Axillary apocrine carcinoma skin : report of a case

The cutaneous apocrine carcinomas are malignant tumors rare adnexal, slowly and preferably located in the axillary growth. A girl aged 24 with no particular medical history was addressed to a right axillary mass slowly evolving for two years, associated with pain in the right upper limb. The echo mammogram had shown a mass in the axilla and supraclavicular and axillary MRI had objectified mass axillary measuring 171mm. Pathological examination with immunostaining was in favor of apocrine carcinoma. The cutaneous apocrine carcinomas are well-known in the mammary glands, but it is difficult to morphologically distinguish between breast cancer and apocrine carcinoma. Pan African Medical Journal. 2016; 23:253 doi:10.11604/pamj.2016.23.253.8121 This article is available online at: http://www.panafrican-med-journal.com/content/article/23/253/full/ © Karima Issara et al. The Pan African Medical Journal ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pan African Medical Journal – ISSN: 19378688 (www.panafrican-med-journal.com) Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net) Case report Open Access


Introduction
The cutaneous apocrine carcinoma is a rare malignant adnexal tumor.They are located preferentially in the axilla.It is difficult to differentiate between cutaneous apocrine carcinoma and cutaneous metastases of mammary adenocarcinomas particular.The prognosis is often marked by a risk of local recurrence and metastatic.We report the case of axillary apocrine carcinoma skin in a girl aged 24.

Patient and observation
This is a girl aged 24, without specific medical history, which arose in consultation for a right axillary mass gradually increasing volume for two years without inflammatory signs operating in a context of conservation general condition.Physical examination revealed a hard mass axillary measuring about 12 cm, attached to the deep plane (Figure 1), associated with muscle weakness throughout the right upper limb and a deficit of the radial nerve realizing the hand drooping appearance.Additional tests in search of the original has been made, a Mammo-ultrasound found a mass the axilla without significant abnormality of both breasts, Axillary MRI objectified a heterogeneous mass right axillary irregular contours measuring 171/88/115 mm embracing and delivering the right axillary artery.Thoraco-abdominal pelvic CT showed no secondary locations.Histological study with immunohistochemistry on biopsy of the mass was in favor of apocrine carcinoma: tumor cells expressed CK7 and CK20 weakly.CD138, CD30, CD3, Melan A, hormone receptors and Hercep Test were negative.The first surgery could not be performed given the involvement of the axillary pedicle.The patient was put on chemotherapy FEC 100.A breast MRI scan done after 6 cycles of chemotherapy objectified axillary mass measuring 161/90 mm coming in contact with the right axillary pedicle remained permeable.Surgery was discussed at this stage but challenged seen the intimate contact of the tumor mass with large axillary vessels.The patient was then put under a kind Weekly Docetaxel chemotherapy at a dose of 24mg / m 2 / week.CONSENT: Written informed consent was obtained from the patient's legal guardians for publication of this case report and any accompanying images.A copy of the written consent is available of review by the editor in chief of this journal.

Discussion
The primary cutaneous apocrine carcinomas are rare malignant adnexal tumors, which grow in zones rich cutaneous apocrine glands, especially the armpit and the vulva [1].They occur most often in the form of nodules or plaques hillocky [2,3].In the literature a hundred cases of cutaneous apocrine carcinomas are reported, mainly located at axillary level [4,5] (Table 1).The cutaneous apocrine carcinoma poses a problem of differential diagnosis with cutaneous metastases of mammary lobular carcinoma [6,7], this difficulty has been highlighted with identification of a number of clinical and histological criteria for the orientation of diagnosis [8] (Table 2).The standard treatment is based on surgery that must be wide with 2-3cm margins [1].Ogata et al. [6] reported a dissection associated with the initial surgery in all patients, returning positive in 89% of cases, suggesting that prophylactic lymph node surgery may improve the prognosis.Thus in absence of any clinical nodal a cleaning must be given in accordance with the size of the lesion, degree of histological differentiation and the presence or absence of vascular invasion.
Regarding adjuvant therapy, the benefit to radiotherapy or chemotherapy is not yet established; our patient had a partial response of less than 25% FEC100 type of chemotherapy without allowing a cancer surgery.But radiotherapy seems to find its indication in cases where a cancer surgery could not be performed due to the anatomical location of the lesion.We have not been able to radiotherapy given the volume of the tumor mass, the lack of published data on tumor response and the dose of 54 Gy critical for brachial plexus underlying.The evolution is usually marked by a loco regional recurrence or metastatic few years after the initial treatment may cause death [2], according Paties et al. [3] among the six patients followed for 2 to 10 years for cutaneous apocrine carcinoma, recurrence was detected in 3 patients whom died.Robson et al. [4] that followed 17 patients between 9 months and 9 years reported a local or metastatic recurrence in 47% of cases and 4 patients died of their disease.

Conclusion
Cutaneous apocrine carcinomas are rare tumors commonly located at axillary level.Give the absence of data on the effectiveness of chemotherapy and radiotherapy, surgery alone a cure.Our case illustrates the care difficulties of this type of tumor when the diagnosis is late and suggests that early diagnosis improves the prognosis.

Table 1 :
Review of cases and cutaneous apocrine carcinoma developments since 1951

Table 2 :
Differential diagnosis of cutaneous apocrine carcinoma between criteria and mammary adenocarcinoma metastasis

Table 1 :
review of cases and cutaneous apocrine carcinoma developments since 1951

Table 2 :
differential diagnosis of cutaneous apocrine carcinoma between criteria and mammary adenocarcinoma metastasis H : homme, F : femme, CK : cytokératine