Aggressive digital papillary adenocarcinoma.
ABSTRACT digital papillary adenocarcinoma (ADPAca) as a rare variant of eccrine sweat gland carcinoma with the propensity to occur in male patients between the fifth and seventh decade.
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ABSTRACT: Aggressive digital papillary adenocarcinoma is a rare malignancy with a propensity for metastases and recurrence. The role of lymph node staging in this tumor is poorly defined. We describe the use of sentinel lymph node mapping and biopsy in staging this tumor. To describe and discuss the use of lymphatic mapping in staging aggressive digital papillary adenocarcinoma. Sentinel lymph node mapping and biopsy was performed after excision of an aggressive digital papillary adenocarcinoma of the toe. Metastatic tumor cells were absent in sentinel lymph nodes by hematoxylin and eosin staining and immunocytochemistry analysis. We describe the first reported case of staging lymph nodes in a patient with aggressive digital papillary adenocarcinoma utilizing sentinel lymph node mapping and biopsy.Dermatologic Surgery 07/2000; 26(6):580-3. · 1.87 Impact Factor
- Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarinoma revisited). Am J Surg Pathol 24 775-84..
- Aggressive digital papillary adenoma and adenocarcinoma: A clinicopathological study of 57 patients, with histochemical, immunophatological, and ultrastructural observation. J Cutan Pathol 14 129-46..
Indian Journal of Cancer | January–March 2011 | Volume 48 | Issue 1
Figure 2: Histological image. Tubulo-alveolar pattern and necrosis
with fibrous stroma are evident on low magnification. Cellular atypia
and pleomorphism are depicted in the inset on the bottom right
(×40 H and E, ×400, H6E, the inset).
Aggressive digital papillary
In 1984, Helwig was the first to describe aggressive
digital papillary adenocarcinoma (ADPAca) as a rare
variant of eccrine sweat gland carcinoma with the
propensity to occur in male patients between the fifth
and seventh decade.[1-3]
A 45-year-old male presented with a history of a mass
on the left palm surface of the thenar eminence. The
patient referred with an increase in size after one and
a half years, the mass gradually became painful when
pressure was applied. The mass was marginally excised.
The pathologic examination revealed an ADPAca.
No suspicious signs were observed at the physical and
radiological examinations. The patient underwent a
wide local excision and sentinel node biopsy under local
Lymphatic mapping was performed on the day before
surgery. Radiopharmaceuticals were injected as a double
aliquot of 7 MBq of 99mTc labeled nanocolloids
(particle size < 80 nm) of human serum albumin
(Nanocoll, Amersham Health, Milan, Italy) in 0.15 ml
of volume, using a 25-gauge needle, intradermally, close
to the scar.
After the radiocolloid injection, early and delayed static
images of arm and thorax, in anterior and oblique
anterior views, were obtained. Two hot spots were
identified; the first one in the epitroclear basin of the
left arm and the second one in the left axillary region
In the operation theater, 1 ml of patent blue was
injected intradermally around the previous surgery
scar area. After local anesthesia, a wide excision (WE)
was performed with 1 cm margins and seven sentinel
lymph nodes (SLNs) were identified and removed; six
axillary and one epitroclear SLNs using a handheld
gamma-detecting probe. The radioactivity in nodes
was confirmed both intraoperatively and after removal.
The pathologic examination revealed that the skin and
soft tissue margins were clear, and no metastatic lymph
nodes were observed.
The patient started a regular follow-up in March 2006
consisting of clinical examination and loco regional
ultrasound (US) evaluation every 4 months, with
hepatic US and chest radiography performed once in a
year. After 44 months on follow up, our patient is still
ADPAca is a rare neoplasm with the potential for
local recurrence and distance metastases. The spread
of metastases may occur via the blood or lymphatic
routes. Bogner et al., in 2003 demonstrated the utility
of SLN biopsy in detecting subclinical metastases of
sweat gland carcinoma, which may occur in early
treatment.  Currently, this neoplasm is classified as a
Letters to Editor
Figure 1: Superior left arm. (a) Early static image. Note: injection site
(black arrow) and two lymphatic vessels. (b) Delayed static image.
Note: axillary spot (black arrow) and epitroclear spot (white arrow).
