PMC5379111_01
Lobules and cords of aggressive digital papillary adenocarcinoma (H & E, original magnification 100x).
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The histopathologic specimens from bone and soft tissue demonstrated small lobules, cords, and single epithelial cells set within a desmoplastic stroma (Figure 1).
The carcinoma is positive for CK 7 (a) and negative for CK 20 (b) (H & E, original magnification 100x).
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TTF-1, prostate specific antigen, synaptophysin, chromogranin, p63, and S-100 (Figure 2). The histopathological differential diagnosis included a primary sweat gland carcinoma (aggressive digital papillary adenocarcinoma) as well as a metastatic adenocarcinoma from an upper gastrointestinal or pancreaticobiliary tract origin.
ADPA lesion after biopsy, dorsal view.
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At the time of postoperative examination the finger had worsened in appearance with increased edema, ecchymosis, and pain (Figures 3 and 4).
ADPA lesion after biopsy, palmar view.
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At the time of postoperative examination the finger had worsened in appearance with increased edema, ecchymosis, and pain (Figures 3 and 4).
ADPA lesion prior to amputation, dorsal view.
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Further progression in appearance at the time of scheduled amputation was observed (Figures 5 and 6).
ADPA lesion prior to amputation, palmar view.
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Further progression in appearance at the time of scheduled amputation was observed (Figures 5 and 6).
In the amputation specimen, the ADPA was found to be present within vascular spaces (a) as well as within the bone (b) (H & E, original magnification 100x).
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Pathologic examination of the amputation specimen demonstrated an ulcerated poorly differentiated adenocarcinoma measuring 4.6 cm with involvement of the dermis, subcutis, and bone and lymphovascular/perineural involvement (Figure 7).