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]

• 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]

• 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]

• 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]

• 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]

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]

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]

[…] 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]

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]

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]

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]

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