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Late Lung Metastasis of a Primary Eccrine Sweat Gland Carcinoma 10 Years after Initial Surgical Treatment: The First Clinical Documentation

Late Lung Metastasis of a Primary Eccrine Sweat Gland Carcinoma 10 Years after Initial Surgical... Hindawi Publishing Corporation Case Reports in Oncological Medicine Volume 2013, Article ID 167585, 4 pages http://dx.doi.org/10.1155/2013/167585 Case Report Late Lung Metastasis of a Primary Eccrine Sweat Gland Carcinoma 10 Years after Initial Surgical Treatment: The First Clinical Documentation 1 2 2 1 1 R. F. Falkenstern-Ge, S. Bode-Erdmann, G. Ott, M. Wohlleber, and M. Kohlhäufl Division of Pulmonology, Klinik Schillerhoehe, Center for Pulmonology and or Th acic Surgery, Teaching Hospital of the University of Tuebingen, Solitude Street 18, 70839 Gerlingen, Germany Division of Pathology, Robert Bosch Krankenhaus, Teaching Hospital of the University of Tuebingen, Auerbachstrasse 110, 70376 Stuttgart, Germany Correspondence should be addressed to R. F. Falkenstern-Ge; rogerfalkenstern@yahoo.de Received 12 March 2013; Accepted 7 April 2013 Academic Editors: Y.-J.Chen, Y.-F.Jiao, andF.A.Mauri Copyright © 2013 R. F. Falkenstern-Ge et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Sweat gland carcinoma is a rare malignancy with a high metastatic potential seen more commonly in elderly patients. The scalp is the most common site of occurrence and it usually spreads to regional lymph nodes. Liver, lungs, and bones are the most common sites of distant metastasis. Late lung metastasis of sweat gland adenocarcinoma aeft r a time span of 5 years is extremely rare. Aim. We report a patient with late lung metastasis of a primary sweat gland carcinoma 10 years aeft r initial surgical resection. Conclusion. Sweat gland carcinomas are rare cancers with a poor prognosis. Surgery in the form of wide local excision and lymph node dissection is the mainstay of treatment. Late pulmonary metastases with a latency of 10 years have never been reported in the literature. This is the first clinical documentation of late lung metastasis from sweat gland carcinoma with a latency period of 10 years. 1. Introduction small ductal epithelia, sometimes with basaloid morphology (to the le)ft , and areas of structures with glandular differ- A 69-year-old man was admitted for evaluation of a solitary entiation (to the right) (Figure 2(a),H&E×100), eventually pulmonary nodule (1.2 cm diameter) in the left upper lobe forming squamous nests (Figure 2(a) inset, H&E×200). (Figure 1(a)). The patient had a history of a sweat gland cancer A later biopsy revealed in part necrotic metastases of in the left axilla, which was successfully resected 10 years basaloid cells organized in ribbons and strands (Figure 2(b), ago. The tumor had then been classified as malignant eccrine H&E×100). porocarcinoma. Postsurgical followup for 10 years showed no Immunohistochemistry revealed positive reactions for metastasis. eTh new solitary pulmonary nodule was resected EMA and CEA and negativity for TTF1, and the tumor was by surgical wedge resection, and histology was found to considered compatible with metastasis of a primary sweat be compatible with a metastasis of sweat gland carcinoma gland adenocarcinoma. (Figure 2(a)). Eight months aeft r the initial wedge-resection, Because of the widespread pulmonary metastasis, metas- multiple bilateral pulmonary metastases were detected in a tasectomy could not be performed. Systemic chemotherapy follow-up CT scan (Figure 1(b)). with docetaxel was initiated; aer ft 6 cycles of monotherapy with docetaxel, restaging showed stable disease. However, 5 months later, we observed widespread metastasis with 2. Histology osseous infiltration, which required palliative radiation, and The initial resection specimen from the solitary left pul- second line therapy with gemcitabine was applied. eTh monary nodule showed infiltration by nests and islands of most recent restaging aeft r 6 cycles gemcitabine showed 2 Case Reports in Oncological Medicine (a) (b) Figure 1: eTh solitary pulmonary metastasis was resected. (b) Eight months aeft r the wedge resection, we found multiple bilateral pulmonary metastases. H&E ×100 H&E ×200 (a) H&E ×100 (b) Figure 2 Case Reports in Oncological Medicine 3 (a) (b) Figure 3: CT scan before the palliative chemotherapy with docetaxel and gemcitabine (a); the reevaluation CT scan (b) showed clear bilateral pulmonary progression after multiple cycles