engleski

A rare and aggressive cutaneous thumb tumour

A 53-year-old white man presented with a 2-month history of a painless periungual ulcerated mass on the lateral aspect of his right thumb, measuring up to 7 mm in diameter (Fig. 1a). The neurovascular function and motion range of the thumb were preserved. The mass was excised, but 2 months later, local recurrence and ipsilateral axillary lymph node metastasis were observed. Partial thumb amputation was performed, shortly followed by another local recurrence (Fig. 1b) and occurrence of pulmonary metastases, detected by multislice computed tomography. After four cycles of carboplatin and paclitaxel chemotherapy, disease progression was noted (additional liver and mediastinal metastases and an increase in the diameter of previously noted metastases). Following four cycles of second-line chemotherapy with 5-fluorouracil and cisplatin, there was no measurable therapeutic response. Unfortunately, the patient died 14 months after metastatic disease was established and 2 years after the primary diagnosis. Histopathological examination showed variably sized, partially cystic tumour nests within the dermis and subcutis, composed of solid and papillary formations covered by atypical epithelial cells (Fig. 2a, b). Lymphovascular invasion was noted and tumour tissue was also detected in the right axillary lymph node on core biopsy (Fig. 2c). There was moderate and focally severe cytological atypia, ample mitotic activity and focal central necrosis within the tumour nests. There was no communication with the epidermis and no invasion of underlying bone. Diagnosis Digital papillary adenocarcinoma (DPAC).

aggressive tumor ; tumb

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