Indian Journal of Cancer | January–March 2011 | Volume 48 | Issue 1
malignant lesion grouping together adenocarcinomas
and aggressive digital papillary adenomas. Low-grade
neoplasm has local malignant potential and distant
metastases have been described just in case of poorly
Histologically, aggressive behavior may be predicted by
high cellular pattern with atypical cytology, mitoses and
necrosis [Figure 2] even tough these parameters are not
consistently related to the outcome.
In literature, the use of SLN biopsy for aggressive
digital papillary adenocarcinoma has been reported in
only five cases,[4-7] and just one was positive for lymph
Rastrelli M, Soteldo J1, Vitali GC1, Mazzarol G2,
Trifirò G3, Tosti G1, Testori A1
Melanoma and Sarcoma Unit, Veneto Oncology Institute,
Via Gattamelata 63, Padua, 1Melanoma and Sarcoma Division,
2Pathology and Laboratory Medicine, 3Nuclear Medicine,
European Institute of Oncology, Via Ripamonti 435, Milan, Italy
Correspondence to: Dr. Marco Rastrelli,
Helwig EB. Eccrine acrospiroma. J Cutan Pathol 1984;11:415-20.
Duke WH, Sherrod TT, Lupton GP. Aggressive digital papillary
adenocarcinoma (aggressive digital papillary adenoma and
adenocarinoma revisited). Am J Surg Pathol 2000;24:775-84.
Kao GF, Helwig EB, Graham JH. Aggressive digital papillary adenoma
and adenocarcinoma: A clinicopathological study of 57 patients,
with histochemical, immunophatological, and ultrastructural
observation. J Cutan Pathol 1987;14:129-46.
Malalfa MP, McKesey P, Stone S, Dudley-Walker S, Cockerell CJ.
Sentinel node biopsy for staging of aggressive digital papillary
adenocarcinoma. Dermatol Surg 2000;26:580-3.
Bogner PN, Fullen DR, Lowe L, Paulino A, Biermann JS, Sondak VK,
et al. Lymphatic mapping and sentinel lymph node biopsy in the
detection of early metastasis from sweat gland carcinoma. Cancer
Bazil MK, Henshaw RM, Werner A, Lowe EJ. Aggressive digital
papillary adenocarcinoma in a 15-year-old female. J Pediatr Hematol
Morita R, Hatta N, Shirasaki F, Hayakawa I, Ohishi N, Takehara K.
Lymphatic mapping and sentinel lymph node biopsy for staging of
aggressive digital papillary adenocarcinoma. Plat Reconstr Surg
Solitary giant cystic liver
metastasis mimicking an
abscess – A word of caution
Solitary large cystic liver metastasis is rare and in the
absence of a known primary malignancy may mimic
an abscess. A 47yearold female presented to the
emergency department with right upper quadrant pain,
fever and chills. Physical examination demonstrated
hepatomegaly with right hypochondrial tenderness.
Laboratory investigations revealed normal hemoglobin
of 11g/dl, raised total leukocyte count of 16400/
mm3, and elevated serum alanine aminotransferase
(ALT) as well as serum aspartate aminotransferase
(AST) levels. USG of upper abdomen showed a
well-defined, round to oval cystic liver lesion with
low-level internal echoes and an irregular wall. CT
depicted a large, solitary, rounded, hypoattenuating
hepatic lesion (12–20 HU) measuring 1312 cm,
having a slightly shaggy and enhancing wall [Figure 1].
There was no abdominal lymphadenopathy or ascites.
Considering the clinical, laboratory, and radiological
picture, a diagnosis of liver abscess was made and
ultrasound-guided pigtail drainage was done. The
culture results of abscess fluid analysis showed growth
of Grampositive bacteria. Subsequent sonograms
demonstrated regression of the lesion and patient
was discharged on oral antibiotics with percutaneous
catheter in situ and was told to come for weekly
followup on an outpatient basis. Follow-up sonogram
after weeks revealed persistent lesion of size 1511cm
despite daily drainage of approximately 35 ml of pus.
CT abdomen was repeated which showed that the
lesion had increased in size and thick irregular walls
with peripheral enhancement, suggestive of a tumor
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Figure 1: Axial contrast-enhanced CT showing a large solitary well-
defined hypodense lesion in the liver with shaggy walls.