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Digital Papillary Adenocarcinoma: Presentation, Natural History and Management.

Carter K, Yao JJ, Melton SD, Lopez J, Huerta S - Rare Tumors (2015)

Bottom Line: We present a rare case of DPA on the ankle in a 54 year-old African American man.Although the most common location for digital papillary adenocarcinoma is on the hands and feet, it can present in other locations.In the following manuscript, we discuss the natural history of this rare tumor including a review of the current literature with emphasis on documented treatment strategies as well as the approach in treating patients with a unique presentation.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of Texas Southwestern Medical Center , Dallas, TX.

ABSTRACT
Digital papillary adenocarcinoma (DPA) is a rare malignant tumor of the sweat glands that often presents as a solitary painless mass on the digits of the hands or feet. We present a rare case of DPA on the ankle in a 54 year-old African American man. Although the most common location for digital papillary adenocarcinoma is on the hands and feet, it can present in other locations. Treatment modalities and concerns such as the level of margin resection, degree of negative margins, and the need for a sentinel lymph node biopsy might be different if the tumor is encountered in locations other than the digits. In the following manuscript, we discuss the natural history of this rare tumor including a review of the current literature with emphasis on documented treatment strategies as well as the approach in treating patients with a unique presentation.

No MeSH data available.


Related in: MedlinePlus

Positron emission tomography images demonstrating a focus of intense activity in the right iliopsoas muscle neighboring the right femoral neck.
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fig002: Positron emission tomography images demonstrating a focus of intense activity in the right iliopsoas muscle neighboring the right femoral neck.

Mentions: This is a case of a 54-year-old African American man with DPA with an unusual location of his initial tumor and whose management required further assessment of metastasis and need of addressing a lateral positive margin. The patient initially presented to clinic in 2012 with complaints of a six-year history of a bump on his left ankle. The patient described the bump as a non-painful mass that had been steadily enlarging over the past several years. There was no history of ulceration, redness, or discharge from the site and the patient denied any constitutional symptoms. On physical exam, the patient had a skin mass approximately 0.5 cm in diameter on the lateral dorsum of his right foot. The mass was freely mobile, non-erythematous, and smooth. At the time of his initial presentation, he expressed interest in surgical removal of the mass. The patient was lost to follow up prior to his surgery and presented to the clinic again in 2014 with the same complaint and indicated that the mass had now grown in size. The patient again denied any constitutional symptoms. The patient underwent excisional biopsy of this lesion. Pathological examination of this specimen demonstrated a 2.0×1.7×1.5 cm circumscribed unencapsulated dermal-based mass with a homogenous tan cut surface. Microscopically, the lesion proved to be an adenocarcinoma with ductal differentiation and predominantly cribriform pattern. Occasional mitotic figures and foci of comedo-like necrosis were present. The histologic findings were diagnostic of DPA (Figure 1). The cauterized lateral margin was positive for tumor. Given the natural history associated with this diagnosis and the positive surgical margin, colonoscopy and positron emission tomography (PET) were ordered. Colonoscopy was negative for malignancy. There was no history of physical findings suggestive of thyroid or breast malignancy. PET demonstrated a focus of intense activity in the right iliopsoas muscle neighboring the right femoral neck that was thought might represent metastatic disease (Figure 2). No other areas demonstrated activity. Based on the results of the PET, a magnetic resonance imaging (MRI) study was obtained, which showed a soft tissue mass anterior to the right femoral neck that was indeterminate in imaging appearance, but was thought to be a possible metastatic lesion. Based on both the PET and MRI results the decision was made to proceed with a fine needle aspiration (FNA) biopsy to determine the nature of the lesion. Computed tomography (CT) guided FNA biopsy of the mass demonstrated changes consistent with an inflammatory process, but showed no malignant cells and no evidence of metastatic adenocarcinoma. He was then re-scheduled for re-excision of margins and follow up for both clinical exam and a screening chest X-ray in 1 year.8 He underwent excisional biopsy of margins, which demonstrated all to be negative for tumor.


