A case of eccrine carcinoma presenting with neurological manifestations

ABSTRACT

INTRODUCTION: Eccrine  carcinoma  is  an  extremely  rare  skin tumor where only 1/13000 specimens have been submitted to dermatopathological  laboratories  in  the  United  States.There  is  no  data  yet  to compare the Philippines with the international  incidence  of  eccrine  carcinoma.  This is a case of a 69-year-old Filipino female who presented with a recurring invasive indolent tumor at the right fronto-parietal area who presented with left sided hemiparesis and seizure.CASE The patient was presented with a recurrent invasive indolent  mass  on  her  right  front-parietal  area,  grossly measuring five by four centimeters, nodular flesh colored,which  extended  intracranially.This was associated with left sided hemiparesis and due to the extent of the tumor encroaching through the brain parenchyma, patient was noted  to  have  seizure  episodes.  The  patient  was  given surgical and radiologic options however, she did not comply and died last December 2015.RESULTS: A cranial MRI with MRA showed a  heterogenous enhancing intracranial mass with extracranial component with compressed entrapped and depressed superior sagittal sinus  by  the  axial  mass  witin  calvarial  penetration  and scalp involvement compressing on the right parietal lobe with parenchyma edema. Biopsy was eventually done and findings were consistent with an eccrine carcinoma.CONCLUSION: This is the first case of eccrine carcinoma in our institution. Due to the paucity of data, there are no guidelines to the management of an eccrine carcinoma. Hence the imperative need to raise awareness regarding this rare tumor because,  without  a  high  index  of  suspicion  this  rare  entity may be overlooked or misdiagnosed. When presented with an indolent invasive recurrent tumor a high index of suspicion that  an  eccrine  Carcinoma  may  be  suspected.Excision biopsy may be done for correct identification of the tumor.