Bernstein Ethan, Bernal Carter, Bol Brandon, Hershenhouse Jacob, Bernstein Matthew
College of Medicine, California Northstate University, Elk Grove, California, USA.
Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Case Rep Oncol Med. 2024 Dec 23;2024:9910470. doi: 10.1155/crom/9910470. eCollection 2024.
Digital papillary adenocarcinoma (DPA) is a rare malignant eccrine tumor often misdiagnosed as a benign condition. A 57-year-old Caucasian male with recurrent paronychia and a subcutaneous mass on the distal phalanx of the right fourth digit was diagnosed with DPA after seeking hand surgery evaluation 5 years following onset. A marginal excisional biopsy was positive for infection and DPA, leading to surgical excision with transmiddle phalangeal amputation for negative margins. DPA, while rare, often presents insidiously, leading to delayed diagnosis and increased risk of metastasis. This tumor has high rates of recurrence and metastasis, most commonly to pulmonary and lymphatic sites. Accurate diagnosis of DPA is challenging due to its resemblance to multiple benign cutaneous conditions. Current treatments focus on surgical excision, with an emphasis on negative margins. Sentinel lymph node biopsy is not routinely performed, although guidelines are difficult to establish due to the rarity of DPA. Diagnosing and treating DPA minimizes metastasis and recurrence. DPA should be considered in patients presenting with recalcitrant or recurring cutaneous lesions. Surgical management remains the primary treatment strategy, with ongoing research needed to optimize treatment protocols and follow-up care.
指状乳头状腺癌（DPA）是一种罕见的恶性小汗腺肿瘤，常被误诊为良性疾病。一名57岁的白种男性，右手中指末节反复出现甲沟炎和皮下肿块，发病5年后寻求手部手术评估，被诊断为DPA。边缘切除活检显示感染和DPA呈阳性，因切缘阴性而行经中节指骨截肢手术切除。DPA虽然罕见，但通常隐匿出现，导致诊断延迟和转移风险增加。这种肿瘤的复发和转移率很高，最常见于肺部和淋巴部位。由于DPA与多种良性皮肤疾病相似，准确诊断具有挑战性。目前的治疗重点是手术切除，强调切缘阴性。尽管由于DPA罕见难以制定指南，但前哨淋巴结活检并非常规进行。诊断和治疗DPA可将转移和复发降至最低。对于出现顽固性或复发性皮肤病变的患者应考虑DPA。手术治疗仍然是主要的治疗策略，需要持续研究以优化治疗方案和随访护理。
