A rare case of a digital papillary carcinoma of the hand with secondary conservative management

Abstract

A digital papillary carcinoma (DPC) is a cancer of the sweat glands which develops on the digits of the hands and feet. With an incidence of 0.08 per 1 000 000 people/year, it is often initially misdiagnosed as a simple ganglion although it has a significant risk of metastasis. Histological analysis is beneficial in the formal diagnosis of DPCs. In this report, we present a rare case of DPC affecting the palm of the hand, rather than the more commonly reported DPC of the digits. We discuss the management strategy utilized in this case and the various prognostic considerations taken into account when deciding on an amputation versus local excision surgical approach. All cases of DPC require regular follow up imaging for early detection of recurrence or new metastases to maximize prognosis.

Keywords: digital papillary carcinoma; ganglion; metastasis; multiloculated cystic adnexal neoplasm; prognosis; tubuloalveolar ductal structures.

Figure 1

axial MRI scan of the left hand showing the DPC at the level of the fifth MCP joint.

Figure 2

coronal MRI scan of the left hand showing the DPC at the level of the fifth MCP joint.

Figure 3

surgically excised DPC. The DPC lesion was excised from the ulnar aspect of the left palm at the level of the fifth MCP joint. The lesion was ~2 cm in diameter and well circumscribed with a dark brown gelatinous appearance.