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 Table of Contents  
CASE REPORT
Year : 2006  |  Volume : 2  |  Issue : 4  |  Page : 209-211

Sweat gland carcinoma with lung metastases


1 Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Amit Bahl
334, AIIMS Doctors Hostel, Masjid Moth, South Extension part II, New Delhi - 110 049
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.29836

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 > Abstract 

Sweat gland carcinoma is a rare skin tumor. The tumor has propensity to spread to lymph nodes and distant metastases has been reported. Their exact incidence in the Indian setting is not known. Aspects related to treatment are also not clearly defined. Though surgery forms the initial treatment approach, adjuvant treatment has not been properly explored. We report here a case of sweat gland carcinoma with bilateral lung metastases.

Keywords: Chemotherapy, radiotherapy, surgery, sweat gland carcinoma


How to cite this article:
Bahl A, Sharma D N, Julka P K, Das A, Rath G K. Sweat gland carcinoma with lung metastases. J Can Res Ther 2006;2:209-11

How to cite this URL:
Bahl A, Sharma D N, Julka P K, Das A, Rath G K. Sweat gland carcinoma with lung metastases. J Can Res Ther [serial online] 2006 [cited 2019 Jun 17];2:209-11. Available from: http://www.cancerjournal.net/text.asp?2006/2/4/209/29836


 > Introduction Top


Sweat gland carcinomas have been reported as early as in 1865.[1] Berg and Mac Davitt provided a classification system for such tumors way back in 1968.[2] These tumors include porocarcinomas; syringomatous carcinomas; ductal carcinomas; adenoid, cystic and mucinous carcinomas. These tumors have also been divided as the eccrine and apocrine varieties. They show aggressive behavior with distant metastases. Lymphatic metastases are common, followed by involvement of bone, lung and skin. These tumors show cytokeratin and are positive for carcinoembryoenic antigen. The overall prognosis of these tumors is poor.

Surgery is the main treatment modality in localized lesions. Adjuvant treatment is not clearly defined but can have an important role, keeping in view their aggressive nature. Postoperative radiotherapy may help in local control of these tumors.[3]

For systemic treatment, various chemotherapy agents have been tried, but no definite treatment recommendations are available. Newer chemotherapy agents need to be tried in the metastatic setting.


 > Case report Top


A 50-year-old woman reported to our tumor clinic in August 2005 with complaints of swelling in the left arm for the last two years. The swelling had increased in size for the last three months. The patient underwent wide local excision of the tumor two months ago without any adjuvant treatment. The growth recurred along with axillary lymphadenopathy and bilateral lung metastases. On examination, there was a proliferative growth 4 x 4 cm in left mid-arm along with erythematous induration [Figure - 1]. The left axilla had multiple firm axillary lymph nodes, with the largest lymph node measuring 3 x 4 cm in size. A biopsy from the arm lesion showed it to be a sweat gland carcinoma [Figure - 2]. A chest X-ray showed evidence of left lung metastatic lesion. A CT scan evaluation showed the evidence of bilateral multiple lung metastases [Figure - 3].

The patient was started on palliative chemotherapy with weekly injection Methotrexate 50 mg IV along with radiotherapy to the primary tumor site with a dose of 20 Gray in five fractions.

The lesion showed considerable reduction at the end of six cycles of chemotherapy and palliative radiotherapy [Figure - 4].

The axillary lymphadenopathy persisted but lung lesions showed a partial response.

The patient received a total of six cycles of weekly chemotherapy and the disease was stable at six months' follow-up. The patient is now being planned for radiotherapy to the axillary lymphadenopathy.


 > Discussion Top


Sweat gland carcinoma is an entity that has been known for long but continues to be a therapeutic dilemma. They have been reported to occur at various sites, including eyelids, scalp, foot digits, breast, axilla, nose, etc. The molecular pathogenesis is poorly understood. A low incidence of loss of heterozygosity at Chromosome 17p has been noticed along with p53 alterations. These tumors are more aggressive than squamous or basal cell carcinoma and early recognition can have implications on response to treatment.

Association of this tumor with immunodeficiency states is not established, though it has been reported to occur in immunosuppressed individuals.[4] These tumors can have varied presentation with metastasis to different sites. Even spinal and bone marrow metastases have been reported. Doley et al[5] have reported a case of sweat gland carcinoma with bony and seventh cranial nerve involvement.

Diagnosis is often delayed due to its low incidence and confusion with other skin tumors. Delgado et al[6] have used sentinel node biopsy of axilla in the diagnosis of these tumors as lymphadenopathy is a common finding.

Yamazaki et al[7] have advocated surgery even in metastatic setting of the tumor. Other studies have found response to both radiotherapy and chemotherapy.

5-Fluorouracil is one agent reported to produce good results. Swanson et al[8] have reported a case with complete response on 5-Fluorouracil treatment.

Local resection plus regional dissection should be performed on patients with LN metastases. Postoperative irradiation may be helpful to increase local control and reduce incidence of distant metastases.[9]

Osaki et al[10] have reported a similar case of axillary sweat gland carcinoma with bilateral lung metastases. The patient was treated with metastectomy of pulmonary lesions, with good survival.

Overall a five-year disease-free survival for these tumors is less than 30%.[11] Treating physicians need to be aware of this entity of tumors in order to distinguish them from squamous or basal cell carcinomas or skin metastases so as to ensure an early diagnosis and treatment.

 
 > References Top

1.Gates O, Warren S, Warvi WN. Tumors of sweat glands. Am J Pathol 1943;19:591-631.  Back to cited text no. 1
    
2.Berg JW, McDivitt RW. Pathology of sweat gland carcinoma. Pathol Ann 1968;3:123-44.   Back to cited text no. 2
    
3.Qi HZ. Clinical manifestations and treatment of sweat gland carcinoma-analysis of 22 cases. Zhonghua Zhong Liu Za Zhi 1988;10:467-9.  Back to cited text no. 3
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4.Toi M, Kauffman L, Peterson L, Myers A. Sweat gland carcinoma in a human immunodeficiency virus-infected patient. Mod Pathol 1995;8:197-8.  Back to cited text no. 4
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5.Doley B, Das AK, Das M. Metastatic sweat gland carcinoma. J Assoc Physics India 2001;49:479-80.  Back to cited text no. 5
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6.Delgado R, Kraus D, Coit DG, Busam KJ. Sentinel lymph node analysis in patients with sweat gland carcinoma. Cancer 2003;97:2279-84.  Back to cited text no. 6
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7.Yamazaki K, Ishida T, Ondo K, Yamamoto K, Odashiro T, Saito G, et al . A sweat-gland tumor metastasizing to the axilla: Report of a case. Surg Today 1998;28:1081-3.  Back to cited text no. 7
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8.Swanson JD Jr, Pazdur R, Sykes E. Metastatic sweat gland carcinoma: Response to 5-fluorouracil infusion. J Surg Oncol 1989;42:69-72.  Back to cited text no. 8
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9.Voutsadakis IA, Bruckner HW. Eccrine sweat gland carcinoma: A case report and review of diagnosis and treatment. Conn Med 2000;64:263-6.  Back to cited text no. 9
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10.Osaki T, Kodate M, Nakanishi R, Mitsudomi T, Shirakusa T. Surgical resection for pulmonary metastases of sweat gland carcinoma. Thorax 1994;49:181-2.  Back to cited text no. 10
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11.Wilson KM, Jubert AV, Joseph JI. Sweat gland carcinoma of the hand (malignant acrospiroma). J Hand Surg Am 1989;14:531-5.  Back to cited text no. 11
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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]


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