Page 33 - Delaware Medical Journal - July-August 2018
P. 33
CASE REPORT
Figure 1
inguinal hernia. He has been scheduled for laparoscopic inguinal hernia repair and will continue to follow up regularly for recurrence of his cancer.
DISCUSSION
The rarity of diseases such as hidradenocarcinoma produces unique challenges to the diagnosis and treatment of such malignancies. Histologic examination remains paramount in accurate diagnosis. There has been interest in identifying immunohistochemical but the results have not been translated into therapeutic potential. There have
been studies that demonstrate the PI3K/ Akt/mTOR pathway as theoretical targets, but clinical application remains anecdotal and has not been shown to be effective.4,5 Additionally, overexpression of EGFR and HER-2 has been investigated as a potential therapeutic avenue.5,6 However, results are variable and there is no data to support treatment of eccrine carcinoma with agents that target these receptors.3
Wide local excision of the tumor remains the standard of care. Sentinel lymph node biopsy (SLNB) has been utilized in the treatment of sweat gland carcinomas, as with other cutaneous cancers. However, the utility of SLNB in sweat gland carcinomas remains unknown. Although it may provide staging information, a long-term Furthermore, data that recommends the use of SLNB in sweat gland carcinoma
is limited to a six-patient case series in which only one of three patients with hidradenocarcinoma had a positive SLNB.7
Radiotherapy has been used as an adjuvant treatment to prevent local recurrence of eccrine hidradenocarcinoma after wide local excision. As expected, support for radiotherapy is based on
small case series or individual case reports.8,9 Additionally, radiotherapy
certain characteristics such as positive margins, poorly differentiated histology, perineural, vascular, or lymphatic invasion, lymph node involvement,
and extracapsular spread.8 Although cases, the lack of high-quality evidence to support its use, as well as the known associated side effects, makes its use controversial.
Lastly, chemotherapy has also been evaluated as a possible adjunct to wide local excision. Similar to radiotherapy, results remain isolated to case reports.2,10-12 Furthermore, there is no single agent or regimen that has been utilized or agreed upon.
In summary, our patient was diagnosed with eccrine hidradenocarcinoma based on characteristic histology and was treated lymph node dissection, radiotherapy, chemotherapy, and targeted therapies in terms of disease-free and overall survival remains unclear and untested.
CONTRIBUTING AUTHORS
■ SHOSHANA LEVI, MD is a third-year General Surgery Resident at Christiana Care Health System and is interested in pursuing specialization in Surgical Oncology.
■ RAAFAT ABDEL-MISIH, MD is a board- certified General Surgeon and fellow of both the Royal College of Surgeons of England and Edinburgh as well as the American College
of Surgeons. He specializes in both Surgical Oncology and head and neck cases.
■ Additional contributions by: WILLIAM KIRBY, MD. Associate Chair, Pathology at Christiana Care Health System.
Del Med J | July/August 2018 | Vol. 90 | No. 6
205