Digital Papillary Adenocarcinoma: Presentation, Natural History and Management.

Carter K, Yao JJ, Melton SD, Lopez J, Huerta S - Rare Tumors (2015)

Positron emission tomography images demonstrating a focus of intense activity in the right iliopsoas muscle neighboring the right femoral neck.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508647&req=5

fig002: Positron emission tomography images demonstrating a focus of intense activity in the right iliopsoas muscle neighboring the right femoral neck.
Mentions: This is a case of a 54-year-old African American man with DPA with an unusual location of his initial tumor and whose management required further assessment of metastasis and need of addressing a lateral positive margin. The patient initially presented to clinic in 2012 with complaints of a six-year history of a bump on his left ankle. The patient described the bump as a non-painful mass that had been steadily enlarging over the past several years. There was no history of ulceration, redness, or discharge from the site and the patient denied any constitutional symptoms. On physical exam, the patient had a skin mass approximately 0.5 cm in diameter on the lateral dorsum of his right foot. The mass was freely mobile, non-erythematous, and smooth. At the time of his initial presentation, he expressed interest in surgical removal of the mass. The patient was lost to follow up prior to his surgery and presented to the clinic again in 2014 with the same complaint and indicated that the mass had now grown in size. The patient again denied any constitutional symptoms. The patient underwent excisional biopsy of this lesion. Pathological examination of this specimen demonstrated a 2.0×1.7×1.5 cm circumscribed unencapsulated dermal-based mass with a homogenous tan cut surface. Microscopically, the lesion proved to be an adenocarcinoma with ductal differentiation and predominantly cribriform pattern. Occasional mitotic figures and foci of comedo-like necrosis were present. The histologic findings were diagnostic of DPA (Figure 1). The cauterized lateral margin was positive for tumor. Given the natural history associated with this diagnosis and the positive surgical margin, colonoscopy and positron emission tomography (PET) were ordered. Colonoscopy was negative for malignancy. There was no history of physical findings suggestive of thyroid or breast malignancy. PET demonstrated a focus of intense activity in the right iliopsoas muscle neighboring the right femoral neck that was thought might represent metastatic disease (Figure 2). No other areas demonstrated activity. Based on the results of the PET, a magnetic resonance imaging (MRI) study was obtained, which showed a soft tissue mass anterior to the right femoral neck that was indeterminate in imaging appearance, but was thought to be a possible metastatic lesion. Based on both the PET and MRI results the decision was made to proceed with a fine needle aspiration (FNA) biopsy to determine the nature of the lesion. Computed tomography (CT) guided FNA biopsy of the mass demonstrated changes consistent with an inflammatory process, but showed no malignant cells and no evidence of metastatic adenocarcinoma. He was then re-scheduled for re-excision of margins and follow up for both clinical exam and a screening chest X-ray in 1 year.8 He underwent excisional biopsy of margins, which demonstrated all to be negative for tumor.

Bottom Line: We present a rare case of DPA on the ankle in a 54 year-old African American man.Although the most common location for digital papillary adenocarcinoma is on the hands and feet, it can present in other locations.In the following manuscript, we discuss the natural history of this rare tumor including a review of the current literature with emphasis on documented treatment strategies as well as the approach in treating patients with a unique presentation.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of Texas Southwestern Medical Center , Dallas, TX.

ABSTRACT
Digital papillary adenocarcinoma (DPA) is a rare malignant tumor of the sweat glands that often presents as a solitary painless mass on the digits of the hands or feet. We present a rare case of DPA on the ankle in a 54 year-old African American man. Although the most common location for digital papillary adenocarcinoma is on the hands and feet, it can present in other locations. Treatment modalities and concerns such as the level of margin resection, degree of negative margins, and the need for a sentinel lymph node biopsy might be different if the tumor is encountered in locations other than the digits. In the following manuscript, we discuss the natural history of this rare tumor including a review of the current literature with emphasis on documented treatment strategies as well as the approach in treating patients with a unique presentation.

No MeSH data available.


Related in: MedlinePlus