of palliative chemotherapies. progressive bilateral pulmonary metastasis (Figures 3(a) and The recommended treatment of all subtypes of sweat 3(b)). gland carcinomas is wide surgical excision along with Duetothe lowperformance status of thepatient with regional lymph node dissection in the presence of clinically severe tumor progression, the palliative chemotherapy was positive nodes. Some authors advocate prophylactic regional stopped and the patient received best supportive care. lymph node dissection especially in patients with recurrent lesions aeft r wide excision or with highly undifferentiated tumors. Sweat gland carcinomas are regarded as resistant to radiotherapy. Chemotherapy has been very infrequently 3. Discussion employed [3, 5–7]. Metastatic eccrine porocarcinoma has proven to be very resistant to many chemotherapeutic agents. This is the first clinical documentation of an extremely late The use of docetaxel in the management of this severe disease pulmonary recurrence of sweat gland carcinoma 10 years after with therapeutical success was previously documented [8]. successful initial resection. Prognostic factors for sweat gland carcinoma are difficult Sweat gland carcinomas are very rare malignant tumors to identify, again owing to the very small number of reported that were first described by Cornil in 1865 [ 1, 2]. They have cases. Prognostic factors include size, histological type, lymph been reported to occur at various sites, including eyelids, node involvement, and distant metastasis. scalp, foot digits, breast, axilla, and nose. eTh molecular pathogenesis is poorly understood. A low incidence of loss Conflicts of Interests of heterozygosity at chromosome 17p has been noticed along with p53 alterations. es Th e tumors are more aggressive than eTh authors declare that they have no conflicts of interests. squamous or basal cell carcinoma [3, 4]. eTh two basic types of sweat glands in the humans References are eccrine and apocrine. eTh eccrine glands are present everywhere, except the lips, glans penis, inner surface of the [1] T. Osaki, M. Kodate, R. Nakanishi, T. Mitsudomi, and T. prepuce, clitoris, and labia minora. Eccrine glands are most Shirakusa, “Surgical resection for pulmonary metastases of dense on palms and soles and respond primarily to cholin- sweat gland carcinoma,” Thorax ,vol.49, no.2,pp. 181–182, 1994. ergic stimuli, hence playing an important role in regulating [2] C.C.K.Smith,“Metastasizingcarcinoma of thesweat glands,” thebodytemperature.Theapocrinesweat glands arelimited British Journal Surgery,vol.43, no.177,pp. 80–84, 1955. to earcanal,the eyelids, theaxilla, theanogenitalregionand [3] A. Bahl, D. Sharma, P. Julka, A. Das, and G. Rath, “Sweat gland the mammary areola and are under the control of sexual carcinoma with lung metastases,” Journal of Cancer Research hormones. However, division of sweat gland carcinomas into and er Th apeutics ,vol.2,no. 4, pp.209–211, 2006. eccrine and apocrine groups is not clinically useful as the [4] M.Toi,L.Kauffman,L.Peterson,L.Golitz,andA.Myers,“Sweat existing literature has not adequately subdivided and studied gland carcinoma in a human immunodeficiency virus-infected theseparateentitieswellenoughtomakethisdistinction patient,” Modern Pathology, vol. 8, no. 2, pp. 197–198, 1995. relevant for clinical purposes. An orderly progression of [5] A.Chintamani,R.D.Sharma, R. Badran,V.Singhal,S.Saxena, spread to regional lymph nodes and distant sites with and A. Bansal, “Metastatic sweat gland adenocarcinoma: a metastatic adenocarcinomas can be observed and shows a clinico-pathological dilemma,” World Journal of Surgical Oncol- poor prognosis [5]. ogy,vol.1,p.13, 2003. 4 Case Reports in Oncological Medicine [6] I. A. Voutsadakis and H. W. Bruckner, “Eccrine sweat gland carcinoma: a case report and review of diagnosis and treatment,” Connecticut Medicine, vol. 64, no. 5, pp. 263–266, 2000. [7] A.Morabito, P. Bevilacqua,S.Vitale, M. Fanelli, D. Gattuso,and G. Gasparini, “Clinical management of a case of recurrent apoc- rine gland carcinoma of the scalp: efficacy of a chemotherapy schedule with methotrexate and bleomycin,” Tumori,vol.86,no. 6, pp. 472–474, 2000. [8] T. A. Plunkett, A. M. Hanby, D. W. Miles, and R. D. Rubens, “Metastatic eccrine porocarcinoma: response to docetaxel (Tax- otere) chemotherapy,” Annals of Oncology,vol.12, no.3,pp. 411– 414, 2001. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

