Primary Cutaneous Apocrine Carcinoma with Distant Metastasis

Abstract

Introduction: Cutaneous apocrine carcinomas (CAC) are rare adnexal malignant tumors preferentially localized in the axillary and anogenital regions. They are characterized by mammillated plaques or asymptomatic nodules and present a differential diagnosis problem with cutaneous metastases of breast adenocarcinoma. Metastatic CACs are a therapeutic challenge. Case presentation: A 63-years-old man, chronic smoker, presented with painless left axillary mammillated plaques that had been slowly evolving for 18 months. Clinical examination found a tumor mass associated with magma of left axillary lymph nodes. Histological study and immunohistochemical staining of the skin evoked the diagnosis of cutaneous metastasis of breast adenocarcinoma. However, the diagnosis of axillary CAC was retained owing to the negativity of explorations in search of a primitive adenocarcinoma and the slow clinical course. Morphological assessment showed lymph node, hepatic and pulmonary metastases. Surgical excision with lymph node dissection was performed followed by chemotherapy. Discussion: Metastatic CACs are rare. Sometimes, the existence of misleading tumor architecture and nonspecific nature of the immunolabeling explain the difficulty of the differential histological diagnosis between axillary CAC and cutaneous metastasis of lobular breast adenocarcinoma. Because of the rarity of this neoplasia no effective treatment is currently established. Conclusion: We report a new case of metastatic axillary CAC. This case illustrates the importance of anatomoclinical correlation in cutaneous oncology and highlighted the need of treatment outcome evaluations of other cases of metastatic CAC to offer optimal treatment.