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Zhang J, He W, Zhang Z, Dong H, Deng X, Wen Q, Li D. Skin metastasis from ovarian cancer with somatic BRCA1 mutation: A case report and literature review. Oncol Lett 2024; 28:348. [PMID: 38872856 PMCID: PMC11170256 DOI: 10.3892/ol.2024.14481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/08/2024] [Indexed: 06/15/2024] Open
Abstract
Skin metastasis from ovarian cancer is rare, and its prognosis is poor. Effective therapeutic strategies are currently lacking, but the combination of various treatment methods shrink the tumor and relieve symptoms. The present study reports a rare case of advanced ovarian cancer with skin metastases and intestinal wall thickening, along with a BRCA1 DNA repair associated (BRCA1) mutation. After standard first-line treatment and non-standard second-line treatment, the patient developed skin metastases. The patient's skin itching, pain and lesions were completely relieved after administering bevacizumab in combination with paclitaxel and carboplatin. After 4 months, skin metastases recurred along with anal distension during maintenance treatment with oral poly(ADP ribose) polymerase (PARP) inhibitors. The patient was treated again with bevacizumab combined with docetaxel, and the anal distension was significantly relieved. Angiogenesis therapy combined with chemotherapy is effective, but that the disease-free survival time is short, and PARP inhibitor maintenance effect is limited even in cases with a BRCA1 gene mutation.
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Affiliation(s)
- Jingheng Zhang
- Department of Oncology, Affiliated Hospital of Clinical School of Medicine, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
- Department of Oncology, Luzhou People's Hospital, Luzhou, Sichuan 646000, P.R. China
| | - Wenfeng He
- Department of Oncology, Affiliated Hospital of Clinical School of Medicine, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Zhenhua Zhang
- Department of Oncology, Affiliated Hospital of Clinical School of Medicine, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Hui Dong
- Department of Pathology, Affiliated Hospital of Clinical School of Medicine, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Xiangyu Deng
- Department of Oncology, Affiliated Hospital of Clinical School of Medicine, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Qinglian Wen
- Department of Oncology, Affiliated Hospital of Clinical School of Medicine, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610044, P.R. China
| | - Dan Li
- Department of Oncology, Affiliated Hospital of Clinical School of Medicine, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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Peng R, Wu W, Li X, Zhou Y, Su J, Wang H. Fingertip cutaneous metastasis of salivary duct carcinoma secondary to scald: A unique case report and a brief review of literature (following CARE guidelines). Medicine (Baltimore) 2024; 103:e38965. [PMID: 39029008 DOI: 10.1097/md.0000000000038965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
RATIONALE Salivary duct carcinoma (SDC) is an aggressive form of cancer, with cutaneous metastasis being a rare occurrence. Furthermore, cutaneous metastasis of SDC secondary to a scald is even rarer, and to the best of our knowledge, our case represents the first such instance. Considering the involvement of the fingers in the metastatic site, which may affect limb function and quality of life, we present this case to explore the reason why scald could lead to distant recurrence and better treatment options. PATIENT CONCERNS An 85-year-old man diagnosed with SDC in the parotid gland found enlarged masses at the fingertips as a consequence of a burn, 6 years after his initial treatment. DIAGNOSES Cutaneous metastasis of SDC in the parotid gland and left thumb loss due to surgery. INTERVENTIONS Radiotherapy was offered, targeting at the masses on the fingers, with dose at 15 Gy in 3 fractions, 12 Gy in 3 fractions, 15 Gy in 3 fractions for both hands and additional 21 Gy in 7 fractions only for left hand. OUTCOMES The tumors shrank after 2 months of radiotherapy and the patient recovered well. Side effects included nail hyperplasia and paronychia. LESSONS Connections between scald and distant metastasis of malignant tumors in this case needed further investigation. Considering reserving function of the fingers while dealing with metastasis, radiotherapy is recommended rather than surgery.
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Affiliation(s)
- Ran Peng
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Wenqi Wu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, People's Republic of China
- Peking University Health Science Center, Beijing, People's Republic of China
| | - Xuemin Li
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Yang Zhou
- Department of Radiation Oncology, Da Qing Long Nan Hospital, Daqing City, Heilongjiang Province, People's Republic of China
| | - Jing Su
- Department of Pathology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, People's Republic of China
- Cancer Center, Peking University Third Hospital, Beijing, People's Republic of China
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3
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Kapoor M, Sundriyal D, Sehrawat A, Khanna M. Carcinoma en Cuirasse as the heralding sign of underlying HER-2 positive male breast cancer. BMJ Case Rep 2024; 17:e259535. [PMID: 38977320 DOI: 10.1136/bcr-2023-259535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
Carcinoma en cuirasse (CeC) is an uncommon presentation of metastatic cutaneous carcinoma, most often originating from breast carcinoma. We present a case study of a man in his 30s exhibiting progressive skin thickening over the left chest, alongside appetite and weight loss. On examination, the patient had painless skin induration and palpable, matted, hard, immobile and non-tender axillary, cervical and inguinal lymphadenopathy. Imaging revealed metabolically active left cervical, retro pectoral, inguinal and bilateral axillary lymph nodes with muscle involvement, likely neoplastic. Histopathology demonstrated metastatic carcinoma, morphologically originating from the breast. CeC most often presents after therapy, but our case reveals that it may be a presenting sign of an occult malignancy. CeC should be differentiated from non-oncological causes of skin thickening. Detailed history, physical examination and appropriate radiological investigations are essential. Although rare in young individuals, neoplastic aetiology should be considered if the history and physical examination suggest it.
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Affiliation(s)
- Mayank Kapoor
- Medical Oncology and Hematology, All India Institute of Medical Sciences-Rishikesh, Dehradun, Uttarakhand, India
| | - Deepak Sundriyal
- Medical Oncology and Hematology, All India Institute of Medical Sciences-Rishikesh, Dehradun, Uttarakhand, India
| | - Amit Sehrawat
- Medical Oncology and Hematology, All India Institute of Medical Sciences-Rishikesh, Dehradun, Uttarakhand, India
| | - Mridul Khanna
- Medical Oncology and Hematology, All India Institute of Medical Sciences-Rishikesh, Dehradun, Uttarakhand, India
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Gschnell M, Volberg C, Hauser C, Krönig L. Cutaneous metastases: From epidemiology to therapy. J Dtsch Dermatol Ges 2024; 22:974-993. [PMID: 38888379 DOI: 10.1111/ddg.15342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 11/20/2023] [Indexed: 06/20/2024]
Abstract
Cutaneous metastases are seen in up to 10% of all oncology patients and can occur in different locations depending on the entity. Cutaneous metastases are often associated with a high psychological burden and, especially in the case of exulceration, with shame and social withdrawal. This review discusses the diagnostic and therapeutic options. The most common tumor entities in which cutaneous metastases are observed are discussed, and local and systemic treatment options are presented according to the current state of research.
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Affiliation(s)
- Martin Gschnell
- Department of Dermatology and Allergology, University Hospital of Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Volberg
- Department of Anesthesia and Intensive Care, University Hospital of Marburg, Philipps University Marburg, Marburg, Germany
- Research Group Medical Ethics, Department of Human Medicine, Philipps University Marburg, Marburg, Germany
| | - Christina Hauser
- Department of Dermatology and Allergology, University Hospital of Marburg, Philipps University Marburg, Marburg, Germany
| | - Lisa Krönig
- Department of Dermatology and Allergology, University Hospital of Marburg, Philipps University Marburg, Marburg, Germany
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Becker SL, Kody S, Fett NM, Hines A, Alavi A, Ortega-Loayza AG. Approach to the Atypical Wound. Am J Clin Dermatol 2024; 25:559-584. [PMID: 38744780 DOI: 10.1007/s40257-024-00865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
The heterogeneity of atypical wounds can present diagnostic and therapeutic challenges; however, as the prevalence of atypical wounds grows worldwide, prompt and accurate management is increasingly an essential skill for dermatologists. Addressing the underlying cause of an atypical wound is critical for successful outcomes. An integrated approach with a focus on pain management and patient engagement is recommended to facilitate enduring wound closure. Advances in treatment, in addition to further research and clinical training, are necessary to address the expanding burden of atypical wounds.