Late Lung Metastasis of a Primary Eccrine Sweat Gland Carcinoma 10 Years after Initial Surgical Treatment: The First Clinical Documentation

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Hindawi Publishing Corporation
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Copyright © 2013 R. F. Falkenstern-Ge et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Publishing Corporation Case Reports in Oncological Medicine Volume 2013, Article ID 167585, 4 pages http://dx.doi.org/10.1155/2013/167585 Case Report Late Lung Metastasis of a Primary Eccrine Sweat Gland Carcinoma 10 Years after Initial Surgical Treatment: The First Clinical Documentation 1 2 2 1 1 R. F. Falkenstern-Ge, S. Bode-Erdmann, G. Ott, M. Wohlleber, and M. Kohlhäufl Division of Pulmonology, Klinik Schillerhoehe, Center for Pulmonology and or Th acic Surgery, Teaching Hospital of the University of Tuebingen, Solitude Street 18, 70839 Gerlingen, Germany Division of Pathology, Robert Bosch Krankenhaus, Teaching Hospital of the University of Tuebingen, Auerbachstrasse 110, 70376 Stuttgart, Germany Correspondence should be addressed to R. F. Falkenstern-Ge; rogerfalkenstern@yahoo.de Received 12 March 2013; Accepted 7 April 2013 Academic Editors: Y.-J.Chen, Y.-F.Jiao, andF.A.Mauri Copyright © 2013 R. F. Falkenstern-Ge et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Sweat gland carcinoma is a rare malignancy with a high metastatic potential seen more commonly in elderly patients. The scalp is the most common site of occurrence and it usually spreads to regional lymph nodes. Liver, lungs, and bones are the most common sites of distant metastasis. Late lung metastasis of sweat gland adenocarcinoma aeft r a time span of 5 years is extremely rare. Aim. We report a patient with late lung metastasis of a primary sweat gland carcinoma 10 years aeft r initial surgical resection. Conclusion. Sweat gland carcinomas are rare cancers with a poor prognosis. Surgery in the form of wide local excision and lymph node dissection is the mainstay of treatment. Late pulmonary metastases with a latency of 10 years have never been reported in the literature. This is the first clinical documentation of late lung metastasis from sweat gland carcinoma with a latency period of 10 years. 1. Introduction small ductal epithelia, sometimes with basaloid morphology (to the le)ft , and areas of structures with glandular differ- A 69-year-old man was admitted for evaluation of a solitary entiation (to the right) (Figure 2(a),H&E×100), eventually pulmonary nodule (1.2 cm diameter) in the left upper lobe forming squamous nests (Figure 2(a) inset, H&E×200). (Figure 1(a)). The patient had a history of a sweat gland cancer A later biopsy revealed in part necrotic metastases of in the left axilla, which was successfully resected 10 years basaloid cells organized in ribbons and strands (Figure 2(b), ago. The tumor had then been classified as malignant eccrine H&E×100). porocarcinoma. Postsurgical followup for 10 years showed no Immunohistochemistry revealed positive reactions for metastasis. eTh new solitary pulmonary nodule was resected EMA and CEA and negativity for TTF1, and the tumor was by surgical wedge resection, and histology was found to considered compatible with metastasis of a primary sweat be compatible with a metastasis of sweat gland carcinoma gland adenocarcinoma. (Figure 2(a)). Eight months aeft r the initial wedge-resection, Because of the widespread pulmonary metastasis, metas- multiple bilateral pulmonary metastases were detected in a tasectomy could not be performed. Systemic chemotherapy follow-up CT scan (Figure 1(b)). with docetaxel was initiated; aer ft 6 cycles of monotherapy with docetaxel, restaging showed stable disease. However, 5 months later, we observed widespread metastasis with 2. Histology osseous infiltration, which required palliative radiation, and The initial resection specimen from the solitary left pul- second line therapy with gemcitabine was applied. eTh monary nodule showed infiltration by nests and islands of most recent restaging aeft r 6 cycles gemcitabine showed 2 Case Reports in Oncological Medicine (a) (b) Figure 1: eTh solitary pulmonary metastasis was resected. (b) Eight months aeft r the wedge resection, we found multiple bilateral pulmonary metastases. H&E ×100 H&E ×200 (a) H&E ×100 (b) Figure 2 Case Reports in Oncological Medicine 3 (a) (b) Figure 3: CT scan before the palliative chemotherapy with docetaxel and gemcitabine (a); the reevaluation CT scan (b) showed clear bilateral pulmonary progression after multiple