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57歳女性。初診の約2年前に左踵内側の褐色局面に気付いた。以後大きさ, 色調に変化はなかった。当科初診時, 同部に8.9×11.9×1.0mm大の, 淡褐色～褐色の扁平隆起性局面を認めた。全摘して組織学的に検討した。表皮には基底層部にメラノサイトの軽度の増数が見出され, 真皮浅層には顕著な線維化層が広範に認められた。この線維化層の下の真皮中深層部に異型細胞の増殖巣が見出され, 免疫染色にてS-100, MART-1陽性, HMB45陰性であった。組織学的に診断困難であったが, 悪性黒色腫を否定できないと考え, 原発巣の拡大再切除とセンチネルリンパ節生検を施行した。センチネルリンパ節の実質辺縁部にMART-1とHMB45陽性の細胞が数個散在性に見出された。本症例を悪性黒色腫と考え, 原発切除創周囲にインターフェロンβ蛋白の局注を施行している。

We experienced a case of apocrine adenocarcinoma of the left axilla. The patient was an 83-year-old man, who had a reddish indurated plaque, 26×26×6mm in size and partly ulcerated, on his left axilla. Biopsy of the lesion showed the features of adenocarcinoma. Because no other neoplasm was found in other organs of the body, we considered the adenocarcinoma as a primary lesion. The patient underwent local resection of the lesion along with lymphnode biopsy under local anesthesia, as he had suffered from cerebral infarction one month before the surgery. Histopathologic examination of the excised lesion revealed features of moderately differentiated adenocarcinoma showing decapitation secretions in glandular structures. The stroma showed marked fibrosis. The diagnosis of apocrine adenocarcinoma was established. The biopsied lymph node revealed metastasis to the node. After the surgery, adjuvant radiotherapy was given to the left axilla. The patient is currently well 24 months after the radiotherapy. [Skin Cancer (Japan) 2003; 18: 165-168]