An unexpected tumour of the finger: review and management

Abstract

We report the case of digital papillary adenocarcinoma in a patient presenting with a solitary fingertip mass. This rare sweat gland tumour has a frequently inconspicuous clinical course but significant potential for recurrence and metastasis. The prognostic implications therefore highlights the necessity of addressing even benign-appearing lesions with expedience.

Keywords: Digital papillary adenocarcinoma; eccrine tumour; finger mass; hand tumour.

Figure 1.

(a,b) Pre-operative images of the distal right middle finger volar surface. Figure b shows the surface ulceration evident at presentation (black arrow).

Figure 2.

Intraoperative image of specimen excised from right distal fingertip.

Figure 3.

(a) Haemotoxylin and Eosin (H&E) stained section showing an overview of the multinodular, circumscribed and predominantly solid tumour (x2). (b) H&E stained section demonstrating multinodular tumour (green arrows) that is largely solid but with and ductal/tubular structures (red arrows) (x2). (c) H&E section demonstrating cystic spaces (red arrows) with papillary projections (green arrows) and tubules (yellow arrows) (x4). (d) H&E section showing double epithelial layer (x20). (e) Epithelial membrane Antigen (EMA) stain positivity. Expressed by ductal epithelial cells (x20). (f) p63 myoepithelial marker stains positive (x20). (g) S-100 stains weakly positive (black arrows) (x20). (h) H&E stained section demonstrating lymphovascular invasion (LVI) (black arrows) (x10). (i) D2-40 (podoplanin) stained section demonstrates lymphatic endothelium (black arrows) supporting the evidence for LVI (x10). (j) Mitotic figures indicated by yellow arrows (x40).

Figure 4.

(a,b) Photographs indicating the area for excision and appropriate margin for conservative partial amputation through the DIPJ. (c) Photograph of the amputated piece sent for histological confirmation of complete excision.