Integrated management of Medoja granthi (Hidradenoma papilliferum): A rare case report

Abstract

Background - Hidradenoma papilliferum (HP) is a rare benign and adnexal neoplasm, affecting middle aged women. It typically presents as a slow-growing, well circumscribed nodular lesion, in the vulvar or perianal region. Owing to its rarity, and close clinical resemblance to common benign perianal lesions, preoperative diagnosis is often challenging and definitive diagnosis relies on histopathological examination. In Ayurveda, this clinical condition is correlated with Medoja granthi (Benign soft tissue tumor). Clinical findings: A 60-year female came with painless, slow progressive perianal swelling along with discomfort while sitting and occasional serous discharge for 6 months. Perineal ultrasonography suspected the condition as proliferating trichilemmal cyst. The specimen was sent for histopathological study to confirm the diagnosis. Intervention: An integrated approach i.e., antibiotics, analgesics, Chedan Karma (surgical excision) and wound management was adopted. Outcome: The histopathological study confirms the condition as HP. Good surgical outcome was obtained with the integrated approach in the form of complete wound healing and no recurrence. Conclusion: The postoperative outcome in the present case of HP with the chronicity of 6 months was satisfactory, with good wound healing and no evidence of recurrence during follow-up period of 40 days. This case highlights the importance of histopathological examination in diagnosing atypical perianal lesions and demonstrates that an integrative management can yield favorable clinical outcomes in HP. Further research in the integrative medicine is necessary for generating evidence-based results.