Primary apocrine sweat gland carcinomas of the axilla: a report of two cases and a review of the literature

Apocrine adenocarcinoma of the head and neck district: Our experience with two cases

INTRODUCTION

Apocrine adenocarcinoma (AA) is a rare gland cancer that appears in the elderly, especially males. Surgery is considered the first option for the management of this tumor.

CASE PRESENTATION

We report two cases of AA that occurred at our Unit of Maxillofacial Surgery. Precisely a case of a woman with AA with a usual presence at the eyelid level and a case of a man with AA with an unusual presence at the neck level.

DISCUSSION

This cancer generally arises in some specific areas of the body that present high concentrations of apocrine glands (such as in Case No.2). But it can also occur in less typical areas, such as the neck (such as in Case No.1).

CONCLUSION

We discuss the surgical management of our cases: both based on our experience and literature data, we recommend extensive surgical excision.

Poorly differentiated cutaneous apocrine carcinomas: histopathological clues and immunohistochemical analysis for the diagnosis of this unusual neoplasm

Primary cutaneous apocrine carcinoma (PCAC) is a rare cutaneous malignancy that is derived from apocrine glands. Histologically, these tumours can appear well-differentiated where diagnosis should be relatively straightforward. However, occasionally these tumours can exhibit high-grade features, and in such instances the diagnosis can be challenging. A retrospective analysis of 12 cases of poorly differentiated PCAC, obtained from large academic institutions, was performed, and summarised below. Immunohistochemical studies were performed in all cases with antibodies against CK7, p63, CAM 5.2, GCDFP-15, GATA3, CEA, PR, ER, HER2, calponin, SMA, androgen receptor and EMA. All 12 cases were poorly differentiated; however, there were some histopathological clues to the diagnosis of apocrine carcinoma; namely, the presence of focal glandular formation, acrosyringial involvement and the presence of single 'pagetoid' cells within epidermis. All tumours were consistently positive for CK7, GATA3 and GCDFP-15 and negative for p63. The tumours had variable expression of CAM5.2, CEA, ER, PR, HER2, androgen receptor and EMA. In three cases, there was a preservation of the myoepithelial cell layer (with calponin and SMA), which also confirmed the primary cutaneous origin. PCAC is a difficult neoplasm to diagnose, as it can appear identical to metastatic carcinomas. We describe 12 cases of poorly differentiated PCAC, highlighting their salient clinical, histopathological and immunohistochemical features, and discuss the potential diagnostic pitfalls in distinguishing this entity from other malignant neoplasms. Our results indicate that a combination of thorough histological inspection coupled with an adequate battery of immunohistochemical stains is necessary to support the diagnosis of PCAC.

Breast carcinoma or sweat gland carcinoma? A report of two cases and a comparison with the literature

Primary apocrine carcinoma of the sweat gland is a neoplasm with a very low incidence that may represent a clinical and histological diagnostic challenge, as well as for adequate local, adjuvant, and advanced disease management. The average age of patients is around 67 years with no gender preference. This cancer develops primarily at the axillary and scalp levels and is clinically characterized by slow growth, but can progress aggressively with local, nodal, and metastatic involvement (primarily lung, liver, and bone). The recommended management, once the histology is established, consists of a wide local resection with a clear margin of 1 to 2 cm and regional lymphadenectomy if clinically positive nodes are detected. The adjuvant treatment (radiotherapy or chemotherapy) and for the advanced disease is not established. We report here the cases of two female patients initially diagnosed with breast cancer who were finally diagnosed with apocrine carcinoma of the sweat gland.

Sentinel lymph node biopsy of primary apocrine sweat gland carcinoma of the axilla: A case report and review of the literature

INTRODUCTION

Primary apocrine sweat gland carcinoma (PASGC) is a rare subtype of sweat gland carcinoma, mostly occurring in the apocrine-dense regions such as the axilla, areola, and scalp.

PRESENTATION OF CASE

An 83-year-old woman developed a red elevating mass on her left axilla, without palpable axillary lymph nodes. Excision biopsy revealed that the tumor was PASGC. Additional wide resection and sentinel lymph node biopsy (SLNB) were performed without any adjuvant therapy. One year after the surgical procedure, the patient did not show any evidence of recurrence and axillary surgical complications.

DISCUSSION

As PASGC arising in the axilla can progress aggressively, differential diagnosis is essential. Previous reports have shown the usefulness of SLNB, but the axillary management for patients with clinically node negative PASGC has not been established because of its rarity. Especially in axillary cases, to identify the true sentinel lymph nodes is sometimes considered inaccurate because the lymphatic flow is complicated in the axilla.

CONCLUSION

Although SLNB in sweat gland carcinoma has believed safety and been performed, this is the first axillary PASGC case that was performed SLNB. Careful follow-up is needed.

A case of eccrine porocarcinoma characterized by a progressive increase in the level of Ki-67 index: case report and review of literature

Background

Eccrine porocarcinoma is an extremely rare skin adnexal malignant neoplasia with highly invasive and metastatic potential. We report an additional case of eccrine porocarcinoma with intracranial metastases. This case is characterized by a complete record of the progress of eccrine porocarcinoma, its immunohistochemistry after three operations showed a progressive increase in the level of Ki-67 index.

