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Metastatic sweat gland adenocarcinoma: A clinico-pathological dilemma.

- World J Surg Oncol (2003)

Bottom Line: Liver, lung and bones are the distant sites of metastasis with fatal results.Surgery in the form of wide local excision and lymph node dissection is the mainstay of treatment.Chemotherapy and/or radiotherapy has limited role.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi 110023 India. chintamani7@rediffmail.com

ABSTRACT
BACKGROUND: Sweat gland adenocarcinoma is a rare malignancy with high metastatic potential seen more commonly in later years of life. Scalp is the most common site of occurrence and it usually spreads to lymph nodes. Liver, lung and bones are the distant sites of metastasis with fatal results. The differentiation between apocrine and eccrine metastatic sweat gland carcinoma is often difficult. The criteria's are inadequate to be of any practical utility. CASE REPORT: Two cases of metastatic sweat gland adenocarcinoma (one of eccrine and the other one of apocrine origin) are being reported on account of the rarity and different outcome. CONCLUSION: Sweat gland carcinomas are rare cancers with a poor prognosis often presenting as histological surprises. Surgery in the form of wide local excision and lymph node dissection is the mainstay of treatment. Chemotherapy and/or radiotherapy has limited role.

No MeSH data available.


Related in: MedlinePlus

Clinical photograph showing recurrent sweat gland adenocarcinoma on the arm.
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Figure 3: Clinical photograph showing recurrent sweat gland adenocarcinoma on the arm.

Mentions: A 20-year-old man presented with a 10 × 8 cm recurrent exophytic growth on the ventral lower aspect of the right arm partly overlying ante cubital fossa (Figure 3). The swelling was tender and fixed to underlying structures. Axillary lymphadenopathy was present. The patient had undergone excision biopsy for a nodular growth in the same area four months earlier. An incision biopsy was taken which was reported as sweat gland adenocarcinoma of apocrine origin. A FNAC from the axillary lymph node confirmed axillary metastasis from the same neoplasm. There was no evidence of distant metastasis. Patient was treated by wide excision and skin grafting of the primary lesion along with axillary lymph node dissection. Histological examination of the resected specimen showed the tumor to be PAS positive and diastase resistant confirming the diagnosis of sweat gland adenocarcinoma of the apocrine origin, resected margins were free and the lymph nodes were involved (figure 4, &5). Patient was asymptomatic for two months following which he developed local recurrence and was taken up for re-excision. At second surgery the tumor was found to infiltrate the neurovascular bundles of the arm and humerus. In order to achieve an R0 resection a mid arm amputation was performed and the patient was referred for postoperative adjuvant treatment. He received adjuvant chemotherapy in form of 5-fluorouracil, and cis-platininum followed by 70 Gy of external beam radiotherapy to the stump and 50 Gy of radiotherapy to axilla. Patient was disease free for six months there after he developed pulmonary metastasis, pleural effusion, and axillary recurrence. He was breathless, comatose and severely dehydrated thus managed by supportive and palliative treatment and died. Unlike the first case this patient died from disease within ten months of the initiation of the disease process.


Metastatic sweat gland adenocarcinoma: A clinico-pathological dilemma.

- World J Surg Oncol (2003)

Clinical photograph showing recurrent sweat gland adenocarcinoma on the arm.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC184447&req=5

Figure 3: Clinical photograph showing recurrent sweat gland adenocarcinoma on the arm.
Mentions: A 20-year-old man presented with a 10 × 8 cm recurrent exophytic growth on the ventral lower aspect of the right arm partly overlying ante cubital fossa (Figure 3). The swelling was tender and fixed to underlying structures. Axillary lymphadenopathy was present. The patient had undergone excision biopsy for a nodular growth in the same area four months earlier. An incision biopsy was taken which was reported as sweat gland adenocarcinoma of apocrine origin. A FNAC from the axillary lymph node confirmed axillary metastasis from the same neoplasm. There was no evidence of distant metastasis. Patient was treated by wide excision and skin grafting of the primary lesion along with axillary lymph node dissection. Histological examination of the resected specimen showed the tumor to be PAS positive and diastase resistant confirming the diagnosis of sweat gland adenocarcinoma of the apocrine origin, resected margins were free and the lymph nodes were involved (figure 4, &5). Patient was asymptomatic for two months following which he developed local recurrence and was taken up for re-excision. At second surgery the tumor was found to infiltrate the neurovascular bundles of the arm and humerus. In order to achieve an R0 resection a mid arm amputation was performed and the patient was referred for postoperative adjuvant treatment. He received adjuvant chemotherapy in form of 5-fluorouracil, and cis-platininum followed by 70 Gy of external beam radiotherapy to the stump and 50 Gy of radiotherapy to axilla. Patient was disease free for six months there after he developed pulmonary metastasis, pleural effusion, and axillary recurrence. He was breathless, comatose and severely dehydrated thus managed by supportive and palliative treatment and died. Unlike the first case this patient died from disease within ten months of the initiation of the disease process.

Bottom Line: Liver, lung and bones are the distant sites of metastasis with fatal results.Surgery in the form of wide local excision and lymph node dissection is the mainstay of treatment.Chemotherapy and/or radiotherapy has limited role.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi 110023 India. chintamani7@rediffmail.com

ABSTRACT
BACKGROUND: Sweat gland adenocarcinoma is a rare malignancy with high metastatic potential seen more commonly in later years of life. Scalp is the most common site of occurrence and it usually spreads to lymph nodes. Liver, lung and bones are the distant sites of metastasis with fatal results. The differentiation between apocrine and eccrine metastatic sweat gland carcinoma is often difficult. The criteria's are inadequate to be of any practical utility. CASE REPORT: Two cases of metastatic sweat gland adenocarcinoma (one of eccrine and the other one of apocrine origin) are being reported on account of the rarity and different outcome. CONCLUSION: Sweat gland carcinomas are rare cancers with a poor prognosis often presenting as histological surprises. Surgery in the form of wide local excision and lymph node dissection is the mainstay of treatment. Chemotherapy and/or radiotherapy has limited role.

No MeSH data available.


Related in: MedlinePlus