Abstract
The authors describe the case of a 71-year-old female patient who initially went to the dermatologist to assess a scalp skin tumor. This lesion was submitted to an incisional biopsy, performed by dermatologist herself, and the result of the anatomopathological examination and immunohistochemical study showed a preliminary diagnosis of metastasis of breast carcinoma. The patient had no history of breast cancer and, in view of this result, she was referred to consult with the mastologist, who carried out an investigation of breast nodules in search of the possible primary focus of the carcinoma, through imaging exams, biopsies and mammotomy, without finding any possible primary focus on the breasts. Finally, the lesion on the scalp was removed in its entirety by the plastic surgeon and a new exam of pathological anatomy and an immunohistochemical study confirmed the diagnosis of metastasis of breast carcinoma. In view of these results, the authors discuss the difficulty in diagnosing differentiation from primary or metastatic neoplasm of the scalp, with the resources currently available, until the conclusion that it was a primary carcinoma of the sweat gland.
Highlights
Primary malignant neoplasms of the sweat glands are rare, constituting less than 1% of all primary malignant skin lesions[1]
What did the researchers do and find? The researchers examined the patient through clinical, imaging, and laboratory analysis tests. They performed comparative studies of the cutaneous malignancy and breast nodules, especially with immunohistochemical examinations. What do these findings mean? The findings show the challenge in differentiating a primary tumor of the sweat gland from a metastatic cutaneous tumor of mammary carcinoma, even with the immunohistochemical resources currently available
The pathology laboratory received a 0.3 cm surgical skin sample, which was microscopically described as a dermis fragment infiltrated by neoplasia consisting of small cells, hyperchromatic nuclei, grouped into small nodules, cords or outlining structures ring, dissecting the entire dermis and with preserved epidermis
Summary
Why was this study done? This study aimed to report and discuss the challenging differential diagnosis between a primary tumor of sweat glands and cutaneous metastasis of mammary carcinoma using anatomopathological and imaging diagnostic resources available today. The researchers examined the patient through clinical, imaging, and laboratory analysis tests They performed comparative studies of the cutaneous malignancy and breast nodules, especially with immunohistochemical examinations. The findings show the challenge in differentiating a primary tumor of the sweat gland from a metastatic cutaneous tumor of mammary carcinoma, even with the immunohistochemical resources currently available. It evidenced the importance of the clinical history, the correct propaedeutics, and a detailed study of the breasts to arrive at the proper diagnosis, ruling out others possibilities
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