Aggressive Digital Papillary Adenocarcinoma of the Hand Presenting as a Felon

Abstract

Aggressive digital papillary adenocarcinoma is a rare eccrine sweat gland malignancy that is frequently misdiagnosed at initial presentation. Histologically, this tumor is similar in appearance to many adenocarcinomas and as such may be diagnosed as a metastatic lesion. We present the case of a patient with digital papillary adenocarcinoma, which was initially diagnosed as a felon. 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.

Aggressive Digital Papillary Adenocarcinoma

“…Examples of drugs used include carboplatin and paclitaxel, docetaxel, gemcitabine, 5-fluoruracil and mitomycin. These have not shown to have any obvious progression free survival or overall survival benefit [6,8,15]. Surgical excision for oligometastases may be warranted as in the case of our patient however there is limited evidence to support this.…”

“…Here we highlight a case of ADPCA that is parallel to previously documented cases [4][5][6][7][8][9][10][11][12][13].…”

Aggressive Digital Papillary Adenocarcinoma at Atypical Site

“…12 As metastasis can be seen even after wide excision or amputation even after 20 years, a regular and long-term follow-up is required. 13 Hormone therapy has been suggested for metastatic disease. 4…”

An unexpected tumour of the finger: review and management

“…All reported cases of positive SLNB resulted in subsequently negative completion lymphadenectomy and there have been several cases (2-17%) of distant metastasis in the absence of regional lymph node involvement [3,4,7]. Without evidence for improvement in long term survival the morbidity of a SLNB currently outweighs its utility in staging but this may change with further case series and research [12].…”

“…We found only one case report in the literature regarding radiation and while there is no series or agreed framework reported, there may be scope for its employment in either neo-adjuvant or post-operative treatment [14]. There is general consensus within published cases that any metastatic disease amenable to surgery should undergo dissection or excision but given the poor response of disseminated disease to alternative treatment regimens, management should be largely preemptive with regular review and early detection of recurrence [4,12]. The minimum recommended followup period is ten years with thorough clinical assessment, yearly chest x-ray and judicious serial axillary ultrasound scans.…”