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Affiliation(s)
- Sarah L Becker
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Shannon Kody
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Nicole M Fett
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | | | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA.
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Tiodorovic D, Stojkovic-Filipovic J, Marghoob A, Argenziano G, Puig S, Malvehy J, Tognetti L, Pietro R, Akay BN, Zalaudek I, Haenssle HA, Müller-Christmann C, Cinotti E, Perrot JL, Zaballos P, Bakos RM, Thomas L, Peris K, Lallas A, Apalla Z, Kreusch JF, Tromme I, Stratigos AJ, Pizzichetta MA, Kandolf L, Longo C, Blum A, Tanaka M, Hofmann-Wellenhof R, Jovic A, Paoli J, Buljan M, Espasandín-Arias M, Cabo H, Saa SR, Salerni G, Nazzaro G, Kaminska-Winciorek G, Damiani G, Geszti F, Kittler H. Dermatoscopic patterns of cutaneous metastases: A multicentre cross-sectional study of the International Dermoscopy Society. J Eur Acad Dermatol Venereol 2024; 38:1432-1438. [PMID: 38483241 DOI: 10.1111/jdv.19962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/14/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND The detection of cutaneous metastases (CMs) from various primary tumours represents a diagnostic challenge. OBJECTIVES Our aim was to evaluate the general characteristics and dermatoscopic features of CMs from different primary tumours. METHODS Retrospective, multicentre, descriptive, cross-sectional study of biopsy-proven CMs. RESULTS We included 583 patients (247 females, median age: 64 years, 25%-75% percentiles: 54-74 years) with 632 CMs, of which 52.2% (n = 330) were local, and 26.7% (n = 169) were distant. The most common primary tumours were melanomas (n = 474) and breast cancer (n = 59). Most non-melanoma CMs were non-pigmented (n = 151, 95.6%). Of 169 distant metastases, 54 (32.0%) appeared on the head and neck region. On dermatoscopy, pigmented melanoma metastases were frequently structureless blue (63.6%, n = 201), while amelanotic metastases were typified by linear serpentine vessels and a white structureless pattern. No significant difference was found between amelanotic melanoma metastases and CMs of other primary tumours. CONCLUSIONS The head and neck area is a common site for distant CMs. Our study confirms that most pigmented melanoma metastasis are structureless blue on dermatoscopy and may mimic blue nevi. Amelanotic metastases are typified by linear serpentine vessels and a white structureless pattern, regardless of the primary tumour.
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Affiliation(s)
- Danica Tiodorovic
- Clinic of Dermatovenerology, University Clinical Center of Nis, Medical Faculty, University of Nis, Nis, Serbia
| | - Jelena Stojkovic-Filipovic
- Clinic of Dermatology and Venereology, University Clinical Center of Serbia, Faculty of Medicine, Department of Dermatology and Venereology, University of Belgrade, Belgrade, Serbia
| | - Ashfaq Marghoob
- Memorial Sloan Kettering Cancer Center, Uniondale, New York, USA
| | | | - Susana Puig
- Dermatology Department, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Josep Malvehy
- Dermatology Department, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Linda Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Rubegni Pietro
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Bengu Nisa Akay
- Medicine Faculty Department of Dermatology, Ankara University, Ankara, Turkey
| | - Iris Zalaudek
- Department of Dermatology and Venerology, Medical University of Trieste, Trieste, Italy
| | - Holger A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | | | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Jean Luc Perrot
- Department of Dermatology, CHU Saint Etienne, Saint-Etienne, France
| | - Pedro Zaballos
- Dermatology Department, Hospital de Sant Pau i Santa Tecla, Tarragota, Spain
| | - Renato Marchiori Bakos
- Department of Dermatology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul-Porto Alegre, Porto Alegre, Brazil
| | - Luc Thomas
- Department of Dermatology, Centre Hospitalier Lyon Sud, Lyons Cancer Research Center, Lyon 1 University, Lyon, France
| | - Ketty Peris
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Aimilios Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Zoe Apalla
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | | | - Isabelle Tromme
- Department of Dermatology and Melanoma Clinic St Luc Hospital, Catholic, University of Louvain, Brussels, Belgium
| | | | - Maria Antonietta Pizzichetta
- Department of Dermatology, University of Trieste, Aviano, Italy
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Lidija Kandolf
- Department of Dermatology and Venereology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emili, Modena, Italy
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Andreas Blum
- Public, Private and Teaching Practice of Dermatology, Konstanz, Germany
| | - Masaru Tanaka
- Department of Dermatology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | | | - Andrija Jovic
- Clinic of Dermatovenerology, University Clinical Center of Nis, Nis, Serbia
| | - John Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, Region Västra Götaland, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Marija Buljan
- Department of Dermatology and Venereology, Sestre Milosrdnice University Hospital Centre, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Horacio Cabo
- University of Buenos Aires, Buenos Aires, Argentina
| | | | - Gabriel Salerni
- Department of Dermatology, Hospital Provincial del Centenario, National University of Rosario, Rosario, Argentina
| | - Gianluca Nazzaro
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Grazyna Kaminska-Winciorek
- Department of Bone Marrow Transplantation and Hematology-Oncology; Skin Cancer and Melanoma Team, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Giovanni Damiani
- Italian Center of Precisione Medicine and Chronic Inflammation Milan, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | - Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Dicu-Andreescu IG, Marincaș MA, Simionescu AA, Dicu-Andreescu I, Prunoiu VM, Ionescu SO, Neicu ȘA, Radu GM, Brătucu E, Simion L. Abdominal Parietal Metastasis from Cervical Cancer: A Review of One of the Most Uncommon Sites of Recurrence Including a Report of a New Case. Life (Basel) 2024; 14:667. [PMID: 38929651 PMCID: PMC11204997 DOI: 10.3390/life14060667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Cervical cancer is the fourth most common cancer in women, the highest mortality being found in low- and middle-income countries. Abdominal parietal metastases in cervical cancer are a very rare entity, with an incidence of 0.1-1.3%, and represent an unfavorable prognostic factor with the survival rate falling to 17%. Here, we present a review of cases of abdominal parietal metastasis in recent decades, including a new case of a 4.5 cm abdominal parietal metastasis at the site of the scar of the former drain tube 28 months after diagnosis of stage IIB cervical cancer (adenosquamous carcinoma), treated by external radiotherapy with concurrent chemotherapy and intracavitary brachytherapy and subsequent surgery (type B radical hysterectomy). The tumor was resected within oncological limits with the histopathological result of adenosquamous carcinoma. The case study highlights the importance of early detection and appropriate treatment of metastases in patients with cervical cancer. The discussion explores the potential pathways for parietal metastasis and the impact of incomplete surgical procedures on the development of metastases. The conclusion emphasizes the poor prognosis associated with this type of metastasis in cervical cancer patients and the potential benefits of surgical resection associated with systemic therapy in improving survival rates.
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Affiliation(s)
- Irinel-Gabriel Dicu-Andreescu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Marian-Augustin Marincaș
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Anca-Angela Simionescu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
| | - Ioana Dicu-Andreescu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
| | - Virgiliu-Mihail Prunoiu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Sânziana-Octavia Ionescu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Ștefania-Ariana Neicu
- Department of Pathological Anatomy, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Gabriela-Mădălina Radu
- Department of Pathological Anatomy, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Eugen Brătucu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Laurențiu Simion
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
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Torre-Castro J, Ríos-Viñuela E, Balaguer-Franch I, Díaz de Lezcano I, Aguado-García Á, Nájera L, Suárez D, Requena L. Perineural Infiltration: A Comprehensive Review of Diagnostic, Prognostic, and Therapeutic Implications. Am J Dermatopathol 2024; 46:271-286. [PMID: 38457673 DOI: 10.1097/dad.0000000000002667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
ABSTRACT Perineural infiltration refers to a neoplastic cell involvement in, around, and through the nerves. It is considered as one of the neoplastic dissemination pathways. Thus, its identification is crucial to establish the prognosis of some malignant skin neoplasms, such as squamous cell carcinoma, and explains the locally aggressive behavior of cutaneous neoplasms, such as microcystic adnexal carcinoma. We have conducted a review of malignant and benign skin tumors in which perineural infiltration has been described, and we also discuss some histopathological findings that may simulate perineural infiltration.
