Abstract
BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.