Large Subcutaneous Manifestation of Poorly-Differentiated Hidradenocarcinoma in a patient with Concomitant Prostate Adenocarcinoma
Document Type
Article
Abstract
Background: Introduction: Hidradenocarcinoma is a rare and aggressive malignancy of eccrine sweat glands. Diagnosis can be difficult due to the dearth of known gene associations and expression profiles. Here, we report an unusual presentation of a large hidradenocarcinoma on the dorsal lumbar region of a male with underlying prostate cancer.
Case: A 59-year old male with extensive family history of breast, prostate, and colon cancer presents with new diagnosis of benign prostatic hyperplasia and a 9.3 cm x 4.9 cm subcutaneous lumbar spine mass. Labs were significant for an elevated alkaline phosphatase and a serum PSA level of 52.8. Radiological surveys were notable for multiple areas of bony lucency in the sacroiliac bones concerning for metastatic disease. Lumbar mass biopsy revealed poorly differentiated androgen receptor- and cytokeratin-positive, but NKX3.1-, PSA-, and PSAP-negative tumor cells with focal glandular and cribriform architecture. Subsequent prostate biopsy was found to contain tumor cells (Gleason score 5/4) positive for PanCK, focal PSA, PSAP, synaptophysin, and chromogranin. Lumbar back mass was excised and characterized as a multinodular cystic neoplasm with intermixed sebocytes and oncocytic/polygonal cells. Further staining revealed strong diffuse p63 and CK5/6 positivity as well as lesional cell CK AE1/AE3, P40, and androgen receptor positivity. EMA and PRAME stains revealed sebocytes and rare ducts. This challenging case favored a diagnosis of poorly differentiated hidradenocarcinoma.
Discussion: Hidradenocarcinoma is a rare tumor with uncharacterized phenotype, pathophysiology, and outcomes. Here, we document perhaps the first case of a large lumbar hidradenocarcinoma in a male with underlying prostate cancer.
First Page
AB186
DOI
10.1016/j.jaad.2023.07.746
Publication Date
9-1-2023
Recommended Citation
Badeti S, Truong T, Shah R, Deb P, Parris B, Jobbagy Z, Galan M, Rao B. 44444 Large Subcutaneous Manifestation of Poorly-Differentiated Hidradenocarcinoma in a patient with Concomitant Prostate Adenocarcinoma. Journal of the American Academy of Dermatology. 2023 Sep 1;89(3):AB186.