Aggressive digital papillary adenoma and adenocarcinoma. A clinicopathological study of 57 patients, with histochemical, immunopathological, and ultrastructural observations

Abstract

Fifty-seven examples of a rare eccrine sweat gland tumor (aggressive digital papillary adenoma and adenocarcinoma) were studied by means of light microscopy, electron microscopy, and immunoperoxidase techniques. The neoplasm occurred as a single, painless mass, almost exclusively on the fingers, toes, and adjacent skin of the palms and soles. 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. The characteristic histologic features included tubuloalveolar and ductal structures with areas of papillary projections protruding into cystic lumina. The stroma varied from thin, fibrous septae to areas of dense, hyalinized collagen. Forty tumors were classified as adenoma (ADPA) and 17 as adenocarcinoma (ADPAca). Histologically, ADPAca was distinguished from ADPA by its poor glandular differentiation and by necrosis, cellular atypia and pleomorphism, invasion of soft tissue and bone, and invasion of blood vessels. Eighteen (50%) patients with ADPA and 8 (47.0%) who had ADPAca developed recurrent lesions (2 months to 9 years) after surgical removal of the tumor. Seven (41.2%) patients with ADPAca developed metastases, of which 5 involved the lung. Three patients died of metastases, 5 to 20 years after surgical treatment of the primary tumor. The histologic malignant features in ADPAca are indicative of potential for distant metastasis and fatality. The recognition of aggressive digital papillary adenoma and adenocarcinoma as a distinct clinicopathological eccrine sweat gland neoplasm is important because of the potential for aggressive local growth and distant metastasis.

Digital papillary adenocarcinoma of the ankle

“…Of the cases studied, 75.4% were of the hand, 23% of the foot, and 1.6% of the calf. [4] Additionally, all 31 cases presented by Suchak et al occurred on either a finger or toe. [6] None of the cases presented on the ankle.…”

“…[4] Kao et al suggests primarily distinguishing DPA based on histological evidence. While all three types of neoplasms share a glandular appearance with focal papillary epithelial projections, DPA has a complex tubuloalveolar pattern distinguishing it from its more common counterparts.…”

“…[3] The majority appear as a flat or slightly elevated lesion, while some are more swollen and thickened. [4] DPA is often undiagnosed for months to years due to their rarity, typically slow progression and lack of symptoms. Left undiagnosed, DPA will metastasize in 14% of cases, 70% of which will be pulmonary metastases.…”

“…Left undiagnosed, DPA will metastasize in 14% of cases, 70% of which will be pulmonary metastases. [4] Standard treatment of DPA includes surgery, with either excision or amputation of the digit involved. While there is no consensus regarding excision margins, a retrospective study has suggested superior results with amputation versus wide local excision.4 Because DPA is rare, it can be misdiagnosed as metastatic papillary adenocarcinoma of the colon, thyroid, or breast.…”

Malignant adnexal neoplasms

“…199 Duke's paper specifically addresses and refutes the work of Kao et al, 200 who felt that criteria existed to distinguish aggressive digital papillary adenoma from aggressive digital papillary adenocarcinoma histologically. In the hands of Kao et al, poor gland differentiation, necrosis, cytologic atypia, mitotic rates and invasion of soft tissue, bone or blood vessels were features that distinguished adenocarcinoma from adenoma.…”