We report an interesting case of aggressive digital papillary adenocarcinoma (ADPCA), a rare eccrine neoplasm with high rates of recurrence and metastatic potential. Diagnosis and treatment is often delayed due to its unusual clinical presentation and it may be confused with other benign lesions. A man aged 71 was referred to the medical oncology clinic with CT scans showing recurrent oligometastatic ADPCA. Initial trauma more than a decade ago to the fourth digit lead to recurrent swelling necessitating a biopsy and subsequent amputation. Routine imaging surveillance then showed recurrence in the axillary lymph nodes for which the patient underwent an axillary node clearance. His most recent scan now shows a growing metastatic pulmonary nodule which is in consideration of resection. There is limited documentation on management of such cases. It is also important not to overlook the possibility of ADPCA when a patient presents with recurrent digital swellings or lesions.
Pragya Attri and Prashanth Hari Dass