Highly variable clinical feature and course of aggressive digital papillary adenocarcinoma

Abstract

Aggressive digital papillary adenocarcinoma (ADPA) is a rare cutaneous tumor with sweat gland differentiation. Due to the high risk of local recurrence and delayed metastasis, the wide local resection of the primary lesion and long-term follow up are recommended for ADPA. Here, we report two cases of ADPA. Case 1 had a blue-gray nodule on the tip of the right middle finger. Case 2 had had a papule on the dorsal side of the left ring finger for 13 years. In both cases, papillary proliferations of the tumor cells showed multilobular adenomatous structures with back-to-back patterns characteristic of ADPA. We amputated the finger at the proximal interphalangeal joint and performed a wide resection of the primary tumor in Case 1 and 2, respectively. Sentinel lymph node biopsy in the axilla was performed, and no sentinel lymph node metastasis was found in either case. Among the previously reported ADPA cases, clinically, most lesions were skin-colored or tan-brown to gray. The blue-gray color in Case 1 is thought to be extraordinary for ADPA. In Case 2, the patient had had the small lesion for more than 13 years and the tumor size had been stable during that long period. The present two cases suggest that ADPA shows a prominent variety of both clinical features and disease courses, and that we cannot exclude the possibility of ADPA even in cases of blue-gray nodules or small, stable, non-progressive papules.

Two distinct pathogenic pathways of digital papillary adenocarcinoma — BRAF mutation or low‐risk HPV infection

“…A history of antecedent trauma prior to tumor recognition has been reported in some cases 6,7 . DPA can exhibit local recurrence (in approximately 30% of cases) and distant metastasis (ranging from 14% to 41%), most commonly affecting the lungs and lymph nodes 7–9 . A wide spectrum of morphology, including cystic, papillary, pseudopapillary, cribriform, or solid architecture has been described in the literature 10,11 .…”

“…6,7 DPA can exhibit local recurrence (in approximately 30% of cases) and distant metastasis (ranging from 14% to 41%), most commonly affecting the lungs and lymph nodes. [7][8][9] A wide spectrum of morphology, including cystic, papillary, pseudopapillary, cribriform, or solid architecture has been described in the literature. 10,11 However, histopathological features have not been well correlated to biologic behavior, specifically recurrence or metastasis.…”

Acquired digital fibrokeratoma: review of its clinical and dermoscopic features and differential diagnosis

“…Furthermore, ADPA usually stains positive for CK7, EMA, and S100 protein and negative for CK20 . Unlike ADFK, ADPA has a high risk of recurrence and delayed metastasis, hence proper diagnosis must be made in a timely manner for early intervention …”