Malignant adnexal cutaneous tumor of the scalp: a case report of difficult differential diagnosis between metastatic breast cancer and primary sweat gland tumor

Abstract

The authors describe the case of a 71-year-old female patient who initially went to the dermatologist to assess a scalp skin tumor. This lesion was submitted to an incisional biopsy, performed by dermatologist herself, and the result of the anatomopathological examination and immunohistochemical study showed a preliminary diagnosis of metastasis of breast carcinoma. The patient had no history of breast cancer and, in view of this result, she was referred to consult with the mastologist, who carried out an investigation of breast nodules in search of the possible primary focus of the carcinoma, through imaging exams, biopsies and mammotomy, without finding any possible primary focus on the breasts. Finally, the lesion on the scalp was removed in its entirety by the plastic surgeon and a new exam of pathological anatomy and an immunohistochemical study confirmed the diagnosis of metastasis of breast carcinoma. In view of these results, the authors discuss the difficulty in diagnosing differentiation from primary or metastatic neoplasm of the scalp, with the resources currently available, until the conclusion that it was a primary carcinoma of the sweat gland.

Primary cutaneous apocrine carcinoma of the scalp

“…On the contrary, metastatic breast adenocarcinoma is often positive for ER and PR [13] . There have been reports that mammaglobin yields better staining in PCAC than in breast adenocarcinoma, and that these 2 tumors can be distinguished based on molecular studies [14,15] . In the reported cases, the probability of metastasis from a primary breast lesion was low as all the patients were men and the tumors were negative for ER and PR.…”

“…based on molecular studies. [14,15] In the reported cases, the probability of metastasis from a primary breast lesion was low as all the patients were men and the tumors were negative for ER and PR. The standard treatment for apocrine carcinoma is surgical excision with or without lymph node dissection.…”

The Path of Humanity in the Pandemic of Covid-19: The Choice of the Realistic, Optimist or Pessimist Scenario

“…In this way, the JHGD, as it does throughout its 31 years of uninterrupted publication, contributes to this debate, and in this issue 30.1 brings good and fruitful discussions about Public Health and the pandemic of COVID-19 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] , with emphasis on the use of fear scale for COVD-19 13 .…”