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

Authors

  • Marcos Alberto Martins Serviço de Cirurgia Plástica do Hospital Samaritano de São Paulo, SP, Brasil.
  • Cinthia Aparecida Moreira Mastologista do Hospital Samaritano de São Paulo, São Paulo, SP, Brasil; Serviço de Mastologia do Hospital Pérola Byington, São Paulo, SP, Brasil.
  • Maria do Carmo Guedes Alcoforado Assunção Queiroz Patologista do Laboratório de Anatomia Patológica - Laboratório LOCUS, São Paulo, SP, Brasil
  • Walter Henrique Martins Serviço de Cirurgia Plástica do Hospital Samaritano de São Paulo, SP, Brasil; Disciplina de Cirurgia Plástica do Centro Universitário Saúde ABC, Santo André, SP, Brasil.
  • Gerson Vilhena Pereira Professor Titular da Disciplina de Cirurgia Plástica do Centro Universitário Saúde ABC. Santo André, SP, Brasil.
  • Luiz Carlos de Abreu Professor Titular do Departamento de Educação Integrada em Saúde da UFES, Espirito Santo, Vitória, Brasil.

DOI:

https://doi.org/10.36311/jhgd.v31.10361

Keywords:

breast carcinoma, sweat gland carcinoma, skin cancer

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.

Downloads

Download data is not yet available.

References

Abenoza P, Ackerman AB. In: Neoplasms with eccrine differentiation – Ackerman’s histologic diagnosis of neoplastic skin diseases: a method by pattern analysis. Philadelphia, PA: Lea & Febiger, 1989.

Vasilakaki T, Skafida E, Moustou E, et al. Primary Cutaneous Apocrine Carcinoma of Sweat Glands: A Rare Case Report. Case Reports in Oncology. 2011;4(3):597-601. DOI: 10.1159/000335244

Zelger BG, Stelzmueller I, Dunst KM, Zelger B. Solid apocrine carcinoma of the skin: report of a rare adnexal neoplasm mimicking lobular breast carcinoma. J Cutan Pathol 2008;35(3):332e6. DOI: 10.1111/j.1600-0560.2007.00804.x

Schweitzer J, Vermeesch J, Zaleski T, et. al. Primary cutaneous apocrine carcinoma: 2 cases and review of the pertinent histologic findings. JAAD Case Rep. 2016 Oct 14;2(5):411-414. DOI: 10.1016/j. jdcr.2016.08.003

Paolino G, Panetta C, Didona D, et. al. Folliculotropic Cutaneous Metastases and Lymphangitis Carcinomatosa: When Cutaneous Metastases of Breast Carcinoma Are Mistaken for Cutaneous Infections. Acta Dermatovenerol Croat. 2016 Jun;24(2):154-7. Available from: https://pubmed.ncbi.nlm.nih. gov/27477179/

Koerner FC. Cutaneous Neoplasms. In: Hoda SA, Brogi E, Koerner FC, Rosen PP (eds) Rosen’s Breast Pathology. 4th. ed. Philadelphia, LWW, 2014.p. 1217 -1237.

Fernandez-Flores A. Primary cutaneous apocrine carcinoma versus metastasis, a plea to the dermatopathology community. Am J Dermatopathol 2010 Dec;32(8):853e4. DOI: 10.1097/ DAD.0b013e3181bbc473

Piris A, Peng Y, Boussahmain C, Essary LR, et al. Cutaneous and mammary apocrine carcinomas have different immunoprofile. Human Pathology - Volume 45, Issue 2, February 2014, p. 320-326. Available from: https://doi.org/10.1016/j.humpath.2013.09.007

Ferringer T. Skin. In: Lin F, Prichard J, editors. Handbook of practical immunohistochemistry: Frequently Asked Questions. New York, NY: Springer, 2015. P. 521-41. Available from: https://doi.org/10.1007/978-1- 4939-1578-1

Kim HK, Chung KI, et.al, Lee TJ. Primary apocrine carcinoma of scalp: report of primary scalp cutaneous apocrine carcinoma indistinguishable from cutaneous metastasis of breast carcinoma. J Plast Reconstr Aesthet Surg. 2012 Mar;65(3):e67-70. DOI: 10.1016/j.bjps.2011.11.001

Pucevich B, Catinchi-Jaime S, Ho J, Jukic DM. Invasive primary ductal apocrine adenocarcinoma of axilla: a case report with immunohistochemical profiling and a review of literature. Dermatol Online J. 2008 Jun 15;14(6):5. Available from: https://escholarship.org/uc/item/3zc2p6qn

Published

2021-03-31

Issue

Section

ORIGINAL ARTICLES