ArticleFrontiers in oncology2026
Case Report: hidradenocarcinoma presenting with lymph node metastasis: a diagnostic challenge and the pivotal role of morphology.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Hidradenocarcinoma (HAC) is a rare malignant sweat gland tumor. When presenting with lymph node metastasis and an occult primary lesion, diagnosis is often significantly delayed. We report a case of a 58-year-old man with right axillary lymphadenopathy in whom the primary tumor remained elusive despite extensive workup, including two lymph node biopsies, multiple immunohistochemical(IHC) panels, and a PET-CT scan. This led to an initial diagnosis of carcinoma of unknown primary (CUP) and the initiation of empirical chemotherapy. Ultimately, a crucial morphological clue-"features favoring cutaneous sweat gland origin"-was identified on a subsequent biopsy, which prompted a systematic dermatological examination. The subsequent dermatological workup yielded the primary lesion: an 8 × 10 cm hidradenocarcinoma on the back, which was deemed inoperable due to its advanced stage. This case highlights a common diagnostic blind spot for cutaneous origins in CUP and underscores the critical role of meticulous histomorphological analysis when immunohistochemistry is equivocal. We thus advocate for the mandatory inclusion of a comprehensive full-body skin examination in the standard diagnostic protocol for CUP to prevent delays in diagnosing such rare yet treatable skin cancers.
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