Sweat Gland Adenocarcinoma of Scalp
A 42-year-old female presented in skin out-patient department (OPD) with history of (h/o) of pus filled lesions over scalp which ruptured leading to ulcer formation since almost 6 months. No h/o cough, cold, fever, vomiting, headache or hematuria present. No h/o weight loss, any GIT symptoms, breathlessness, chest pain or eye symptoms present. No H/o DM/HT/BT/TB/epilepsy/asthma/IHD/COPD/thyroid disease.\nOn examination single 4 × 5 cm non-tender ulcer with irregular and unhealthy margin, serous and foul-smelling discharge and slough, present over the occipital region of scalp []. Bilateral cervical lymph nodes enlarged and ruptured forming a well-defined round to oval ulcer of 2-3 cm in size with purulent discharge, rolled margin on left side and pus discharge with eschar formation on right side [].\nRoutine investigations, liver function test (LFT) and renal function test (RFT) were in normal range. Chest X-ray/ECG/USG abdomen and computed tomography (CT) brain was normal. Patient was seronegative with normal venereal disease research laboratory (VDRL). Wedge shaped biopsy done from the ulcer over scalp by surgeon, showed epidermal ulceration, malignant epithelial cells arranged in cribriform pattern, nest, cords and in strands. The cells are pleomorphic with round to oval nuclei and dispersed chromatin, have eosinophilic and indistinct cytoplasm with nuclear and nucleolar pleomorphism. Few cells have foamy vacuolated cytoplasm, zone of necrosis and abnormal mitotic figures. Intraductal necrosis was also noted []. Changes were suggestive of adenocarcinoma of sweat gland over scalp. Wide local excision of ulcer was done with rotational flap and regional lymph node dissection.