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Aggressive Digital Papillary Adenoma
Aggressive Digital Papillary Adenocarcinoma

Presentation

Higher magnification revealed that neoplastic cells presented with nuclear atypicality and increased mitoses (62 mitoses per 10 high power fields) (Fig. 2C). Necrosis and stromal hyalinization were presented focally. [journals.lww.com]

Case Presentation A 51-year-old, right-hand-dominant electrician presented to the outpatient clinic, with a slow-growing, painless mass over the middle phalanx of his dominant index finger (Figures 1-2). This had been present for over 20 years. [cureus.com]

Entire Body System

  • Lymphadenopathy

    On the thoracoabdominopelvic computed tomography, there was no evidence of organ metastasis or lymphadenopathies. [karger.com]

    He had no axillary lymphadenopathy. A close-margin excision biopsy of the mass with some overlying skin (Figure 3) showed a dermal tumour that was lobular and partially cystic. [cureus.com]

  • Swelling

    Swelling of the distal phalanx of the right middle finger without prior trauma or infection. Intraoperative view of a cystic brown tumor with a soft consistency. [ncbi.nlm.nih.gov]

    This case highlights that a rare malignant tumor, presenting with a swelling on the digit, can mimic benign conditions, such as ganglion, cyst, or local infection. [karger.com]

Immune System

  • Axillary Lymphadenopathy

    He had no axillary lymphadenopathy. A close-margin excision biopsy of the mass with some overlying skin (Figure 3) showed a dermal tumour that was lobular and partially cystic. [cureus.com]

Skin

  • Sweating

    We do not endorse non-Cleveland Clinic products or services Policy Aggressive digital papillary adenocarcinoma (ADPA) is a rare malignancy of the sweat glands. [consultqd.clevelandclinic.org]

    Microscopic features were distinct from those of other eccrine sweat gland tumors and often led to the diagnosis of such metastatic carcinoma as that of the breast. [pubmed.ncbi.nlm.nih.gov]

    Keywords: aggressive digital papillary adenocarcinoma, tumor, sweat glands Introduction Sweat gland carcinomas are rare malignant tumors of the skin.1–5 One entity is the aggressive digital papillary adenocarcinoma. [ncbi.nlm.nih.gov]

    Lymphatic mapping and sentinel lymph node biopsy in the detection of early metastasis from sweat gland carcinoma. Cancer 2003;97:2285-9. [PUBMED] [FULLTEXT] 6. Bazil MK, Henshaw RM, Werner A, Lowe EJ. [indianjcancer.com]

Psychiatrical

  • Suggestibility

    Thus, this suggests that having a reexcision or amputation does not absolutely protect against metastatic disease. The most frequent site of distant metastasis is the lung parenchyma. [journals.lww.com]

    Because of this it has been suggested that this entity be regarded as “malignant with definite metastatic potential” [2, 4, 8]. [hindawi.com]

  • Aggressive Behavior

    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. Figure 2: Histological image. [indianjcancer.com]

Workup

Laboratory workups include thyroid function test, carcinoembryonic antigen (CEA), carbohydrate antigen (CA)‐19, and carbohydrate antigen (CA)‐125 levels which were normal. [ncbi.nlm.nih.gov]

Treatment

It usually presents as a single mass on a finger, and excision and amputation treatments are often unsuccessful with local recurrence. [consultqd.clevelandclinic.org]

No consensus has been published regarding the treatment of this disease. A review of the diagnosis, pathology, treatment, and adjunctive treatments of aggressive digital papillary adenocarcinoma are also included. 1. [hindawi.com]

Prognosis

[…] after developing metastasis, the 5‐year overall survival was once reported to be 20 years.8 Therefore, this indicates that this is a low‐grade tumor, and if it is diagnosed at its early stage and treated appropriately, patients would have very good prognosis [ncbi.nlm.nih.gov]

The role of sentinel node biopsy as a determinant of prognosis and the potential survival impact of regional lymphadenectomy remains to be determined. [cureus.com]

Etiology

thigh (1 case) (Dermatol Surg 2018;44:911, Medicine (Baltimore) 2016;95:e4110) Pathophysiology Ultrastructural finding (see below) and eccrine glands are abundant in acral sites This is because digital papillary adenocarcinoma is an eccrine tumor Etiology [pathologyoutlines.com]

The etiology of DPA is largely unknown; a BRAF-V600E mutation has been reported in one case [6], but the significance of this finding is unclear, with new reports of genetic tumor overexpression of FGFR2 [7]. [karger.com]

Epidemiology

A population based-study based on Surveillance, Epidemiology, and End Results (SEER) data by Rismiller et al. has determined the rate of regional disease spread to be 22.3% [1]. [cureus.com]

Pathophysiology

8408/3 - Digital papillary adenocarcinoma Sites Usually digits (fingers and toes), rarely palm and sole, hands are more common (> 80%) than feet Rarely, face (2 cases), thigh (1 case) (Dermatol Surg 2018;44:911, Medicine (Baltimore) 2016;95:e4110) Pathophysiology [pathologyoutlines.com]

Prevention

These authors found subsequent radical excision to be imperative to prevent local recurrence. [ncbi.nlm.nih.gov]

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