|Year : 2014 | Volume
| Issue : 2 | Page : 390-392
Primary cutaneous sweat gland carcinoma
Xiao-Xia Wang1, Hai-Yan Wang2, Jun-Nian Zheng2, Jian-Chao Sui1
1 Department of Clinical Oncology, Wendeng Central Hospital of Weihai, The Affiliated Hospital of Weifang Medical College,Weihai, China
2 The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
|Date of Web Publication||14-Jul-2014|
Wendeng Central Hospital of Weihai, The Affiliated Hospital of Weifang Medical College,Weihai 264400, China.3 East Mi-shan Road, Weihai, Shandong
Source of Support: Program for New Century Excellent Talents in
University (NCET.08.0700), Conflict of Interest: None
Primary cutaneous sweat gland carcinoma is a rare neoplasm of malignant sweat gland lesions. It is characterized clinically with non-symptomatic, slow-growing nodules. We report the case of a patient with cutaneous sweat gland carcinoma with local recurrence and metastasis to the lung that was treated with surgical resection therapy and chemotherapy. The initial neoplasm was excised but biopsy was not performed. The tumor then recurred 7 years later, was re-excised, biopsy was performed, and diagnosed as a low-grade hidradenocarcinoma. We presented a very good result of chemotherapy in the treatment of this rare malignant disease. It demonstrates that adjunct chemotherapy is effective to control the condition of malignant sweat-gland carcinomas patient.
Keywords: Chemotherapy, metastasis, recurrence, surgical resection, sweat gland carcinoma
|How to cite this article:|
Wang XX, Wang HY, Zheng JN, Sui JC. Primary cutaneous sweat gland carcinoma. J Can Res Ther 2014;10:390-2
| > Introduction|| |
Malignant sweat-gland tumors are rare neoplasms originating from the epidermal sweat ducts. The tumor is often located on the head, neck, and perineum as an asymptomatic tumor in the early stage. It started as a slow-growing benign tumor with a rare incidence of distant metastases. Due to its low incidence and high rate of local recurrence, classical standard of diagnosis and therapy remains to be elucidative.
| > Case report|| |
A 35-year-old woman presented with a long history of right-shoulder cutaneous lesion. In the early 2003s, the patient found an exospheric mass with pain on the right shoulder and gradually developed. The mass was excised without biopsy in a local hospital. In 2010s, the patient suffered a second surgery because of the local recurrence. Biopsy suggested it was a low-grade hidradenocarcinoma. Owning to the economic reason, the sufferer did not receive any treatment. The patient again noticed a small tumor and the tumor had progressively enlarged on the right shoulder in the area of the previous operation site after the primary operation [Figure 1]. Aggressive excision was performed on the patient. After the pathological review, the final diagnosis was low-grade hidradenocarcinoma [Figure 2]. The patient complained of chest distress and her trouble became aggravated in July, 2011. The chest computed tomography (CT) in July 2011 revealed multiple lung metastases [Figure 3]a. After that, the patient chose to accept six cycles of chemotherapy with cisplatin plus vinorelbine (NP) protocol (vinorelbine 40 mg IV D1, 8 and Cisplatin 30 mg IV D2-5, repeat every 21 days). There were remissions of clinical symptoms and lesion of lung during the treatment [Figure 3]b. The patient appears to have stable disease at the end of six cycles of chemotherapy [Figure 3]c.
|Figure 1: The patient again noticed several small tumor and the tumor had progressively enlarged on the right shoulder in the area of the previous operation site in 2010s|
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|Figure 2: (a) The definitive histopathology showed small cellular nests of adenocarcinoma lying in pools of extracellular mucin that were separated by fibrocollagenous septae with involvement of underlying muscle. There was no evidence of lymphatic invasion (H and E, ×10), (b) H and E, ×20|
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|Figure 3: (a)The computed tomography of July 2011 revealed multiple lung metastases, (b)The computed tomography of December 2011 revealed remissions of lung lesion, (c)The computed tomography of April 2012 displayed the disease was stable|
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| > Discussion|| |
Sweat-gland carcinoma affects both sexes equally in the fifth to sixth decade of life and usually shows as a solitary, firm nodule positioned on the head, neck, or more rarely, other sites. We present a case of primary sweat-gland carcinoma of the skin in the right shoulder.
It is difficult to make a proper diagnosis since this type of tumor is characterized by varying clinical appearance and histological features. The advantage of diagnosis is that this disease is easy to detect early since it arise from the surface of the body. However, considerable number of disadvantages increased the difficulty of diagnosis. First, a benign tumor must be eliminated in the differential diagnosis since it is a slow-growing carcinoma. Second, when a node is recognized in the predilection site such as head, neck, and perineum, the possible inspection methods include ultrasound, CT, and biopsy must be carried out. Finally, due to the limited amount of literature and cases documented, it is important to have a basic knowledge of this disease process as a differential diagnosis when dealing with cutaneous lesions.
Therapy consists mainly of surgical excision, chemotherapy, and radiation. ,, Surgery is the first choice for management of such a sweat-gland tumor since this type of carcinoma typically features a poor response to chemotherapy and radiotherapy.  Recent studies suggest that Mohs' micrographic surgery is the method of choice ,, compared to conventional surgical excision. The use of Mohs' micrographic surgery was proposed by Wildemore recently in order to decrease the recurrence rate of this type of tumor.  Without therapy, the course of the disease is very slow and long duration, but multiple recurrences have been described.
The role of radiation therapy in sweat-gland carcinoma has changed from radio-resistance in earlier reports  to good local control in recent studies  with technological advances in radiation therapy over the years. However, it still needs to be elucidated and hopefully, future studies will provide a better understanding of the radiation therapy.
The role of chemotherapy in sweat-gland carcinoma remains unclear. In one report, no response was observed in four cases of pediatric Eccrine porocarcinoma (EPC) treated with a combination of 5-fluorouracil, doxorubicin, and cyclophosphamide after 1 year of therapy.  In the case of our patient, she initially suffered a local excision. We recommend that the disease should initially be treated with surgical excision with broad tumor margins and regional lymph node dissection, which would decrease the recurrence rate and distant metastasis of this type of tumor. The tumor in our patient had already spread to the lungs at the time of initial diagnosis in our department. The patient was, therefore, treated with chemotherapy which consisted of six cycles of Navelbine and cisplatin. After the combination chemotherapy, there were no significant changes in the size and number of primary and metastasis lesions. Our case demonstrates that aggressive surgery with adjunct chemotherapy is effective to control the condition of patient. Given the history of our case, cutaneous sweat-gland carcinoma with local recurrence and metastasis to the lung have a good response to chemotherapy. It is necessary to carry out a detailed systematic examination, such as whole-body CT and RI in the case of local recurrence and lymph-node metastasis.
| > Acknowledgments|| |
This project is supported by grants from the Program for New Century Excellent Talents in University (NCET-08-0700).
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