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Affiliation(s)
- Juan Torre-Castro
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Elisa Ríos-Viñuela
- Department of Dermatology, Instituto Valenciano de Oncología, Escuela de Doctorado Universidad Católica de Valencia, Valencia, Spain
| | | | | | | | - Laura Nájera
- Department of Pathology, Puerta de Hierro University Hospital, Universidad Autónoma, Majadahonda, Madrid, Spain
| | - Dolores Suárez
- Department of Pathology, Puerta de Hierro University Hospital, Universidad Autónoma, Majadahonda, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Wang KL, Crum OM, Swanson AA, Johnson EF. Cutaneous metastasis of uterine carcinosarcoma mimicking drug eruption. JAAD Case Rep 2024; 47:44-46. [PMID: 38645799 PMCID: PMC11033079 DOI: 10.1016/j.jdcr.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Affiliation(s)
- Katherine L. Wang
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Olivia M. Crum
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Amy A. Swanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Emma F. Johnson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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10
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Onalaja-Underwood AA, Sokumbi O. Eruptive Papules as a Cutaneous Manifestation of Metastatic Prostate Adenocarcinoma. Am J Dermatopathol 2023; 45:828-830. [PMID: 37883967 DOI: 10.1097/dad.0000000000002559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
ABSTRACT Cutaneous metastasis from prostate cancer is a rare manifestation, occurring in less than 1% of all cases of prostate cancer. Prostate cancer metastasis occurs most often in lymph nodes and bones. In this study, we present the case of a 55-year-old man with prostate adenocarcinoma and progressive papules on his left chest that developed shortly after androgen deprivation therapy was initiated. This case emphasizes the significance of considering cutaneous metastasis in the diagnostic differential when assessing patients with a history of cancer and the need to thoroughly evaluate these cases.
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Affiliation(s)
| | - Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL
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11
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Ghantarchyan H, Abbas N, Lewis A, Chamanadjian C, Kambiz R. A Rare Presentation of Metastatic Breast Cancer Manifesting As Diffuse Nodular Skin Lesions. Cureus 2023; 15:e49633. [PMID: 38161904 PMCID: PMC10755805 DOI: 10.7759/cureus.49633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
We present a 63-year-old African American female with a prior medical history of gastroesophageal reflux disease (GERD) and uterine fibroids whose primary concern was vaginal bleeding. She had no prior medical care established, and the last mammogram was conducted 10 years prior with normal results. She has had multiple ED visits for symptoms of reflux and vaginal bleeding and has been discharged with a primary care follow-up referral each time. On physical exam, there was evidence of nodular skin lesions, tightening of the skin on her face, neck, and back, as well as nodular skin lesions on her neck, back, chest, and abdomen, notably progressing in number, not in size, in a caudal fashion. Further exam findings included telangiectasias predominantly on her right hand. On initial laboratory studies, she was hypercalcemic with an elevated calcium level of 13 mg/dL. Initial imaging included a CT scan of her chest, abdomen, and pelvis, which revealed pulmonary embolism and uterine fibroids, with the largest measuring 5.9 x 4.3 x 5.3 cm, as well as bilateral breast masses noted to be a BI-RADS 3 on ultrasound. A skin biopsy completed early on in the hospitalization revealed metastatic breast cancer, specifically high-grade, poorly differentiated infiltrating mammary carcinoma of the lobular type. Similarly, a right breast mass biopsy illustrated resemblant findings, specifically invasive mammary carcinoma with mixed ductal and lobular features. She was ultimately treated with ribociclib and fulvestrant (KR1) and discharged from the hospital with oncology and primary care follow-up.
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Affiliation(s)
| | - Nia Abbas
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Azaria Lewis
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | | | - Raoufi Kambiz
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
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Souza BDCE, Miyashiro D, Pincelli MS, Sanches JA. Cutaneous metastases from solid neoplasms - Literature review. An Bras Dermatol 2023; 98:571-579. [PMID: 37142464 PMCID: PMC10404505 DOI: 10.1016/j.abd.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 05/06/2023] Open
Abstract
Cutaneous metastases from solid tumors are uncommon events in clinical practice. Most of the time, the patient already has the diagnosis of a malignant neoplasm when the cutaneous metastasis is detected. However, in up to one-third of cases, cutaneous metastasis is identified before the primary tumor. Therefore, its identification may be essential for starting treatment, although it is usually indicative of poor prognosis. The diagnosis will depend on clinical, histopathological, and immunohistochemical analysis. Sometimes the identification of the primary site is difficult; however, a thorough analysis using imaging tests and constant surveillance is important.
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Affiliation(s)
- Bruno de Castro E Souza
- Department of Dermatology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Denis Miyashiro
- Department of Dermatology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcella Soares Pincelli
- Department of Dermatology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Antonio Sanches
- Department of Dermatology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
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13
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Niebel D, Kranert P, Berneburg M, Drexler K, Eichborn MI, Braess J, Allgäuer M, Karrer S. Indurated erythema of abdominal skin: An unusual presentation of metastatic endometrial carcinoma—Case report with literature review. SKIN HEALTH AND DISEASE 2022; 3:e136. [PMID: 37013123 PMCID: PMC10066756 DOI: 10.1002/ski2.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/07/2022]
Abstract
Carcinoma erysipelatoides (CE) is a rare clinical manifestation of cutaneous metastasis, which mimics inflammatory conditions such as erysipelas. Depending on the site of the originating tumour, unusual manifestations involving different sites of the body may occur. We herein report a case of a 60-year-old female patient with metastatic endometrial carcinoma presenting as CE of the abdominal skin and the inguinal folds. Even though the diagnosis of advanced malignancy had been established before and she was currently receiving chemotherapy (carboplatin and paclitaxel), the clinical appearance closely resembled fungal (candidal intertrigo) and consecutively bacterial (erysipelas) infection, which resulted in treatment with antimycotics and antibiotics at first. Dermatohistopathological examination of skin biopsies revealed a diffuse and nodular infiltrate of pleomorphic atypical tumour cells with strong expression of cytokeratin 7 and PAX8, also detectable within lymphatic vessels. Therapy comprised antiseptic ointments to prevent superinfection, palliative electron beam radiation and supportive care. Since there were no targetable KRAS-, NRAS- and BRAF-gene mutations, systemic therapy was switched to checkpoint inhibition (pembrolizumab) in combination with lenvatinib. The overall prognosis of cutaneous metastasis of endometrial carcinoma is dismal with most patients succumbing to disease within few months. Similarly, our patient died after 3 months due to sepsis in the course of malignant pleural effusion. We aim to highlight the possibility of unusual sites of CE and the risk of respective clinical misdiagnoses.
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Affiliation(s)
- Dennis Niebel
- Department of Dermatology University Hospital Regensburg Regensburg Germany
| | - Paula Kranert
- Department of Dermatology University Hospital Regensburg Regensburg Germany
| | - Mark Berneburg
- Department of Dermatology University Hospital Regensburg Regensburg Germany
| | - Konstantin Drexler
- Department of Dermatology University Hospital Regensburg Regensburg Germany
| | | | - Jan Braess
- Clinic for Oncology and Hematology Krankenhaus der Barmherzigen Brüder Regensburg Germany
| | - Michael Allgäuer
- Clinic for Radiation Therapy Krankenhaus der Barmherzigen Brüder Regensburg Germany
| | - Sigrid Karrer
- Department of Dermatology University Hospital Regensburg Regensburg Germany
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14
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Zhang RY, Zhu SJ, Xue P, He SQ. Cutaneous metastasis from esophageal squamous cell carcinoma: A case report. World J Clin Cases 2022; 10:4676-4683. [PMID: 35663085 PMCID: PMC9125271 DOI: 10.12998/wjcc.v10.i14.4676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/27/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal cancer is a common cause of cancer-related death worldwide. Cutaneous metastasis of esophageal squamous cell carcinoma is rare, particularly in diffuse skin metastasis. CASE SUMMARY In this case report, we describe an 82-year-old male who was diagnosed with esophageal squamous cell carcinoma. The tumor was staged as T4N3M1 (Stage IVB). The pathological findings revealed poorly differentiated squamous cell carcinoma of the esophagus. Four months after diagnosis, the patient began chemotherapy, and symptoms were relieved after four cycles of chemotherapy. After that, the patient returned home without a systematic physical examination. One year after diagnosis, the patient realized that the skin of the abdominal wall was hard and rough without pain, and the color became darker than normal skin. Thirteen months after diagnosis, a biopsy of the patient's abdominal lesion revealed that the skin metastasis was derived from the esophagus. Then the patient received two cycles of apatinib combined with docetaxel, but the abdominal lesion worsened. Two cycles of nivolumab were administered, but the patient eventually died of multiple organ failure. CONCLUSION This report highlights cutaneous metastasis as a late and untreatable metastasis of esophageal cancer.
