Jackson Elise M, Cook Joel
University of Virginia School of Medicine, USA.
Dermatol Surg. 2002 Dec;28(12):1168-72. doi: 10.1046/j.1524-4725.2002.02118.x.
Papillary eccrine adenoma (PEA) is a rare benign sweat gland neoplasm first described by Rulon and Helwig in 1977. Although these lesions typically behave in a benign fashion, PEA's on the volar surfaces may demonstrate more aggressive biologic behavior. Additionally, aggressive digital papillary adenomas (ADPA) may histologically simulate PEAs and behave in a more malignant fashion.
To present a case report of a patient with an incompletely excised PEA that was successfully extirpated using Mohs micrographic surgery (MMS).
A 51-year-old black woman was evaluated for the treatment of an incompletely excised PEA located on the dorsum of her left hand at the base of the thumb. Mohs micrographic surgery was felt to be the ideal treatment choice because of incomplete prior resections, ill-defined clinical borders, the need for conservative surgical excision to preserve sensory and motor function of the left hand, and the previously reported more aggressive nature of this tumor when located on volar surfaces. The patient underwent a two-stage, six section micrographically controlled excision using the fresh tissue technique.
Complete resection of the PEA without significant damage to neurovascular structures.
This case demonstrates the increasingly important role MMS is playing in the surgical management of a wide variety of cutaneous tumors. To our knowledge, this is the first time MMS has been used in the resection of a PEA.
乳头状小汗腺腺瘤（PEA）是一种罕见的良性汗腺肿瘤，1977年由鲁隆和赫尔维希首次描述。尽管这些病变通常表现为良性，但手掌表面的PEA可能表现出更具侵袭性的生物学行为。此外，侵袭性指状乳头状腺瘤（ADPA）在组织学上可能模拟PEA，并表现出更恶性的行为。
报告一例不完全切除的PEA患者，通过莫氏显微外科手术（MMS）成功切除。
对一名51岁黑人女性进行评估，以治疗位于左手拇指根部背侧的不完全切除的PEA。由于先前切除不完全、临床边界不清、需要保守手术切除以保留左手的感觉和运动功能，以及先前报道的该肿瘤位于手掌表面时更具侵袭性的性质，莫氏显微外科手术被认为是理想的治疗选择。患者采用新鲜组织技术进行了两阶段、六个切片的显微控制切除。
PEA完全切除，神经血管结构未受明显损伤。
本病例表明MMS在各种皮肤肿瘤的手术治疗中发挥着越来越重要的作用。据我们所知，这是首次将MMS用于PEA的切除。
