Digital Papillary Adenocarcinoma: Presentation, Natural History and Management

Abstract

Digital papillary adenocarcinoma (DPA) is a rare malignant tumor of the sweat glands that often presents as a solitary painless mass on the digits of the hands or feet. We present a rare case of DPA on the ankle in a 54 year-old African American man. Although the most common location for digital papillary adenocarcinoma is on the hands and feet, it can present in other locations. Treatment modalities and concerns such as the level of margin resection, degree of negative margins, and the need for a sentinel lymph node biopsy might be different if the tumor is encountered in locations other than the digits. In the following manuscript, we discuss the natural history of this rare tumor including a review of the current literature with emphasis on documented treatment strategies as well as the approach in treating patients with a unique presentation.

Digital papillary adenocarcinoma of the ankle

“…DPA of the ankle is a particularly unique presentation of the disease. [2] In 1987 Kao et al published a retrospective study of 57 cases of DPA. They examined the basic clinical presentation of DPA, the disease course, treatment, and differential diagnosis.…”

“…Continual follow up with thorough exam and possible chest X-rays to monitor for lung metastasis is important due to the high rate of recurrence and metastasis. [2] 2. CASE REPORT A 66-year-old African American male presented with a 10-year history of a slowly growing, asymptomatic lesion on his left lateral heel.…”

“…These tumors are most common in Caucasian men in their 5th-7th decades of life, and most often present on the volar surface of fingers and toes, the palmar surface of the hand, and the soles of the feet. [2] They are three times more common on the digits of the hand compared to the foot.…”

Papillary adnexal neoplasm (aggressive digital papillary adenocarcinoma) on the ankle of a 15‐year‐old girl: case report and review of literature from a pediatric perspective

“…Ankle is an uncommon site for this tumor even in adults with only three cases reported so far . Among these, two were primary tumors – one on the posterolateral left ankle of a 40‐year‐old man and the other on lateral right ankle of a 54‐year‐old man . The first was excised incompletely and followed by wide excision and sentinel lymph node biopsy, both of which were negative for tumor .…”

“…As the name suggests, this tumor usually occurs on fingers and toes with the most distal volar portion of the finger being the most common location. Non‐digital locations such as dorsum of hand, dorsum of foot, web spaces of fingers and toes, periungual/subungual, palm, sole and ankle have been described but very rare. Three largest series of this tumor reported so far do not have any case on the ankle .…”