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Affiliation(s)
- Rui-Yan Zhang
- Department of Oncology, Wangjing Hospital, China Academy of Chinese Medicine Sciences, Beijing 100102, China
| | - Shi-Jie Zhu
- Department of Oncology, Wangjing Hospital, China Academy of Chinese Medicine Sciences, Beijing 100102, China
| | - Peng Xue
- Department of Oncology, Wangjing Hospital, China Academy of Chinese Medicine Sciences, Beijing 100102, China
| | - Sheng-Qi He
- Department of Oncology, Wangjing Hospital, China Academy of Chinese Medicine Sciences, Beijing 100102, China
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15
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Petrelli F, Ghidini A, Simioni A, Campana LG. Impact of electrochemotherapy in metastatic cutaneous melanoma: a contemporary systematic review and meta-analysis. Acta Oncol 2022; 61:533-544. [PMID: 34889156 DOI: 10.1080/0284186x.2021.2006776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/11/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Electrochemotherapy (ECT) harnesses electric pulses to enhance cytotoxic drug delivery into tumors and has entered the armamentarium to treat superficially metastatic melanoma. We performed a systematic review and meta-analysis to assess treatment patterns and patient outcomes. METHODS PubMed, Medline, Embase, and the Cochrane Library databases were queried for publication from inception to September 2020. Primary outcome measures were overall and complete response rate (ORR and CRR); secondary outcomes included local control rate (LCR) and overall survival (OS). RESULTS Twenty-seven studies met the selection criteria for a total of 1161 individuals (mean age 71 years) and 5308 tumors (weighted mean size 14 mm). The majority of patients (n = 1124) underwent bleomycin-ECT. Aggregate ORR was 77.6% (95% confidence interval [CI] 71.0 - 83.2%) and CRR 48% (95% CI 42 - 54%), with no significant difference between the route of bleomycin administration (ORR, 69.2 vs. 81.9% following intravenous or intratumoral bleomycin, p = .37) and tumor size (p = .69). When reported (n = 8 studies), 1- and 2-year LCR ranged from 54 to 89% and 72 to 74%, respectively, and 1-year OS (n = 3 studies) from 67 to 89%. CONCLUSIONS ECT with either intratumoral or intravenous bleomycin confers a high therapeutic response in cutaneous metastatic melanoma. Moderate evidence supports its low toxicity and durability of local control.HighlightsElectrochemotherapy (ECT) is associated with a 77% overall response rate (ORR).Intravenous and intratumoral bleomycin are equally effective.There are no relevant toxicity concerns.One-year local tumor control rate ranges from 54 to 89%.Current literature has significant variation in reporting.
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Affiliation(s)
| | | | - Andrea Simioni
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
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16
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Alsaghyir AA, Alhajress GI, Aldraihem K, Alhaidar A, Nazer AI. Leiomyosarcoma Invading the Vena Cava: A Case Report. Cureus 2022; 14:e22838. [PMID: 35399419 PMCID: PMC8980250 DOI: 10.7759/cureus.22838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/05/2022] Open
Abstract
Leiomyosarcoma is an aggressive soft tissue tumor originating from smooth muscle cells typically of the uterus, gastrointestinal, or genitourinary system. The most common site of leiomyosarcoma of soft tissue is the retroperitoneum, accounting for 50% of all cases. The majority of patients are asymptomatic, which may be due to the large retroperitoneal cavity. However, when symptoms do occur, they are vague in nature. The most common growth pattern is an entirely extravascular mass. We are presenting an interesting case of a 65-year-old lady, who was referred to our hospital as a case of large left retroperitoneal mass with left renal vein thrombosis. She was biopsied and diagnosed with leiomyosarcoma with invasion into descending colon and the left renal vein, which led to renal vein thrombus. In the last few decades, there is a lack of studies about leiomyosarcoma invading the renal vein and Inferior Vena Cava (IVC). As far as we know, the leiomyosarcoma of a major blood vessel is extremely rare. Since leiomyosarcoma often has a late presentation with the advanced stage when detected, a high index of suspicion is needed to be detected early and avoid such a complication.
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17
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Erythematous Nodule on the Upper Back: Answer. Am J Dermatopathol 2022; 44:232-233. [PMID: 35171888 DOI: 10.1097/dad.0000000000002121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Gerhardt CA, Krenitsky A, Ravichandran S, Moore S, Tsai KY, Correa-Selm L. Metastatic prostate cancer masquerading as lymphangioma circumscriptum. JAAD Case Rep 2022; 22:24-26. [PMID: 35282158 PMCID: PMC8904409 DOI: 10.1016/j.jdcr.2022.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Caroline A. Gerhardt
- Morsani College of Medicine, University of South Florida, Tampa, Florida
- Correspondence to: Caroline A. Gerhardt, BS, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Boulevard, Tampa, FL 33612.
| | - Amanda Krenitsky
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida
| | - Sairekha Ravichandran
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Sarah Moore
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Kenneth Y. Tsai
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Lilia Correa-Selm
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
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19
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Li ZH, Wang F, Zhang P, Xue P, Zhu SJ. Diagnosis and guidance of treatment of breast cancer cutaneous metastases by multiple needle biopsy: A case report. World J Clin Cases 2022; 10:345-352. [PMID: 35071538 PMCID: PMC8727255 DOI: 10.12998/wjcc.v10.i1.345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/16/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast cancer patients have a high skin metastasis rate. However, reports on treatment of cutaneous metastases of breast cancer are scarce.
CASE SUMMARY We report the treatment process for one breast cancer case with bone, lung, and skin metastases. The patient was a 43-year-old woman with advanced breast cancer and skin metastasis. She underwent pathological diagnosis by needle biopsy to guide the treatment. When the disease progressed, a new pathological diagnosis was determined by needle biopsy to guide the treatment. The patient received chemotherapy, endocrine therapy, and photodynamic dynamic therapy, followed by sonodynamic therapy.
CONCLUSION Repeated puncture should be performed for advanced breast cancer with skin metastasis, in order to obtain the pathology and directly determine diagnosis when the disease progresses. The treatment should focus on controlling the systemic metastasis, rather than the local disease.
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Affiliation(s)
- Zhong-Hui Li
- Department of Oncology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, Beijing Province, China
| | - Fang Wang
- Department of Oncology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, Beijing Province, China
| | - Ping Zhang
- Department of Pathology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, Beijing Province, China
| | - Peng Xue
- Department of Oncology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, Beijing Province, China
| | - Shi-Jie Zhu
- Department of Oncology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, Beijing Province, China
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20
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Duran J, Plaza JA. Update on Immunohistochemical Techniques in Dermatopathology. A focus on Adnexal Neoplasms. Semin Diagn Pathol 2022; 39:265-287. [DOI: 10.1053/j.semdp.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 11/11/2022]
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21
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Gaw CE, Turn CS, Rheingold SR, Castelo-Soccio L, Tencer J, Gans AS, Scarfone RJ. Scalp Nodules and Facial Droop in an Infant. Pediatrics 2021; 148:peds.2021-049969. [PMID: 34610947 DOI: 10.1542/peds.2021-049969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/24/2022] Open
Abstract
A previously healthy, term, 5-week-old girl initially presented to her primary care physician with a solitary, enlarging scalp nodule. The infant was otherwise well without additional signs or symptoms of illness. Over the next several weeks, the nodule continued to grow, and additional lesions appeared on her scalp. An ultrasound of the primary nodule revealed a hypoechoic structure favored to represent a serosanguinous fluid collection. After evaluation by general surgery and dermatology, she underwent a scalp biopsy of the largest lesion. While biopsy specimen results were pending, her parents noted that she was developing increased irritability, difficulty closing her right eye, and facial weakness. She was referred to the emergency department where a right-sided facial droop involving the brow and forehead was noted. The skin biopsy specimen results, along with subsequent laboratory studies and imaging, led to the final diagnosis.
