Page 32 - Delaware Medical Journal - July-August 2018
P. 32
Hidradenocarcinoma of the Scalp: A Rare and Aggressive Sweat Gland Carcinoma Shoshana Levi, MD; Raafat Abdel-Misih, MD
Hidradenocarcinoma is a rare and aggressive malignancy arising from the sweat glands that accounts for <0.001%
of all tumors. We present a case of a 61-year-old man
who was treated for eccrine hidradenocarcinoma of the scalp diagnosed after excisional biopsy. This report highlights the importance of histologic examination of all soft tissue masses in order to identify
rare malignant processes. Furthermore, in cases of rare pathologies without established guidelines, we stress the importance of multidisciplinary discussions.
INTRODUCTION
Primary eccrine malignancies are a rarity, making up less than 0.01% of all skin cancers. Hidradenocarcinoma is a form
of eccrine malignancy characterized histologically by spindle cells laden
with eosinophilic cytoplasm and clear
nuclear pleomorphism. They have been most commonly reported on the head
and neck, especially on the face, with
rare occurences on the scalp. Wide local excision is the mainstay of treatment, with
and recurrence rates up to 50%. These tumors are generally aggressive, with nodal and visceral metastases reported at 39% and 28% respectively. Given the for nodal or distant metastases in these tumors, additional therapeutic strategies, including sentinel lymph node mapping and biopsy, post-excisional radiation therapy, chemotherapy, and targeted therapies such as monoclonal antibodies, have been explored and utilized.1,2
CASE REPORT
A 61-year-old male with a history of hypertension, hyperlipidemia, and prostate cancer presented for surgical evaluation
of a mass on his left parietal scalp. The patient had noticed the mass several months prior and had been manually expressing purulent and serous material. He had no complaints and no pain to
the area. The mass was approximately 2 cm, located on the left parietal scalp and irregular yet mobile. There was no associated lymphadenopathy.
Prior to surgical consultation, the patient had an ultrasound of the lesion. Imaging revealed a solid mass with vascularity,
The patient underwent excisional biopsy on March 7, 2017. The nodule measured 2.0 x 2.0 x 1.7 cm, as described by the pathologist, and came within 1 mm
of the peripheral deep margin of the specimen. Histologically, the tumor demonstrated features consistent with eccrine hidradenocarcinoma (Figure 1). The specimen was reviewed by
an in-house pathologist, as well as a dermatopathologist at the Mayo Clinic in consultation. The interpretations were in agreement.
Morphologically, there were features typical of an eccrine hidradenoma, such as a partially solid and partially cystic proliferation of epithelial cells with clear cell changes. Malignant features that characterize hidradenocarcinoma, such as hypercellularity, high nuclear grade, high mitotic activity, and necrosis, were also 3
The patient returned for wide local excision of the area. A 6.0 x 1.5 cm ellipse with a depth of 0.4 cm was sent for pathological examination. There was no evidence of residual carcinoma. The tumor was assigned a pT1 stage for less than or equal to 2 cm.
The patient was noted to be doing well in a follow-up examination. His surgical incision was healing and he remained asymptomatic. He did have a new complaint of swelling in his right groin, which was found to be due to a reducible
204
Del Med J | July/August 2018 | Vol. 90 | No. 6
Abstract
