PMC5852884_01
Eccrine carcinoma. Infiltrative, poorly differentiated neoplasm in a nested to trabecular pattern. Nuclei are relatively uniform with notably prominent nucleoli (hematoxylin-eosin, original magnification x200).
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Histopathological analysis of the skin resection (Figure 1) supported the initial diagnosis of EC.
Progression of the disease despite treatment with carboplatin, paclitaxel, and radiotherapy (a, b), with subsequent partial treatment response two months after starting capecitabine (c, d). Axial postcontrast CTs of the pelvis show metastatic left pelvic lymph nodes, with decrease in size of a metastatic left external iliac chain lymph node from 2.2 x 1.1 cm (white arrow, a) to 1.5 x 0.9 cm (white arrow (c)) with capecitabine treatment. Coronal postcontrast CTs of the left leg (b) before and (d) after capecitabine treatment show similar cutaneous metastases (white arrows) with decreased size of a metastatic lymph node (L).
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CT scans in October 2011 revealed left pelvic lymph node metastases (Figure 2(a)) as well as recurrence in the left leg (Figure 2(b)). CT studies (Figure 2) revealed an overall partial response with a decrease in size of the left pelvic lymph node metastases (Figure 2(c)) and cutaneous lesions in the left leg (Figure 2(d)).
Progression of disease 18 months after starting capecitabine treatment. Axial postcontrast CT of the pelvis (a) shows increased size of a centrally necrotic left external chain lymph node, measuring 2.2 x 1.7 cm (white arrow). Postcontrast sagittal T1 MRI (b) and noncontrast coronal FLAIR MRI (d) of the brain show a new rim enhancing 1.2 cm metastasis in the right posterior parietal lobe with surrounding edema (white arrows). Coronal postcontrast CT of the chest and abdomen (c) shows new right pleural metastasis (arrows), mediastinal and hilar lymph node (L), and left lateral chest wall soft tissue (S) metastases, as well as an enlarging right lower lobe pulmonary metastasis (P) and right adrenal metastasis superimposed on an existing adrenal adenoma (A).
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CT studies showed interval enlargement of left pelvic lymph node, right adrenal, and pulmonary metastases (Figures 3(a) and 3(c)). New metastatic disease was identified in the thoracic and abdominal lymph nodes, the right pleura, and cutaneous tissue (Figure 3(c)). An MRI of the brain revealed multiple metastases with index lesions in the right posterior parietal lobe (Figures 3(b) and 3(d)).