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Affiliation(s)
| | | | | | | | | | - Anjuli S Gans
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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22
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Cutaneous Metastasis in a Previously Known Case of Ovarian Dysgerminoma: A Case Report. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.104715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Cutaneous metastasis is an uncommon manifestation that mostly occurs in patients with previous gastrointestinal or gynecological malignancies. Local recurrence usually can be seen in surgical incisions. Dysgerminomas are rare ovarian tumors that usually have local invasions, but metastases are infrequent. Here, we described a case of dysgerminoma and cutaneous metastasis in the surgical incision. Case Presentation: The patient was a 39-year-old woman previously known as ovarian dysgerminoma, who had undergone surgery one year ago. Ultrasound examination a year after surgery showed a 35 × 33 millimeters hypoechoic solid tumor in the left ovary and another 3 masses with similar echo pattern and vascularity were found in the surgical incision. Magnetic resonance imaging (MRI) findings were compatible with cutaneous metastasis of pervious dysgerminoma. Pathologic evaluation and Immunohistochemistry (IHC) confirmed dysgerminoma's skin metastasis. She received chemotherapy due to the recurrence of malignancy. Conclusions: Local recurrence and metastases (even in the skin) should be kept in mind and the clinician must examine the surgical site skin in patients with a history of malignancy.
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23
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Lebeck Lee C, Zwerner J, O'Brian B, Eng C. Cutaneous Lymphangitic Carcinomatosis as the First Sign of Recurrent Malignancy in a Patient With a History of Rectal Adenocarcinoma. Clin Colorectal Cancer 2021; 20:368-371. [PMID: 34690067 DOI: 10.1016/j.clcc.2021.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Cody Lebeck Lee
- VA Tennessee Valley Healthcare System, Department of Internal Medicine.
| | - Jeffrey Zwerner
- Vanderbilt University Medical Center, Department of Dermatology, Nashville, TN
| | - Brittany O'Brian
- Vanderbilt University Medical Center, Department of Medicine, Division of Hematology and Oncology, Nashville, TN
| | - Cathy Eng
- Vanderbilt University Medical Center, Department of Medicine, Division of Hematology and Oncology, Nashville, TN
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24
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Chiesa-Estomba CM, Lechien JR, Ayad T, Calvo-Henriquez C, González-García JÁ, Sistiaga-Suarez JA, Dequanter D, Fakhry N, Melesse G, Piazza C. Clinical and histopathological risk factors for distant metastasis in head and neck cancer patients. ACTA ACUST UNITED AC 2021; 41:6-17. [PMID: 33746217 PMCID: PMC7982761 DOI: 10.14639/0392-100x-n0879] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/06/2020] [Indexed: 12/18/2022]
Abstract
The incidence of distant metastasis (DM) in head and neck squamous cell cancer (HNSCC) is relatively low. Multiple risk factors have been described for development of DM at baseline and after treatment. However, to date, there is no meta-analysis or systematic review investigating the relationships between clinical and histopathological factors and the appearance of DM in HNSCC patients. Among 1,272 eligible articles, 23 met inclusion criteria for qualitative analysis, and 6 for quantitative analysis. The meta-analysis on 5,353 patients showed that hypopharyngeal site, T3-T4 categories, extranodal extension, positive lymph node size > 6 cm, locoregional failure after previous treatment(s) and poor differentiation all significantly increase the risk of DM. According to our results, patients with the above-mentioned clinical and histopathological risk factors should be considered at high risk for DM and therefore submitted to strict pre-treatment assessment and undergo careful post-therapeutic follow-up.
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Affiliation(s)
- Carlos Miguel Chiesa-Estomba
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain.,Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS)
| | - Jerome R Lechien
- Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Department of Human Anatomy and Experimental Oncology, University of Mons, Mons, Belgium
| | - Tareck Ayad
- Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Division of Otolaryngology - Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Christian Calvo-Henriquez
- Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Department of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Ángel González-García
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | | | - Didier Dequanter
- Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Nicolas Fakhry
- Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Department of Otolaryngology - Head and Neck Surgery, Universitary Hospital of la Conception, Marseille, France
| | - Gebeyehu Melesse
- Department of Otolaryngology - Head and Neck Surgery, Bahir Dar University, Tibebe Ghion Specialised Hospital, Bahir Dar, Ethiopia
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
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25
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Chen JW, Zheng LZ, Xu DH, Lin W. Extensive cutaneous metastasis of recurrent gastric cancer: A case report. World J Clin Cases 2021; 9:6575-6581. [PMID: 34435028 PMCID: PMC8362582 DOI: 10.12998/wjcc.v9.i22.6575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cutaneous metastasis is a rare event associated with poor prognosis for gastric cancer and has been rarely reported in the literature.
CASE SUMMARY A 69-year-old male patient who had undergone salvage gastrectomy and a few courses of adjuvant chemotherapy 3 mo earlier for recurrent gastric cancer developed widespread cutaneous metastases. Due to the patient’s intolerance to further adjuvant chemotherapy, he was placed in hospice care and expired 1 mo later. In the literature, gastric cancers are rarely reported as the primary malignancies for cutaneous metastasis. We, thus, provide an update on a case review published in 2014 by reviewing 10 more case reports dated from 2014 to 2020. The average age for the new group of patients was 59.4 ± 18.88-years-old. Thirty percent of the patients presented with cutaneous lesions and advanced gastric cancer synchronously while 70% developed cutaneous metastases 1.3 years to 14 years after the initial treatment for primary gastric cancer. Eighty percent of the patients received either local excision or chemo ± radiation therapy to treat their cutaneous metastases.
CONCLUSION This report highlights cutaneous metastasis as a late and untreatable metastasis of gastric cancer.
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Affiliation(s)
- Jun-Wei Chen
- Department of Clinical Medicine, The School of Clinical Medicine, Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Clinical Medicine, The Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China
| | - Long-Zhi Zheng
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China
| | - De-He Xu
- Department of Clinical Medicine, The School of Clinical Medicine, Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Clinical Medicine, The Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China
| | - Wei Lin
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China
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26
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Li P, Barbieri A, Walther Z, McNiff J, Panse G. Epidermotropic metastasis of squamous cell carcinoma of the tonsil: A case report with molecular confirmation. J Cutan Pathol 2021; 48:1514-1519. [PMID: 34302376 DOI: 10.1111/cup.14108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022]
Abstract
Metastasis of oropharyngeal squamous cell carcinoma (SCC) to skin is uncommon and portends a poor prognosis. Clinical history and histopathology are key to discerning between metastatic disease vs de novo SCC of the skin. We describe a case of an HPV+ tonsillar SCC in a 77-year-old male, with metastasis to the neck skin. This case is unique because of prominent in situ epidermal involvement on skin biopsy specimen, complicating the distinction between primary and secondary disease. The nature of the lesion was resolved using next-generation sequencing of both the primary oropharyngeal SCC and skin lesion biopsy specimens. Both tumors showed identical ATR D1639G somatic mutations, while the skin lesion contained an additional POLE F1366L mutation. Clonal evolution of metastatic lesions is a well-described phenomenon; comparing the genetic profiles of primary and metastatic specimens can be useful in evaluating the tumor origin as well as identifying targetable genetic aberrations.
