adenocarcinoma. The characteristic two-layer epithelium will be absent in metastatic tumors.

This image of hidradenoma papilliferum shows variable glandular shapes and decapitation secretions from the apical portion of the glandular epithelium.

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