Aggressive digital papillary adenoma / adenocarcinoma - Foot and Ankle

Summary
Description

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.

People and Age
This tumor affects men more than women, with a mean age at presentation of 52 yrs (range: 19-83 yrs).
Symptoms and Presentation
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.
Brief desc of tx
Aggressive surgical re-resection or amputation if necessary to avoid local recurrence.
Tumor Name
aggressive digital papillary adenoma carcinoma - foot and ankle
Tumor Type
Tumors of the Foot and Ankle
Benign or Malignant
Malignant
Body region
ankle and foot, leg
Most Common Bones
multiple bones
Position within the bone
surface
Tumor behavior
aggressive
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%.