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however&#44; it has been reported in several locations&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this study&#44; the authors report the case of a 42-year-old female patient who sought care during the National Skin Cancer Campaign complaining of a nine-month-old lesion on the buttock&#46; Dermatological examination evidenced the presence of an erythematous&#44; hardened&#44; asymptomatic tumor&#44; of approximately 5&#8239;cm&#44; located in the lateral region of the right gluteus with nine months of evolution &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; She denied any trauma or previous injuries at the site&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In view of the clinical picture&#44; the hypotheses of dermatofibrosarcoma and proximal epitheloid sarcoma were raised&#46; A 5-mm punch biopsy was performed for histopathological examination which revealed nests and cords of cuboidal cells in the deep dermis&#44; with eosinophilic cytoplasm&#44; mildly pleomorphic and hyperchromatic nuclei&#44; and formation of tubular structures and ductal lumens&#44; arranged in a myxoid and collagenous stroma&#44; compatible with a skin adnexal tumor &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The patient returned two months after the biopsy&#59; an increase in the size of the lesion and elimination of continuous hyaline secretion were observed&#46; Spindle-shaped excision was performed&#44; with a safety margin of 2&#8239;cm&#44; without recurrence of the lesion after 12 months of follow-up&#46; The immunohistochemical analysis of the excised lesion was positive for cytokeratins of 40&#44; 48&#44; 50&#44; and 50&#46;6&#8239;kDa &#40;AE1&#47;AE3&#41;&#44; 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Seven months after the first approach&#44; she underwent another surgery&#44; performed by a surgical oncologist&#44; to remove the oval mass in the right iliac fossa identified by CT of the pelvis&#46; The histopathological study showed malignant neoplasia infiltration of the lymph node&#44; consisting of the proliferation of cells with clear eosinophilic cytoplasm&#44; vesicular nucleus&#44; and evident nucleolus&#44; with foci of ductal differentiation and solid areas&#44; with frequent necrosis and numerous mitoses&#46; The immunohistochemical panel of the affected lymph node showed expression of p63 protein&#44; in addition to EMA and cytokeratin in the ductal areas&#44; favoring the diagnosis of metastatic hidradenocarcinoma &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; One year after diagnosis&#44; the patient is being followed-up at the state oncology reference service&#44; with no signs of local recurrence&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The diagnosis of hidradenocarcinoma is fundamentally based on histopathological and immunohistochemical findings&#46; A panel positive for p63&#44; CK15 and D2-40 is observed preferentially in primary adnexal tumors&#44; while the negativity for these markers is found preferentially in skin metastases&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In this report&#44; the finding of immunoreactivity with p63 suggests that it was a primary adnexal neoplasia&#46; Local recurrence of hidradenocarcinoma is observed in more than 50&#37; of cases&#44; and distant metastases are observed in approximately 60&#37; of cases&#44; mainly in lymph nodes&#44; lungs&#44; and bones&#44; which is why it is necessary to keep following-up these patients and screening for metastases&#46; The differential diagnosis is challenging because the lesion looks benign and similar to other skin tumors&#46; Hidradenoma &#40;benign variant&#41;&#44; lipoma&#44; hemangioma&#44; lymphangioma&#44; squamous cell carcinoma&#44; basal cell carcinoma&#44; malignant melanoma&#44; dermatofibrosarcoma&#44; and other benign and malignant adnexal tumors&#44; in addition to metastatic tumors for the skin&#44; are reported as differential diagnoses&#46; The treatment of choice is complete surgical excision of the lesion with a wide safety margin&#46; Due to the high local recurrence and regional lymph node involvement&#44; surgery with a wide safety margin&#44; not specified in the literature&#44; and resection of regional lymph nodes followed by postoperative radiotherapy appear to be the appropriate initial therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It is important to highlight the role of the National Cancer Campaign carried out by the Brazilian Society of Dermatology&#44; where the patient was first seen&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors&#8217; contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Andrey Amorim de Lima&#58; Drafting and editing of the manuscript&#59; critical review of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Monica Santos&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Patricia Motta de Morais&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Carlos Alberto Chirano Rodrigues&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Case Letter
Hidradenocarcinoma
Andrey Amorim de Limaa,
Autor para correspondência
amorim_andrey@hotmail.com

Corresponding author.
