Department of Medical Oncology, Southern University of Science and Technology Hospital, Shenzhen, China.
Department of Biochemistry, School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, 518055, China.
BMC Geriatr. 2024 Oct 15;24(1):836. doi: 10.1186/s12877-024-05428-w.
Apocrine carcinoma associated with Paget's disease is a rare malignancy that typically manifests in elderly individuals, predominantly affecting the geriatric population. It commonly arises in regions rich in apocrine glands and often exhibits an insidious onset, potentially requiring several years to be diagnosed.
An 80-year-old male was simultaneously diagnosed with scrotal apocrine carcinoma (showing Paget changes) and early-stage gastric cancer. Whole-genome exome sequencing confirmed these as independent malignancies with minimal genetic overlap, indicating that they were two primary tumors. The patient initially underwent successful surgery but experienced recurrence and metastasis. Treatment with capecitabine and paclitaxel showed promising responses, highlighting similarities between breast and apocrine carcinomas. Challenges were noted in the use of genetic testing and drug susceptibility assessments for treatment guidance. Notably, HER-2 expression in metastatic lesions, a trait of apocrine carcinoma, has remained unexplored due to negative HER-2 FISH results and a lack of available targeted therapies in China.
Elderly patients often exhibit a lesser degree of aggressiveness toward treatment following a diagnosis of malignant tumors. It is imperative to carefully consider how to strike a balance between effective treatment and maintaining a satisfactory quality of life for these patients. This case underscores the complexity of treating coexisting rare cancers in older adults and emphasizes the need for personalized treatments and continued innovation in cancer therapy. The insights gained offer significant value in understanding and managing such rare cancer cases.
伴 Pagets 病的大汗腺癌是一种罕见的恶性肿瘤，主要发生在老年人群，以老年人群为主。它通常发生在富含大汗腺的区域，并且发病隐匿，可能需要数年才能确诊。
一名 80 岁男性同时被诊断为阴囊大汗腺癌（表现为 Pagets 样改变）和早期胃癌。全基因组外显子组测序证实这些是独立的恶性肿瘤，遗传重叠很少，表明它们是两个原发性肿瘤。患者最初接受了成功的手术，但出现了复发和转移。卡培他滨和紫杉醇治疗显示出有希望的反应，这表明乳腺癌和大汗腺癌之间存在相似性。在使用基因检测和药物敏感性评估来指导治疗时遇到了挑战。值得注意的是，由于转移性病变中 HER-2 的表达（大汗腺癌的特征）呈阴性，且中国缺乏可用的靶向治疗药物，因此尚未探索转移性病变中 HER-2 的表达。
老年患者在诊断出恶性肿瘤后，往往对治疗的积极性较低。必须仔细考虑如何在有效治疗和维持这些患者满意的生活质量之间取得平衡。这个病例强调了治疗老年患者同时存在的罕见癌症的复杂性，并强调了为癌症治疗提供个性化治疗和持续创新的必要性。所获得的见解对于理解和管理此类罕见癌症病例具有重要价值。
