Skin, Papillary digital eccrine adenocarcinoma [LMP39416]

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Diagnostic Modality: 
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Disease Category: 
Neoplasia
Diagnosis: 
Papillary digital eccrine adenocarcinoma
Species: 
Human
Organ System: 
Skin
Gender: 
Male
Age: 
43 years
Diagnosis Code: 
ICD-10: C44.6 | ICD-O: 8408/3
Slide Contributor Information
Majerski, A., Sade, S.

Keywords

papillary digital carcinoma, adenocarcinoma, adnexal tumour, PDEA

Clinical History

Excisional biopsy, soft tissue (right thumb).

Clinical Discussion

Papillary digital adenocarcinoma (PDEA) occurs as a solitary painless mass, almost exclusively on the fingers, toes and adjacent parts of the palms and soles. Most tumours are nodular growths, less than 2cm in diameter. Over 90% are grossly cystic.

This case exhibits papillary digital adenocarcinoma of the eccrine sweat glands. This is a malignant adnexal tumour. The excisional specimen reveals subcutaneous fibroadipose tissue containing a well-circusmcribed, central cystic lesion with associated scarring and hemorrhagic changes. The cyst appears to be surrounded by a dense fibrous capsule and its contents include a complex papillary epithelial proliferation with evident glandular (eccrine) differentiation. Lesional cells show mild cytologic atypia and scattered mitotic activity (approx. 7 per 10hpf). There is no geographic tumoural necrosis or infiltrative growth.

PDEA can be a challenging and under-recognized entity, often mistaken for benign adnexal tumour, but shows aggressive metastatic/malignant potential. Given this, a correct diagnosis is crucial.