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Affiliation(s)
- Philippa Li
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrea Barbieri
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Zenta Walther
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer McNiff
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gauri Panse
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
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27
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Teyateeti P, Ungtrakul T. Retrospective review of cutaneous metastasis among 11,418 patients with solid malignancy: A tertiary cancer center experience. Medicine (Baltimore) 2021; 100:e26737. [PMID: 34398051 PMCID: PMC8294925 DOI: 10.1097/md.0000000000026737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 06/25/2021] [Indexed: 01/04/2023] Open
Abstract
Cutaneous metastasis (CM) occurs infrequently and usually presents during the later stages of cancer, and has a poor prognosis. Although there are insufficient current data, cancer treatment changes could have a positive impact on the outcome. This retrospective study aimed to review the pattern and prognosis of CM in patients with solid malignancy in a tertiary cancer center in Thailand.We reviewed the medical records of cancer patients diagnosed with CM between October 2009 and August 2015 at Chulabhorn Hospital, a tertiary cancer center in Thailand. Patients with primary skin cancer and hematological malignancies were excluded. We collected and analyzed data, including the time of cancer diagnosis and CM, type of cancer, clinical characteristics, and survival outcome.Of 11,418 patients, there were 33 (0.3%) were diagnosed with CM. Breast cancer was the most common primary cancer (12 cases, 36%). Skin nodules were commonly detected on the anterior chest wall. Also, 79% of CM patients had concomitant visceral metastasis. The median overall survival of those with CM was 9.21 months (95% confidence interval 4.75-83.38 months) regardless of presentation either at onset or disease recurrence (P = .083). However, the change of management was affected in 78% diagnosed with a later stage of CM. No statistical difference in survival was observed between breast cancer and non-breast cancer patients (8.79 vs 9.21 months, P = .613).Despite CM being a sign of poor prognosis, it may still be an indicator for changing cancer patients' treatment. Hence, early CM diagnosis and prompt novel therapy may positively affect outcomes for cancer patients.
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Affiliation(s)
- Phurichaya Teyateeti
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Teerapat Ungtrakul
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
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Del Puerto C, Jaque A, Gonzalez-Bombardiere S, Molgó M. Cutaneous Metastasis From Parotid Tumors: A Report of 2 Cases and Literature Review. Am J Dermatopathol 2021; 43:514-520. [PMID: 33534212 DOI: 10.1097/dad.0000000000001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Cutaneous metastases from parotid tumors are uncommon and imply a poor prognosis. In this article, we report 2 new cutaneous metastasis cases from 2 different parotid malignancies and 42 additional cases from a literature review. Clinical manifestations, localization, and outcomes of skin metastasis from parotid tumors are described. Although infrequent, parotid neoplasms may develop skin metastasis many years after the initial diagnosis, mostly in the head and neck region. Therefore, long-term follow-up and periodic skin examination of these patients is mandatory. Dermatologists and surgeons must have a high index of suspicion when evaluating any skin lesion arising on these patients because cutaneous metastasis from parotid neoplasms generally implies a poor prognosis.
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Affiliation(s)
- Constanza Del Puerto
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; and
| | - Alejandra Jaque
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; and
| | | | - Montserrat Molgó
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; and
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29
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Ronen S, Suster D, Chen WS, Ronen N, Arudra SKC, Trinidad C, Ivan D, Prieto VG, Suster S. Histologic Patterns of Cutaneous Metastases of Breast Carcinoma: A Clinicopathologic Study of 232 Cases. Am J Dermatopathol 2021; 43:401-411. [PMID: 34006731 DOI: 10.1097/dad.0000000000001841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
ABSTRACT Cutaneous metastasis may be the initial sign of internal malignancy but more often represents a late manifestation of widely disseminated disease. Breast carcinoma is the most common malignancy to metastasize to the skin. Although several studies have detailed the histopathologic patterns of cutaneous metastasis from internal malignancies, very little has been published regarding metastases of breast carcinoma to the skin. Furthermore, the histopathologic and clinical features observed in the cases of breast carcinoma with local skin involvement as opposed to cases exhibiting distant cutaneous metastases have not been adequately investigated. We have reviewed 232 cases of breast carcinoma with cutaneous metastases from 2 large institutions. All cases of carcinoma of the breast with involvement of the skin of the anterior chest wall were compared with those with distant cutaneous metastases. Two hundred thirty-two cases in 199 patients were included, of which 126 had skin involvement exclusively involving the ipsilateral anterior chest, and 106 had biopsy-proven distant cutaneous metastases. Twelve patients had both local and distal spread. Distant cutaneous metastases showed a predilection for the contralateral anterior chest wall area, followed by the head and neck, back, and abdomen. Histologically, most of the tumors presented in this series showed features of infiltrating ductal carcinoma. In both ipsilateral and distant metastases, the tumors demonstrated little change in histologic features from the primary lesion; however, the distant metastases showed a tendency to display more poorly differentiated features. The mean patient survival when cutaneous involvement was localized to the skin of the anterior chest wall was 23 months as compared with 20.6 months when distant sites were affected. A comparison of the clinicopathologic features of the patients presented in this series suggests that alternate biological mechanisms may apply for local and distant skin metastases from breast carcinoma.
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Affiliation(s)
- Shira Ronen
- Staff Member, Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH
| | - David Suster
- Assistant Professor, Department of Pathology, Rutgers University, New Jersey Medical School, Newark, NJ
| | - Wei-Shen Chen
- Assistant Professor, Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, FL
| | - Natali Ronen
- Pathology Resident, Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Doina Ivan
- Professor, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and
| | - Victor G Prieto
- Professor, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and
| | - Saul Suster
- Professor, Departments of Pathology, Medical College of Wisconsin, Milwaukee, WI
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30
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Ben Hamouda M, Aounallah A, Tlili T, Kenani Z, Gammoudi R, Ghariani N, Belajouza C, Sriha B, Denguezli M. Morphea-Like Carcinoma En Cuirasse Revealing a Bilateral Breast Cancer. Am J Med 2021; 134:e394-e395. [PMID: 33359773 DOI: 10.1016/j.amjmed.2020.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/07/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Amina Aounallah
- Department of Pathology, Farhad Hachad Hospital, Sousse, Tunisia
| | - Taghrid Tlili
- Department of Dermatology, Farhad Hachad Hospital, Sousse, Tunisia
| | - Zied Kenani
- Department of Pathology, Farhad Hachad Hospital, Sousse, Tunisia
| | - Rima Gammoudi
- Department of Pathology, Farhad Hachad Hospital, Sousse, Tunisia
| | - Najet Ghariani
- Department of Pathology, Farhad Hachad Hospital, Sousse, Tunisia
| | | | - Badreddine Sriha
- Department of Dermatology, Farhad Hachad Hospital, Sousse, Tunisia
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31
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Chaitanya S A, Kumar A A, Dalakoti P, Basude M, Kumar S, Jonathan GT, Rao TS, Rao S LMCS, Nemade H. Dermal metastases in oral cancer after curative treatment: a single institution cohort study. Br J Oral Maxillofac Surg 2021; 59:814-819. [PMID: 34325947 DOI: 10.1016/j.bjoms.2021.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
Dermal metastasis (DM) is, by definition, the involvement of the skin by cancer cells that originate from cancer elsewhere in the body. The skin is considered a rare site of distant failure in head and neck cancer and DM is the bearer of a poor outcome. Literature about it is limited so this study was undertaken to analyse the factors associated with its incidence and outcomes. A prospectively maintained database on operated cases of oral cancer at a tertiary cancer centre was analysed, and patients who developed dermal metastases during follow up were evaluated. Factors that contributed to early DM and predicted survival after its development were studied. A total of 68 patients (2.8%) had DM as the first presentation of recurrence after a median disease-free period of five months. Early DM was significantly associated with skin involvement by the primary tumour at the time of presentation (p=0.06), extracapsular extension of nodes (p=0.004), and with those who required adjuvant chemotherapy in view of aggressive histology (p=0.021). Median (range) survival after the detection of DM was 97 (5-328) days (3.25 months). Surgical excision of isolated cases was associated with significantly increased survival after detection (p=0.05). Whenever it is feasible without too much morbidity, solitary DM should be excised.
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Affiliation(s)
- A Chaitanya S
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Banjara Hills Road No 10, Hyderabad, Telangana 500034, India.
| | - A Kumar A
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Banjara Hills Road No 10, Hyderabad, Telangana 500034, India.
| | - P Dalakoti
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Banjara Hills Road No 10, Hyderabad, Telangana 500034, India.
| | - Madhunarayana Basude
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Banjara Hills Road No 10, Hyderabad, Telangana 500034, India.
| | - S Kumar
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Banjara Hills Road No 10, Hyderabad, Telangana 500034, India.
| | - G T Jonathan
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Banjara Hills Road No 10, Hyderabad, Telangana 500034, India.
| | - T S Rao
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Banjara Hills Road No 10, Hyderabad, Telangana 500034, India.
| | - L M C S Rao S
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Banjara Hills Road No 10, Hyderabad, Telangana 500034, India.
| | - H Nemade
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Banjara Hills Road No 10, Hyderabad, Telangana 500034, India.