cycles of palliative chemotherapies. progressive bilateral pulmonary metastasis (Figures 3(a) and The recommended treatment of all subtypes of sweat 3(b)). gland carcinomas is wide surgical excision along with Duetothe lowperformance status of thepatient with regional lymph node dissection in the presence of clinically severe tumor progression, the palliative chemotherapy was positive nodes. Some authors advocate prophylactic regional stopped and the patient received best supportive care. lymph node dissection especially in patients with recurrent lesions aeft r wide excision or with highly undifferentiated tumors. Sweat gland carcinomas are regarded as resistant to radiotherapy. Chemotherapy has been very infrequently 3. Discussion employed [3, 5–7]. Metastatic eccrine porocarcinoma has proven to be very resistant to many chemotherapeutic agents. This is the first clinical documentation of an extremely late The use of docetaxel in the management of this severe disease pulmonary recurrence of sweat gland carcinoma 10 years after with therapeutical success was previously documented [8]. successful initial resection. Prognostic factors for sweat gland carcinoma are difficult Sweat gland carcinomas are very rare malignant tumors to identify, again owing to the very small number of reported that were first described by Cornil in 1865 [ 1, 2]. They have cases. Prognostic factors include size, histological type, lymph been reported to occur at various sites, including eyelids, node involvement, and distant metastasis. scalp, foot digits, breast, axilla, and nose. eTh molecular pathogenesis is poorly understood. A low incidence of loss Conflicts of Interests of heterozygosity at chromosome 17p has been noticed along with p53 alterations. es Th e tumors are more aggressive than eTh authors declare that they have no conflicts of interests. squamous or basal cell carcinoma [3, 4]. eTh two basic types of sweat glands in the humans References are eccrine and apocrine. eTh eccrine glands are present everywhere, except the lips, glans penis, inner surface of the [1] T. Osaki, M. Kodate, R. Nakanishi, T. Mitsudomi, and T. prepuce, clitoris, and labia minora. Eccrine glands are most Shirakusa, “Surgical resection for pulmonary metastases of dense on palms and soles and respond primarily to cholin- sweat gland carcinoma,” Thorax ,vol.49, no.2,pp. 181–182, 1994. ergic stimuli, hence playing an important role in regulating [2] C.C.K.Smith,“Metastasizingcarcinoma of thesweat glands,” thebodytemperature.Theapocrinesweat glands arelimited British Journal Surgery,vol.43, no.177,pp. 80–84, 1955. to earcanal,the eyelids, theaxilla, theanogenitalregionand [3] A. Bahl, D. Sharma, P. Julka, A. Das, and G. Rath, “Sweat gland the mammary areola and are under the control of sexual carcinoma with lung metastases,” Journal of Cancer Research hormones. However, division of sweat gland carcinomas into and er Th apeutics ,vol.2,no. 4, pp.209–211, 2006. eccrine and apocrine groups is not clinically useful as the [4] M.Toi,L.Kauffman,L.Peterson,L.Golitz,andA.Myers,“Sweat existing literature has not adequately subdivided and studied gland carcinoma in a human immunodeficiency virus-infected theseparateentitieswellenoughtomakethisdistinction patient,” Modern Pathology, vol. 8, no. 2, pp. 197–198, 1995. relevant for clinical purposes. An orderly progression of [5] A.Chintamani,R.D.Sharma, R. Badran,V.Singhal,S.Saxena, spread to regional lymph nodes and distant sites with and A. Bansal, “Metastatic sweat gland adenocarcinoma: a metastatic adenocarcinomas can be observed and shows a clinico-pathological dilemma,” World Journal of Surgical Oncol- poor prognosis [5]. ogy,vol.1,p.13, 2003. 4 Case Reports in Oncological Medicine [6] I. A. Voutsadakis and H. W. Bruckner, “Eccrine sweat gland carcinoma: a case report and review of diagnosis and treatment,” Connecticut Medicine, vol. 64, no. 5, pp. 263–266, 2000. [7] A.Morabito, P. Bevilacqua,S.Vitale, M. Fanelli, D. Gattuso,and G. Gasparini, “Clinical management of a case of recurrent apoc- rine gland carcinoma of the scalp: efficacy of a chemotherapy schedule with methotrexate and bleomycin,” Tumori,vol.86,no. 6, pp. 472–474, 2000. [8] T. A. Plunkett, A. M. Hanby, D. W. Miles, and R. D. Rubens, “Metastatic eccrine porocarcinoma: response to docetaxel (Tax- otere) chemotherapy,” Annals of Oncology,vol.12, no.3,pp. 411– 414, 2001. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014

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