Case presentation

We herein report a case of a 37-year-old-male with eccrine carcinoma occurring on the left posterior occipital scalp which invaded the skull and dura, presenting with progressive headache. This patient has performed three surgeries in total. During the last hospitalization, he underwent an extended surgical resection, lymphadenectomy, myocutaneous flap transplantation and vascular anastomosis in our institution. After surgery, he was treating with radiotherapy at 200 Gray in 12 fractions. But one year after the operation, he developed chest tightness, imaging examination and biopsy puncture revealed pulmonary metastasis.

Conclusion

Intracranial metastasis of eccrine porocarcinoma is a late event with poor prognosis. This case emphases on that progressively increased level of Ki-67 index may predict more chance to occur the intracranial metastasis of scalp eccrine porocarcinoma, long-term follow-up and appropriately dense follow-up interval is necessary.

Overlooked adenocarcinoma of the scalp

An apocrine adenocarcinoma of the scalp is a rare diagnosis in internal medicine. The article reviews the pathophysiology of the diagnosis and new, nonsurgical treatment options including radiation therapy and topical chemotherapy treatments.

Primary apocrine carcinoma of an unusual site

Primary apocrine carcinoma is a rare malignancy most commonly occurring in apocrine dense areas like axilla. There are only about 200 cases reported to date. We report a case of primary apocrine carcinoma present at an unusual site, that is, the arm. A wide local excision of the mass was done and was diagnosed as apocrine carcinoma on histopathological examination and was confirmed by immunohistochemistry. Wide local excision is the treatment required.

[Atypical course of an apocrine sweat gland carcinoma of the axilla : A very rare malignant tumor and its interdisciplinary treatment]

We report on an atypical clinical course of a patient with the very rare diagnosis of an apocrine sweat gland carcinoma with lymphatic metastasis, a single metachronous distant metastasis and a now reached survival time of more than 4 years and give a review about the current literature. Only a very small number of cases have been described. The recommendations for diagnostics and treatment of this tumor, therefore, are not based on prospective randomized studies but upon case reports and on new immunohistochemical and genetic markers.

Apocrine sweat gland adenocarcinoma: A rare case report and review

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Apocrine Sweet Gland Adenocarcinoma is a very uncommon cancer that can cause structural deformities by metabolic disorder (paraneoplastic syndrome).

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That’s the first case related on Brazil.

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This case contributes to the best choice of the exams required for detection of this rare cancer (there is no consensus in the literature by the limited number of cases).

Introduction

Primary apocrine sweat gland carcinoma (PASGC) is an extremely rare neoplasia whose management and treatment are still evolving. The only curative therapy is wide local excision. Many patients have metastasis at the time of the diagnosis, mainly because this neoplasm has been misdiagnosed as some benign skin lesions.

Presentation of case

We herein report a case of a 72-year-old-man with PASGC affecting the axilla and regional lymph nodes that underwent surgical resection and lymphadenectomy at our Institution. This is the first case reported in Brazil.

Discussion

Our observation suggests just a MRI as necessary to study tumoral limits and lymph nodes and a full surgical excision with free margins is decisive for success.

Conclusion

Despite the PASGC be a rare cancer and require expensive tests, knowledge of this disease is critical to reduce costs in medical services without availability of investment.

Epidemiological and histopathological analysis of 40 apocrine sweat gland carcinomas in dogs: a retrospective study

Introduction: Apocrine sweat gland carcinomas (ASGCs) are malignant neoplasms of dogs and other animals, rarely reported worldwide. The aim of this study was to summarise the occurrence of this cancer in a population of dogs in Poland between 2009 and 2014 with regards to histological features and body location of the tumours, as well as age, sex and breed of the cancer-affected dogs.

Material and Methods: The study involved 40 canine ASGC cases diagnosed in five national veterinary pathology laboratories. The material was processed according to routine histological methods.

Results: Histological types of the tumours involved simple and complex apocrine carcinoma of cystic/papillary (62.5%), solid (15%), and tubular type (12.5%), as well as apocrine ductal carcinoma (10%). The epidemiological analysis revealed peak incidence of the cancer in dogs between 8 and 14 years of age, with the most commonly affected sites being forelimbs and thorax. The highest number of the cancer cases was diagnosed in mixed breed dogs and German Shepherds; no sex predilection was noted.

Conclusion: To the authors’ knowledge, this is the first report recounting the study on canine malignant apocrine sweat gland tumours in Poland providing detailed phenotypical and histological data, which are otherwise rarely described in veterinary literature. This type of cancer appears to be diagnosed more frequently in dogs than in humans. Being an easily accessible material for research, canine ASGCs might serve as a relevant animal model for studies related to pathogenesis of sweat gland tumours.

Primary apocrine carcinoma of the axilla in a male patient: a case report

Primary apocrine sweat gland carcinoma is a rare neoplasm. It is usually slow growing and is often suspected to be a benign disease at initial assessment. A thorough clinical and histological workup is required for diagnosis. Treatment of choice is wide local excision with clear margins.