Mariano Melissa, Jani Chinmay, Khanna Prateek, Patel Dipesh, Perry John, Yalamarti Bhargavi, Abner Anthony
Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA.
Radiology, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA.
Cureus. 2022 Mar 15;14(3):e23183. doi: 10.7759/cureus.23183. eCollection 2022 Mar.
Eccrine carcinomas are rare cutaneous cancers that tend to be locally aggressive. Here we report a rare case of a mucinous eccrine carcinoma presenting in axillary lymph nodes without an identifiable primary lesion. This is a 69-year-old male with a past medical history of benign prostatic hyperplasia, melanoma, basal cell carcinoma, hypercholesterolemia, hypertension, and arthritis who was found to have an elevated prostate-specific antigen. Transrectal prostate biopsies confirmed adenocarcinoma of the prostate. A chest CT scan performed for further staging of prostate cancer identified new left axillary lymphadenopathy and positron emission tomography (PET)-CT imaging showed moderate fluorodeoxyglucose (FDG) uptake in the lymph nodes of the left axilla and left subpectoral regions. Lymph node tissue obtained by core needle biopsy demonstrated high-grade carcinoma with a nonspecific immunohistochemical profile. Complete left axillary lymphadenectomy was performed, revealing mucinous eccrine carcinoma. He was started on hormonal therapy for prostate cancer and radiation therapy for axillary eccrine carcinoma at the same time. Based on our literature review, this appears to be the first case of eccrine carcinoma in axillary lymph nodes with an unknown primary. This case is further complicated by synchronous primary prostate cancer. After a multidisciplinary tumor board review, it was decided that his axillary disease should be treated as a primary mucinous carcinoma with complete lymphadenectomy followed by localized radiation. The patient had stable disease at the six-month follow-up. Cancers with unknown primary lesions pose unique challenges in disease management. Without established recommendations or guidelines, multidisciplinary discussions and a collaborative approach are needed.
小汗腺癌是一种罕见的皮肤癌，往往具有局部侵袭性。在此，我们报告一例罕见的黏液性小汗腺癌，表现为腋窝淋巴结出现病变，而未发现明确的原发灶。这是一名69岁男性，既往有良性前列腺增生、黑色素瘤、基底细胞癌、高胆固醇血症、高血压和关节炎病史，发现前列腺特异性抗原升高。经直肠前列腺活检证实为前列腺腺癌。为进一步对前列腺癌进行分期而进行的胸部CT扫描发现左侧腋窝有新的淋巴结肿大，正电子发射断层扫描（PET）-CT成像显示左腋窝和左胸肌下区域的淋巴结有中度氟脱氧葡萄糖（FDG）摄取。通过粗针活检获得的淋巴结组织显示为高级别癌，免疫组化结果不具有特异性。进行了左侧腋窝淋巴结清扫术，结果显示为黏液性小汗腺癌。他同时开始接受前列腺癌的激素治疗和腋窝小汗腺癌的放射治疗。根据我们的文献回顾，这似乎是首例原发灶不明的腋窝淋巴结小汗腺癌病例。该病例因同时患有原发性前列腺癌而更加复杂。经过多学科肿瘤委员会的会诊，决定将其腋窝疾病作为原发性黏液性癌进行治疗，先进行彻底的淋巴结清扫术，然后进行局部放疗。患者在六个月的随访中病情稳定。原发灶不明的癌症在疾病管理方面带来了独特的挑战。由于没有既定的建议或指南，需要进行多学科讨论并采取协作方法。