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32
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Rudningen KE, Hinshaw MA, Aylward JL, Xu YG. Characteristics, evaluation and outcomes of patients with squamous cell carcinoma lacking histologic continuity to the epidermis. J Am Acad Dermatol 2021; 86:662-665. [PMID: 33617913 DOI: 10.1016/j.jaad.2021.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Kyle E Rudningen
- Department of Dermatology at the University of Wisconsin School of Medicine and Public Health. One South Park St, 7th Floor, Madison, WI 53715
| | - Molly A Hinshaw
- Department of Dermatology at the University of Wisconsin School of Medicine and Public Health. One South Park St, 7th Floor, Madison, WI 53715
| | - Juliet L Aylward
- Department of Dermatology at the University of Wisconsin School of Medicine and Public Health. One South Park St, 7th Floor, Madison, WI 53715
| | - Yaohui Gloria Xu
- Department of Dermatology at the University of Wisconsin School of Medicine and Public Health. One South Park St, 7th Floor, Madison, WI 53715.
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33
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Milam EC, Rangel LK, Pomeranz MK. Dermatologic sequelae of breast cancer: From disease, surgery, and radiation. Int J Dermatol 2020; 60:394-406. [PMID: 33226140 DOI: 10.1111/ijd.15303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 01/24/2023]
Abstract
The care of breast cancer patients is important to dermatologists. Breast cancer's initial presentation, clinical progression, and its associated treatments can result in a variety of cutaneous complications. Dermatologists may be the first to identify a breast cancer diagnosis, as a subset of patients first present with direct extension of an underlying tumor or with a cutaneous metastasis. The surgical treatment of breast cancer also begets a variety of skin sequelae, including postoperative lymphedema, soft tissue infections, seromas, pyoderma gangrenosum, and scarring disorders. Moreover, breast cancer radiation treatment commonly results in skin changes, which can range from mild and temporary dermatoses to chronic and disfiguring skin ulceration, fibrosis, and necrosis. Radiation may also precipitate secondary malignancies, such as angiosarcoma, as well as rarer dermatologic diseases, such as radiation-induced morphea, lichen planus, and postirradiation pseudosclerodermatous panniculitis. Finally, breast cancer is also associated with an array of paraneoplastic phenomena, including Sweet's syndrome and the rarer intralymphatic histiocytosis. Herein, we review the dermatological manifestations of breast cancer, including conditions associated with its presentation, progression, and treatment sequelae. Chemotherapy-induced cutaneous side effects are beyond the scope of this review. This article provides a comprehensive review for dermatologist to be able to identify, diagnose, and manage breast cancer patients from initial presentation to treatment monitoring and subsequent follow-up.
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Affiliation(s)
- Emily C Milam
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lauren K Rangel
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Miriam K Pomeranz
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
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34
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Kramer DE, Kerolus MG, Tan LA, Patel S, Reddy V, Chen M. Embolization of an Exophytic Posterior Neck Mass Secondary to a Cutaneous Renal Cell Carcinoma Metastasis. Neurointervention 2020; 15:162-166. [PMID: 32772032 PMCID: PMC7608493 DOI: 10.5469/neuroint.2020.00206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/08/2020] [Indexed: 11/24/2022] Open
Abstract
Renal cell carcinoma (RCC) commonly metastasizes to the lung, liver, bones, and brain; however, cutaneous metastases remain rare with few reported cases. Since RCCs have the propensity to metastasize to highly vascular areas, the scalp and skin of the head and neck region are likely locations for cutaneous metastases. We report a rare case of a large, exophytic, cauliflower-like, hemorrhagic, metastatic mass of the posterior neck. This is the first reported case of a head and neck cutaneous RCC metastasis treated with endovascular embolization prior to surgical resection. Due to the increased vascularity of RCCs and risk of excessive hemorrhage during resection, adjunctive embolization of cutaneous head and neck metastasis may have a role. Essential characteristics to our treatment strategy are discussed with a review of pertinent literature.
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Affiliation(s)
- Dallas E Kramer
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Mena G Kerolus
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Lee A Tan
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Smita Patel
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Vijaya Reddy
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Michael Chen
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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35
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Maguire M, Drumm C, Woods G, Mullally W, Redmond M, Grogan L, O'Kane M. A case of delayed-onset scarring alopecia in a 75-year-old woman. Clin Exp Dermatol 2020; 45:768-770. [PMID: 32369207 DOI: 10.1111/ced.14211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M Maguire
- Departments of, Department of, Dermatology, Beaumont Hospital, Dublin, Ireland
| | - C Drumm
- Departments of, Department of, Dermatology, Beaumont Hospital, Dublin, Ireland
| | - G Woods
- Department of, Pathology, Beaumont Hospital, Dublin, Ireland
| | - W Mullally
- Department of, Oncology, Beaumont Hospital, Dublin, Ireland
| | - M Redmond
- Department of, Pathology, Beaumont Hospital, Dublin, Ireland
| | - L Grogan
- Department of, Oncology, Beaumont Hospital, Dublin, Ireland
| | - M O'Kane
- Departments of, Department of, Dermatology, Beaumont Hospital, Dublin, Ireland
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36
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Zusstone EM, Korman AM, Kaffenberger BH, Chung CG. Purpuric patches and telangiectasias on the chest. JAAD Case Rep 2020; 6:263-265. [PMID: 32258293 PMCID: PMC7109376 DOI: 10.1016/j.jdcr.2020.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Abraham M Korman
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Catherine G Chung
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio.,Department of Pathology, The Ohio State University, Columbus, Ohio
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37
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Alkan A, Kayış D, Çelik SY, Uylaş S, Demir Pektaş S, Oral Tapan Ö, Gökdoğan O, Türkkan G, Genç S, Tanrıverdi Ö. Management of a glottic squamous cell carcinoma with cutaneous metastasis. J Oncol Pharm Pract 2020; 26:1495-1498. [PMID: 32028840 DOI: 10.1177/1078155219900782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Oral cavity malignancies constitute 30% of head and neck cancers. The most common distant metastatic sites of glottic carcinoma are usually lung, liver and bone. Although the cutaneous metastasis of head and cancers have been reported with an incidence of 0.7-2.4%, skin metastasis of glottic carcinoma is extremely rare. CASE REPORT A 69-year-old male patient was admitted to the emergency department with hemoptysis, dyspnea, weakness in lower extremities and difficulty in swallowing. There were subcutaneous lesions with a diameter of 2-5 cm in the scalp, posterior chest wall, nose and abdomen. In addition, there was an ulcerating, painful mass on the right lateral part of the tongue. The biopsy of lesions on tongue and skin revealed a glottic squamous cell carcinoma with cutaneous metastasis.Management and outcome: The patient was treated with cisplatin 50 mg/m2 on day 1, cetuximab 500 mg/m2 on day 1 and 5-fluorouracil 1000 mg/m2 daily on days 1 and 2, repeated every two weeks. After the first cycle of chemotherapy, the lesions on the skin regressed and dysphagia improved. DISCUSSION There are limited data about the incidence, diagnostic measures and treatment modalities of glottic cancer with cutaneous metastasis. Our case could provide an important experience to literature by its atypical presentation and treatment-sensitive nature.
