Treatment of Metastatic Sweat Gland Carcinomas: Response in Two Cases

Sweat gland carcinomas are a rare group of tumors with the potential of destructing local tissue infiltration as well as regional and distant metastasis. Due to the limited availability of reference from the literature, the management of sweat gland carcinomas is both complex and cumbersome. Sweat gland carcinomas can be divided into eccrine and apocrine categories and occur primarily in adult patients, with a peak incidence during the fifth and sixth decades [1-2]. The majority of sweat gland carcinomas occur in the genital skin and perineum, followed by the trunk, head, neck and lower extremities. Regional and distant lymph node metastases frequently occur in a certain number of patients, but visceral metastases are seldom found. The metastasis sites mainly include lymph nodes, lungs and bone [3-5]. According to the available literature, radical surgical excision is the prior and standard treatment with the clearance of draining lymph nodes [6]. Some chemotherapeutic drugs, such as fluoropyrimidines, taxanes and cisplatin, have been reported to be active agents for metastatic sweat gland carcinomas [2,7-8]. However, the effect of adjuvant chemotherapy and radiotherapy remain elusive, and classical standards of diagnosis and therapy are still not clarified. Here, we report two cases of metastatic sweat gland carcinomas. In one case, the remission of nearly 6 months was achieved through chemotherapy of GP regimen; while in another case, the size of draining axillary lymph nodes was effectively controlled by oral administration of tamoxifen.


Introduction
Sweat gland carcinomas are a rare group of tumors with the potential of destructing local tissue infiltration as well as regional and distant metastasis. Due to the limited availability of reference from the literature, the management of sweat gland carcinomas is both complex and cumbersome. Sweat gland carcinomas can be divided into eccrine and apocrine categories and occur primarily in adult patients, with a peak incidence during the fifth and sixth decades [1][2]. The majority of sweat gland carcinomas occur in the genital skin and perineum, followed by the trunk, head, neck and lower extremities.
Regional and distant lymph node metastases frequently occur in a certain number of patients, but visceral metastases are seldom found. The metastasis sites mainly include lymph nodes, lungs and bone [3][4][5]. According to the available literature, radical surgical excision is the prior and standard treatment with the clearance of draining lymph nodes [6]. Some chemotherapeutic drugs, such as fluoropyrimidines, taxanes and cisplatin, have been reported to be active agents for metastatic sweat gland carcinomas [2,[7][8]. However, the effect of adjuvant chemotherapy and radiotherapy remain elusive, and classical standards of diagnosis and therapy are still not clarified. Here, we report two cases of metastatic sweat gland carcinomas. In one case, the remission of nearly 6 months was achieved through chemotherapy of GP regimen; while in another case, the size of draining axillary lymph nodes was effectively controlled by oral administration of tamoxifen.
©2019 The Authors. Published by the JScholar under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/ by/3.0/, which permits unrestricted use, provided the original author and source are credited.

Case 1
A 58-year-old patient, who presented fever and an apparent weight loss for two months duration, was registered in October 2014. Six months ago, the patient firstly noted a small single nodular lesion in the middle of his abdomen. Without regional lymph node dissection the patient accepted radiother- With the rapid progress of metastatic lesions for the following two months, the patient later died on May 15 due to complications A long survival (more than thirteen months) and a remarkable remission (nearly 6 months) were achieved.
The lesion was excised without draining lymph node dissection in June 2014.CT manifested enlarged bilateral axillary lymph nodes after surgery.
CT scanning showed swelling bilateral axillary lymph nodes, particularly on the left side, and metastasis to the liver, lungs, left adrenal and retroperitoneal lymph nodes.
The size of the swelling lymph nodes in bilateral axilla was obviously reduced.

Case 2
A 71-year-old patient registered in the oncology in patient department presented enlargement of regional lymph     nodes for the past one month. One month ago, he noticed that a small single nodular lesion located in the up-right abdomen for many years was gradually increasing in size with a rough surface.
The lesion was locally excised without draining lymph node dissection in March 2018. He only accepted radiotherapy from the primary surgical bed due his old age and history of cerebrovascular diseases. However, he did not insist on radiotherapy after There has been a report about the successful therapy of using adjuvant tamoxifen for metastatic sweat gland adenocarcinoma in an old female patient with ER(+) [9]. Here, we empirically applied tamoxifen citrate therapy, aiming to partly change the course of the disease. The therapy prevented the further increase in the size of the axillary lymph nodes, indicating the possible substantial therapeutic benefit of antiestrogen therapy [9][10]. Therefore, monitoring the hormone receptor expression in these neoplasms regularly will be of great significance, and the benefit of adjuvant anti-hormonal therapy in sweat gland adenocarcinoma should be further assessed.
In this paper, two cases of metastatic sweat gland carcinoma have been reported owing to the rarity and significant outcomes. A complete remission of six months duration was achieved for one patient, and a status of stable disease was achieved for another patient.
Due to the small number of reported cases, prognostic factors of sweat gland carcinomas, which possibly include lesion size, histological type, lymph node involvement and distant metastasis, are difficult to identify.
In October 2014,the pictures were not taken. However, the lesion of the patient after radiotherapy from the primary surgical bed remained unchanged as shown in the following pictures. Mean while, there was a small single nodular lesion in the middle of his abdomen.
Hence, larger and group-wide trials are needed to prospectively evaluate the application of chemotherapy and help the identification of these prognostic factors in advanced sweat gland carcinomas.