A 45-year-old man presented to the surgical wing with swelling in the right axilla of 2 months duration. There was a past history of pulmonary tuberculosis, two years back, for which patient had taken anti tubercular treatment. On examination the thyroid, breasts, chest, abdomen, and per rectal examinations were normal. Examination of axilla revealed a tiny, indurated, non tender, pink skin nodule of about 5 mm diameter (figure 1) with multiple, firm, non tender, discrete, axillary lymph nodes measuring 1 to 4 cm.
Hematological and biochemical investigations were within normal limits. Chest roentgenogram showed healed tubercular lesion in right apical area. A contrast enhanced computerized tomographic scan (CECT) of the chest and fiber optic bronchoscopy was carried out which did not reveal any significant pathology except healed fibro cavitatory lesion in the right apex. Ultrasound examination of both the breasts, and abdomen was essentially normal. Fine needle aspiration cytology (FNAC) from the axillary lymph node revealed metastatic adenocarcinoma. Excision biopsy of the lymph node and suspected primary skin lesion was performed which revealed metastatic sweat gland adenocarcinoma with solid and glandular pattern (figure 2). The tumor cells were Periodic Acid Schiff (PAS) positive, diastase sensitive and were estrogen receptor negative. A diagnosis of sweat gland adenocarcinoma, probably of eccrine origin was made. An axillary lymph node dissection along with excision of the previous scar was carried out. While raising the upper skin flap two-satellite cutaneous nodules each measuring, 2-3 mm in diameter, were found and were excised en bloc. Histological examination of the resected specimen confirmed the diagnosis of metastatic sweat gland adenocarcinoma of eccrine origin. Patient had an uneventful recovery and is disease free after two years of follow-up.