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Apocrine adenocarcinoma presenting as a large ulcerated axillary mass
1Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Background:
Apocrine adenocarcinomas are one of the rarest cutaneous cancers with few reported cases. Previously regarded nonspecifically as sweat gland tumors variants, they are now established as apocrine derivatives. Most occur in the axilla.
Objective:
To provide a gross and histological description of an apocrine adenocarcinoma presenting in a 49-year-old African-American man.
Methods:
The mass was removed en bloc with axillary lymph node dissection. The specimens were routinely embedded, and sectioned. Hematoxylin & eosin and periodic acid Schiff staining was done. Ploidy evaluation was performed by cytometry.
Results:
The mass was firm, nontender, and mobile (15 x 14 x 7 cm) with overlying areas of ulcerated skin. It was closely associated with the axillary vessels, and latissimus dorsi and pectoralis major muscles, but was well circumscribed with extensive dystrophic calcification. Histological examination revealed an adenocarcinoma with predominant apocrine features. The tumor was arranged in solid sheets and large glands in the reticular dermis and had a loose trabecular pattern extending to the ulcerated skin surface. Two of seven local lymph nodes were positive for tumor; level two and three nodes were negative for tumor. DNA ploidy study determined the tumor to be an aneuploid cell line with an 18% S-phase fraction.
Conclusions:
Tumor growth in this patient was rapid, histology unfavorable, and local nodes positive. However, aggressive surgical intervention resulted in 12 months follow-up without evidence of recurrence.