A 46-year-old female patient presented with a palpable perianal mass devoid of skin anomalies. Endosonography revealed a cystic structure with homogeneous content and an echogenic wall, located 2 cm perianal in the epifascial space. Primary total excision was indicated, and intraoperatively, a livid cystic structure was identified at the transition to the rima ani, lacking connection to the anal canal and exhibiting limited mobility. Histologically, the excised tissue showed findings consistent with hidradenoma papilliferum, an exceedingly rare occurrence in the perianal region. Proctologists should include hidradenoma papilliferum in their differential diagnosis for benign anal tumors.
