Microscopic examination of the first biopsy specimen showed a small solid and cystic deep dermal tumor (Figure 2). There was a pseudocolumnar and columnar epithelial lining of the cystic space with areas of papillary projections composed of monomorphous cells. Some of the cells lining the cystic space showed decapitation secretions, and in the lumen there was a small solid sheet of uniform cells without clinically significant atypia. There was evidence of poor glandular formation and few mitotic figures. Clinical and histopathologic diagnosis was consistent with ADPAC.