sweat gland carcinoma ( sgc ) is a rare tumor particularly over scalp , which was reported first in 1865 .
the treatment of choice is wide excisional biopsy , with extensive excision and regional lymph node dissection .
we report a case of 42-year - old female with ulcerative lesion over scalp since 6 months proved as sgc on histopathology with local spread to cervical lymph nodes without any bony infiltration .
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 . on 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 [ figure 1 ] .
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 [ figure 2 ] .
ulcer with irregular and unhealthy margin , serous discharge and slough over the occipital region of scalp well - defined round to oval ulcer ( a ) with purulent discharge on left side ( b ) eschar formation on right side routine 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 .
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 [ figure 3 ] .
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 .
epidermal ulceration , malignant epithelial cells arranged in cribriform pattern , nest , cords and in strands , h and e , ( a ) 4 , ( b ) 10 ( c ) tumor island with central necrosis in strands .
pleomorphic cells with round to oval nuclei , dispersed chromatin , eosinophilic and indistinct cytoplasm with nulear and nucleolar pleomorhism .
sgc represents a rare group of tumors with potential for destructive local tissue infiltration and regional as well as distant metastasis .
the sweat gland neoplasms comprised 0.05% of all surgical pathological specimens , and only 12% of these tumors are carcinomas .
it is found frequently in the elderly with an average age of about 53 year .
they have been reported to occur at various sites , including eyelids , scalp , foot digits , breast , axilla , and nose .
the majority of the lesions start as painless red or violet papules slowly growing and progressing to form solid nodules infiltrating subcutaneous tissue .
ulceration of skin is uncommon , occurring mainly in recurrent or large lesions at the back or gluteal region .
increase in size , ulceration and bleeding following minor trauma prompts the patients to seek medical advice .
a low incidence of loss of heterozygosity at chromosome 17p has been noticed along with p53 alterations .
sgc are broadly divided into : 
 tumors bearing resemblance to their benign counterpartsthose without or minimal resemblance to their benign counterparts are further classified in to : 
 eccrine adenocarcinomasmucinous eccrine carcinomasadenoid cystic eccrine carcinomasaggressive digital papillary adenoma / carcinoma . 

 
tumors bearing resemblance to their benign counterparts those without or minimal resemblance to their benign counterparts are further classified in to : 
 eccrine adenocarcinomasmucinous eccrine carcinomasadenoid cystic eccrine carcinomasaggressive digital papillary adenoma / carcinoma . 
 
eccrine adenocarcinomas mucinous eccrine carcinomas adenoid cystic eccrine carcinomas aggressive digital papillary adenoma / carcinoma .
sweat gland adenocarcinoma belongs to the latter group and is defined as a tumor without any pathological characteristics .
pathogenesis of this neoplasm is not precisely understood , mainly due to the limited number of case reports .
it usually appears as a moderate to poorly differentiated adenocarcinoma with regional variation , ranging from true ductule formation to an infiltrative anaplastic cellular zone .
the histological features of malignancy are the same as most epithelial tumors , i.e. increased cellularity , enlarged nuclei , cellular pleomorphism and presence of bizarre mitotic figures .
. tumors like sweat gland adenocarcinoma invading bone that are extremely rare has been reported .
tumors show an asymmetry with cords and lobules of polygonal cells , limited to epidermis or extend into dermis .
there will be cystic lumina within tumor nests , nuclear atypia with frequent mitosis and necrosis .
malignant cells have large hyperchromatic , irregularly shaped nuclei and may be multi - nucleated and are rich in glycogen .
the recommended treatment of all subtypes of sweat gland carcinomas is wide surgical excision along with regional lymph node dissection in clinically positive nodes .
prognostic factors for sgc are difficult to identify , again owing to the very small number of reported cases , but includes size , histological type , lymph node involvement , and distant metastasis .
our patient was a middle - aged female , presented with ulcer over scalp which clinically caused confusion , as squamous or basal cell carcinoma ; but histopathology eliminated it to be adenocarinoma of sweat gland , which has spread to regional lymph nodes but not yet infiltrated the bone , with no metastasis elsewhere was present .
adenoid sgc were reported over abdomen , chest , axilla vulva and forearm but not over scalp . a case of sweat gland tumor over arm
two cases of metastatic sweat gland adenocarcinoma one of eccrine and the other one of apocrine origin ) have been reported .
sgc can be considered as clinico - pathological dilemmas with an unpredictable biological behavior , rarely diagnosed clinically .
 sweat gland adenocarcinoma is a rare tumor particularly over scalp . 
 they have potential to be benign as well as distant metastasis . 
 usually presents with papules or nodules . 
 ulcerative morphology is uncommon . wide surigical excision with regional lymph not dissection is the treatment of choice . 
 a 42-year - old female with sweat gland adenocarcinoma of scalp is reported with cervical lymph node involvement . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION