primary cutaneous apocrine gland carcinoma , a subtype of sweat gland carcinoma , is an extremely rare malignant neoplasm [ 1 , 2 , 3 ] .
most of these neoplasms involve the axilla , but lesions can also occur elsewhere on the skin . most often , they are indolent and slowly developing , but some are rapidly progressive and extremely aggressive [ 1 , 4 , 5 , 6 ] .
the treatment of choice is wide local excision with clear margins , with or without lymph node dissection [ 1 , 3 , 5 , 7 ] .
a 67-year - old man presented to our hospital with an ulcerated nodule in the right axilla measuring 1  0.8 cm .
the nodule had been present for more than 3 years , but only grew in size over the past 6 months . bilateral breast examination , skin examination and complete lymph node survey
were unremarkable . ultrasound examination and a mammogram revealed no significant lesions in either breast , consistent with the physical examination .
microscopic examination revealed a well - to - moderately differentiated adenocarcinoma which contained ductal and glandular structures with obvious apocrine features .
in addition , the cytoplasm of the tumour cells contained pas - positive diastase - resistant granules without iron - staining granules .
the tumour tissue invaded the papillary and reticular dermis and ulcerated the epidermis without extension to the subcutaneous tissue ( fig . 1 , fig .
the immunohistochemical study showed that the tumour cells were positive for ker7 , ema and e - cadherin and negative for cea , sloop and psa .
no oestrogen or progesterone receptors were detected , making the diagnosis of male breast cancer metastaticto the axilla unlikely ( fig .
cutaneous apocrine gland carcinoma , a subtype of sweat gland carcinoma , is a very rare malignant neoplasm arising in areas of high apocrine sweat gland density . to date , only few cases ( about 50 cases ] have been reported in the literature .
these lesions occur primarily in the axilla , but can also occur elsewhere on the skin [ 1 , 2 , 3 9 ] .
apocrine adenocarcinoma usually develops de novo but has also been observed to arise in association with other benign tumours such as apocrine adenoma and apocrine hyperplasia [ 10 , 11 ] .
most of the neoplasms are relatively indolent and slowly developing over months to years , but some are rapidly progressive and extremely aggressive .
they mostly present as nodules or masses 23 cm in size , without any additional symptoms [ 1 , 3 , 5 , 6 ] .
one third of the patients have regional lymph node involvement at diagnosis . also , some patients have died from metastases to the lungs , liver , bone , brain and kidney [ 1 , 3 , 5 ] .
the histologic picture likes as an adenocarcinoma that may be well , moderate or poorly differentiated [ 1 , 3 , 9 ] .
the cytoplasm of the tumour cells contains pas - positive , diastase - resistant granules and often iron - positive granules [ 1 , 7 , 9 , 12 ] .
the differential diagnosis of apocrine gland carcinoma from metastatic mammary adenocarcinoma is not possible on morphological grounds , and immunohistochemistry , except for a few cases , does not allow distinction between them .
malignant sweat gland tumours are often positive for oestrogen and progesterone receptors , and these markers are therefore of limited usage in differential diagnosis [ 1 , 3 , 9 ] .
features that favour the diagnosis of a primary apocrine gland carcinoma are the presence of neoplastic glands high in the dermis , apocrine glands near the tumour and intracytoplasmic granules of iron .
the treatment of choice is wide local excision with clear margins , with or without regional lymph node dissection .
postoperative radiotherapy and chemotherapy in patients with moderately or poorly differentiated tumours have been used as adjunctive treatments but have shown little benefit on mortality [ 1 , 3 , 5 , 13 , 14 ] .
there is a high incidence of local recurrence ( 28% in one report ] , and prophylactic nodal dissection does not reduce the incidence of local recurrence .
primary apocrine carcinoma of sweat glands is a very rare tumour , and there are no guidelines for the treatment of recurrent or metastatic disease .
 cutaneous apocrine gland carcinoma , a subtype of sweat gland carcinoma , is a very rare malignancy , and only few cases have been reported in the literature . 
 many of these carcinomas are indolent and slowly developing , but some are rapidly progressive . 
 the treatment of choice is wide local excision with clear margins , with or without lymph node dissection . 
 we report a case of a 67-year - old man who came to our hospital with an ulcerated nodule in the right axilla measuring 1  0.8 cm . 
 histological evaluation showed features of an apocrine gland carcinoma arising in an area of high apocrine gland density . 
Introduction
Case Report
Discussion