, Monica Santosa, Patricia Motta de Moraisb, Carlos Alberto Chirano Rodriguesc
a Teaching and Research Department, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
b Department of Dermatopathology, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
c Department of Dermatological Surgery, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cutaneous hidradenocarcinoma is a rare malignant neoplasm&#44; originating from the eccrine sweat glands&#44; and corresponding to 6&#37; of the eccrine malignant tumors&#46; It presents as a solitary&#44; asymptomatic&#44; slow-growing skin lesion&#44; and may take an aggressive clinical course&#44; with lymph node involvement and distant metastases&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Classically&#44; it is a carcinoma reported with <span class="elsevierStyleItalic">de novo</span> onset&#44; with no signs of previous hidradenoma&#46; It most often affects patients from the fourth decade of life onwards&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Classically&#44; the head and neck are the most affected sites&#59; however&#44; it has been reported in several locations&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this study&#44; the authors report the case of a 42-year-old female patient who sought care during the National Skin Cancer Campaign complaining of a nine-month-old lesion on the buttock&#46; Dermatological examination evidenced the presence of an erythematous&#44; hardened&#44; asymptomatic tumor&#44; of approximately 5&#8239;cm&#44; located in the lateral region of the right gluteus with nine months of evolution &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; She denied any trauma or previous injuries at the site&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In view of the clinical picture&#44; the hypotheses of dermatofibrosarcoma and proximal epitheloid sarcoma were raised&#46; A 5-mm punch biopsy was performed for histopathological examination which revealed nests and cords of cuboidal cells in the deep dermis&#44; with eosinophilic cytoplasm&#44; mildly pleomorphic and hyperchromatic nuclei&#44; and formation of tubular structures and ductal lumens&#44; arranged in a myxoid and collagenous stroma&#44; compatible with a skin adnexal tumor &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The patient returned two months after the biopsy&#59; an increase in the size of the lesion and elimination of continuous hyaline secretion were observed&#46; Spindle-shaped excision was performed&#44; with a safety margin of 2&#8239;cm&#44; without recurrence of the lesion after 12 months of follow-up&#46; The immunohistochemical analysis of the excised lesion was positive for cytokeratins of 40&#44; 48&#44; 50&#44; and 50&#46;6&#8239;kDa &#40;AE1&#47;AE3&#41;&#44; p63 protein &#40;DAK-p63&#41;&#44; epithelial tumor glycoprotein &#40;BerEp4&#41;&#44; and carcinoembryonic antigen &#8211; CEA &#40;polyclonal&#41;&#46; Partial positivity was observed for epithelial membrane antigen &#8211; EMA &#40;E29&#41;&#46; Histopathological and immunohistochemical findings favored the diagnosis of hidradenocarcinoma&#46; Tumor blood markers&#44; such as lactic dehydrogenase &#40;DHL&#41;&#44; alpha-fetoprotein&#44; and CEA&#44; were normal&#46; Computed tomography &#40;CT&#41; of the abdomen and pelvis without contrast showed the presence of an oval mass with defined contours and margins in the right iliac fossa &#40;ipsilateral to the excised tumor&#41; adjacent to the sartorius muscle&#44; measuring about 4&#46;2&#8239;&#215;&#8239;2&#46;2&#8239;cm&#44; heterogeneous&#44; with areas of soft tissue density &#40;32 uH&#41; and interspaced slightly hypodense areas&#44; with apparently non-specific liquid density&#46; No abnormalities were observed in the abdominal and pelvic organs&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient was referred to an oncologic center&#46; Seven months after the first approach&#44; she underwent another surgery&#44; performed by a surgical oncologist&#44; to remove the oval mass in the right iliac fossa identified by CT of the pelvis&#46; The histopathological study showed malignant neoplasia infiltration of the lymph node&#44; consisting of the proliferation of cells with clear eosinophilic cytoplasm&#44; vesicular nucleus&#44; and evident nucleolus&#44; with foci of ductal differentiation and solid areas&#44; with frequent necrosis and numerous mitoses&#46; The immunohistochemical panel of the affected lymph node showed expression of p63 protein&#44; in addition to EMA and cytokeratin in the ductal areas&#44; favoring the diagnosis of metastatic hidradenocarcinoma &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; One year after diagnosis&#44; the patient is being followed-up at the state oncology reference service&#44; with no signs of local recurrence&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The diagnosis of hidradenocarcinoma is fundamentally based on histopathological and immunohistochemical findings&#46; A panel positive for p63&#44; CK15 and D2-40 is observed preferentially in primary adnexal tumors&#44; while the negativity for these markers is found preferentially in skin metastases&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In this report&#44; the finding of immunoreactivity with p63 suggests that it was a primary adnexal neoplasia&#46; Local recurrence of hidradenocarcinoma is observed in more than 50&#37; of cases&#44; and distant metastases are observed in approximately 60&#37; of cases&#44; mainly in lymph nodes&#44; lungs&#44; and bones&#44; which is why it is necessary to keep following-up these patients and screening for metastases&#46; The differential diagnosis is challenging because the lesion looks benign and similar to other skin tumors&#46; Hidradenoma &#40;benign variant&#41;&#44; lipoma&#44; hemangioma&#44; lymphangioma&#44; squamous cell carcinoma&#44; basal cell carcinoma&#44; malignant melanoma&#44; dermatofibrosarcoma&#44; and other benign and malignant adnexal tumors&#44; in addition to metastatic tumors for the skin&#44; are reported as differential diagnoses&#46; The treatment of choice is complete surgical excision of the lesion with a wide safety margin&#46; Due to the high local recurrence and regional lymph node involvement&#44; surgery with a wide safety margin&#44; not specified in the literature&#44; and resection of regional lymph nodes followed by postoperative radiotherapy appear to be the appropriate initial therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It is important to highlight the role of the National Cancer Campaign carried out by the Brazilian Society of Dermatology&#44; where the patient was first seen&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors&#8217; contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Andrey Amorim de Lima&#58; Drafting and editing of the manuscript&#59; critical review of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Monica Santos&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Patricia Motta de Morais&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Carlos Alberto Chirano Rodrigues&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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ISSN: 03650596
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