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Aggressive digital papillary adenoma / adenocarcinoma - Foot and Ankle

Summary

Aggressive digital papillary adenocarcinoma is a rare cutaneous tumor of eccrine sweat gland origin that occurs on the plantar surfaces of the digits in the hand and foot.

This tumor affects men more than women, with a mean age at presentation of 52 yrs (range: 19-83 yrs).
It can have an indolent clinical course without symptoms or change for years. The average tumor size is 1.7 cm and the mas may be present from 2 months to 15 years. Pain is a frequent presenting complaint.
Aggressive surgical re-resection or amputation if necessary to avoid local recurrence.
Complete Information on this Tumor
Introduction and Definition: 

Aggressive digital papillary adenocarcinoma is a rare cutaneous tumor of eccrine sweat gland origin that occurs on the plantar surfaces of the digits in the hand and foot. It can have an indolent clinical course without symptoms or change for years. Because of this, it may be misdiagnosed as a benign entity. Metastasis has been reported to occur in 14% of cases, with both widespread metastasis and frequent metastasis to the lungs. The usefulness of lymph node sampling has not been defined. Both a benign and a malignant variant of this tumor have been described, but a more recent review has cast doubt on the reliability of the histologic differentiation of these two variants. It appears that the histological features of this lesion do not allow for reliable differentiation between the benign and malignant forms, nor do the histological features allow for the distinction between tumors that have aggressive clinical course and go on to metastasize from tumors that behave in a benign fashion.

Therefore, both digital papillary adenoma and digital papillary adenocarcinoma should be treated in similar fashion, and can be designated as aggressive digital papillary adenocarcinoma

Symptoms and Presentation: 

It can have an indolent clinical course without symptoms or change for years.

Preferred Biopsy Technique for this Tumor: 
Excisional biopsy is recommended for indolent soft tissue masses on the plantar surfaces of the digits.
Treatment Options for this Tumor: 
Aggressive surgical re-resection or amputation if necessary to avoid local recurrence. No effective treatment is available for metastatic disease.
Outcomes of Treatment and Prognosis: 
Aggressive surgical treatment is associated with a decrease in the rate of local recurrence from 50% to 5%.