Lung Cancer |

Metastatic Digital Sweat Gland Carcinoma Simulating Recurrent Lung Carcinoma FREE TO VIEW

Bartosz Buchcic, MD; Dr. Odile David, MD; Dr H. Ari Jaffe, MD
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University of Illinois, Chicago, IL

Chest. 2014;146(4_MeetingAbstracts):615A. doi:10.1378/chest.1988059
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SESSION TITLE: Cancer Case Report Posters I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Sweat gland carcinoma, first described in 18651, is a rare malignancy with a varying histology and complex classification. Diagnosis is often delayed due to low incidence and confusion with other skin tumors and cutaneous metastases from visceral malignancies. We present a case with simultaneous digital and lung masses in a patient with prior history of resected squamous cell lung cancer.

CASE PRESENTATION: A 77-year-old woman with 50 pack year history of smoking and previous squamous cell cancer (pT1aN0), s/p RML lobectomy, but without radiation or chemotherapy, re-presented after 3 years with a 3 month history of a painful, growing and ulcerated digital mass [Fig.1] but no respiratory symptoms. Imaging showed edema and bone destruction. CXR revealed a large RUL mass and prior operative changes. PET/CT documented 18FDG avidity in the finger (SUV 19.6), an 8.5 x 7.5 cm RUL mass abutting the pleural surface with extension to the hilum (SUV 26.5) and right hilar adenopathy (SUV 16.7) [Fig.2]. The resected digital mass revealed poorly differentiated sweat gland carcinoma (pT2Nx) [Fig.3]. The lung mass biopsy confirmed metastatic sweat gland carcinoma [Fig.4], as it was histologically similar to the digital mass and distinctly different from the original lung cancer. The patient declined surgical evaluation and is being treated with concurrent chemo- and radiation therapy.

DISCUSSION: Sweat gland carcinomas are uncommon with incidence of 0.005 percent of epithelial malignancies2. Age at presentation varies, with most occurring in the later decades. Most grow slowly but rarely, rapidly and aggressively with metastases involving lymph nodes, bones, liver, lungs and skin. Clinical behavior correlates with histology, degree of differentiation, and clinical stage. Definitive data are lacking regarding recurrence, prognosis and treatment3.

CONCLUSIONS: Lung masses occurring in the context of sweat gland carcinoma may represent metastatic disease even in patients with prior lung cancer and significant tobacco exposure. Currently, there is no consensus on treatment beyond wide local excision.

Reference #1: Coril, V. Contributions a l'histoire du developpement histologique des tumeurs epitheliales. J. de l'anat. et physiol., I865, 2, 266-276

Reference #2: Hall J, et. al. Sweat-gland Tumours: A Clinical Review of Cases in One Centre Over 20 Year. Clinical Oncology (2006) 18:351-359

Reference #3: Nidal A Obaidat, et. al. Skin adnexal neoplasms—part 2: An approach to tumours of cutaneous sweat glands J Clin Pathol 2007;60:145-159

DISCLOSURE: The following authors have nothing to disclose: Bartosz Buchcic, Dr. Odile David, Dr H. Ari Jaffe

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