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Affiliation(s)
- Ali Alkan
- Medical Oncology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Deniz Kayış
- Internal Medicine, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Serkan Yaşar Çelik
- Pathology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Selçuk Uylaş
- Medical Oncology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Suzan Demir Pektaş
- Dermatology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Özge Oral Tapan
- Chest Diseases, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Ozan Gökdoğan
- Otorhinolaryngology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Görkem Türkkan
- Radiation Oncology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Sebahat Genç
- Chest Diseases, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Özgür Tanrıverdi
- Medical Oncology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
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38
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Cebeci D, Yaşar Ş, Güneş P, Aytekin S. Telangiectatic Carcinoma - Like Lymphangioma Circumscriptum. A Rare Form of Cutaneous Metastasis of Breast Carcinoma: Case Report. Med Arch 2020; 74:391-392. [PMID: 33424097 PMCID: PMC7780820 DOI: 10.5455/medarh.2020.74.391-392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: The Breast cancer is the most common malignancy in middle-aged women and that causes skin metastasis. Skin metastasis in internal cancer cases is a very rare condition and may be difficult to diagnose and have poor prognostic marker. Cutaneous metastasis of breast carcinoma is mostly seen as direct invasion and/or local infiltration. However, in addition to the well-known types, cutaneous metastases may mimic many benign skin lesions and therefore may be difficult to diagnose. Case report: In this article we present a 36-year-old woman with telangiectatic carcinoma-like lymphangioma circumscriptum, a rare form of cutaneous metastasis skin metastases. It can be the first sign of internal malignancies, so early diagnosis is very important at this stage. Conclusion: Therefore, solitary lesions or benign dermatoses seen in the skin and not associated with specific disease should be considered as tumor metastasis especially in female patients with a history of breast cancer and differential diagnosis must be made.
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Affiliation(s)
- Dua Cebeci
- Department of Dermatology and Venerology, Famagusta State Hospital, Famagusta, North Cyprus
| | - Şirin Yaşar
- Dermatology And Venerology Department, Haydarpaşa Training And Reasearch Hospital, Famagusta, North Cyprus
| | - Pembegül Güneş
- Department of Pathology, Haydarpaşa Training And Reasearch Hospital Famagusta, North Cyprus
| | - Sema Aytekin
- Dermatology And Venerology Department, Haydarpaşa Training And Reasearch Hospital, Famagusta, North Cyprus
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39
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Electrochemotherapy for the palliative management of cutaneous metastases: A systematic review and meta-analysis. Eur J Surg Oncol 2019; 45:2257-2267. [DOI: 10.1016/j.ejso.2019.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/21/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022] Open
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40
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Nakamura F, Seino M, Suzuki Y, Sakaki H, Sudo T, Ohta T, Tsutsumi S, Nagase S. Successful management of cutaneous lymphangitis carcinomatosa arising from cervical cancer with paclitaxel-cisplatin and bevacizumab combination therapy: a case report and review of the literature. J Med Case Rep 2019; 13:328. [PMID: 31699140 PMCID: PMC6836488 DOI: 10.1186/s13256-019-2262-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 09/22/2019] [Indexed: 12/24/2022] Open
Abstract
Background Globally, cervical cancer is the fourth most common cancer in women. Here, we report a case of cutaneous lymphangitis carcinomatosa arising from cervical cancer, an extremely rare and treatment-resistant condition. Case presentation A 64-year-old Japanese woman presented with genital bleeding. She was diagnosed as having stage IB1 squamous cell cervical cancer and subsequently treated with radiotherapy. Approximately 2 years after the curative radiotherapy, she developed itching, skin rash, and small nodules on her left femoral and pubic area. Slight 18F-fluorodeoxyglucose uptake was detected at her left femoral skin on positron emission tomography with computed tomography. A histopathological examination was performed on a biopsy sample from an erythematous macule on her left femoral skin and vulva. Consequently, she was diagnosed as having cutaneous lymphangitis carcinomatosa arising from cervical cancer. Paclitaxel (135 mg/m2), cisplatin (50 mg/m2), and bevacizumab (15 mg/kg) combination therapy was administered every 21 days. Both itching and rash improved after three treatment cycles. After the completion of six cycles, skin erythema in the femoral and vulval area disappeared completely. Our patient experienced a 25-month symptom-free interval after the last chemotherapy session. Conclusion Our findings suggest that combination chemotherapy plus bevacizumab is an effective therapeutic option in patients with cutaneous lymphangitis carcinomatosa arising from cervical cancer.
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Affiliation(s)
- Fumihiro Nakamura
- Department of Obstetrics and Gynecology, Yamagata University, School of Medicine, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-9585, Japan
| | - Manabu Seino
- Department of Obstetrics and Gynecology, Yamagata University, School of Medicine, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-9585, Japan.
| | - Yuriko Suzuki
- Department of Obstetrics and Gynecology, Yamagata University, School of Medicine, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-9585, Japan
| | - Hirotsugu Sakaki
- Department of Obstetrics and Gynecology, Yamagata University, School of Medicine, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-9585, Japan
| | - Takeshi Sudo
- Department of Obstetrics and Gynecology, Yamagata University, School of Medicine, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-9585, Japan
| | - Tsuyoshi Ohta
- Department of Obstetrics and Gynecology, Yamagata University, School of Medicine, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-9585, Japan
| | - Seiji Tsutsumi
- Department of Obstetrics and Gynecology, Yamagata University, School of Medicine, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-9585, Japan
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Yamagata University, School of Medicine, 2-2-2 Iidanishi, Yamagata, Yamagata, 990-9585, Japan
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41
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Alrefaie SI, Alshamrani HM, Abduljabbar MH, Hariri JO. Skin metastasis from squamous cell carcinoma of the cervix to the lower extremities: Case report and review of the literature. J Family Med Prim Care 2019; 8:3443-3446. [PMID: 31742189 PMCID: PMC6857425 DOI: 10.4103/jfmpc.jfmpc_541_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/22/2019] [Accepted: 09/11/2019] [Indexed: 12/04/2022] Open
Abstract
Squamous cell carcinoma of cervix commonly metastasizes to the lymph nodes of the pelvis and skin metastasis is a rare presentation even in the late stages of cervical cancer. We report here the first case of cervical cancer with skin metastasis in Saudi Arabia in a 69-year-old female that preceded the diagnosis of cervical carcinoma. Microscopic examination of the skin lesion revealed poorly differentiated squamous cell carcinoma. The patient was in stage IVB based on the International Federation of Gynecology and Obstetrics (FIGO) staging system. Due to her late presentation and advanced stage, the decision was to place the patient on palliative therapy. Later, the patient passed away due to the progression of her disease. The case reported in this paper emphasizes the need for a complete clinical assessment to rule out metastatic disease from cases with known cervical cancer and include skin examination in their follow-up.
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Affiliation(s)
- Sumayyah I Alrefaie
- Department of Dermatology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Hussein M Alshamrani
- Department of Dermatology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Jehad O Hariri
- Department of Dermatology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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42
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Abstract
Neoplastic cells originating from a primary cancer can uncommonly spread to the skin, where they suggest a poor prognosis for the patient. In women, melanoma, breast, ovarian, oral cavity, and lung are the most common primary sources; in men, melanoma, lung, colon, and squamous cell carcinoma of the head and neck predominate. The classic presentation of cutaneous metastases is a firm, painless, flesh-colored to an erythematous dermal nodule (or nodules); however, several other presentations, including inflammatory, cicatricial, and bullous lesions, have been reported. Cutaneous metastases may also mimic benign conditions such as lipomas, hemangiomas, or cellulitis. A high degree of clinical suspicion is necessary, and the diagnosis is confirmed by biopsy, which may also be used to establish the primary malignancy if unknown, as the histopathologic appearance of the metastatic tissue may mimic the primary tumor. Treatments include excision of the metastases, chemotherapy, immunotherapy, radiation, and/or palliative care.
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Affiliation(s)
- Joanna Jaros
- Department of Internal Medicine, AMITA St. Joseph Hospital, Joliet, Illinois, USA
| | - Samantha Hunt
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Eucabeth Mose
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Olivia Lai
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois, USA.
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43
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Basic-Jukic N, Mesar I, Kirincich J. Cutaneous Metastasis as a Presenting Feature of Renal Adenocarcinoma in a Renal Transplant Recipient: A Case Report. Transplant Proc 2019; 51:3072-3073. [PMID: 31611123 DOI: 10.1016/j.transproceed.2019.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 10/25/2022]
Abstract
Cutaneous metastases of urological malignancies are a rare phenomenon. We present a case of a renal transplant recipient who presented with skin nodule 12 years posttransplant. Pathohistologic evaluation revealed metastasis from the renal adenocarcinoma. The patient was treated with temsirolimus and later with sorafenib; however, he died 13 months after the initial presentation with a functional renal allograft.
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Affiliation(s)
- Nikolina Basic-Jukic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Ines Mesar
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
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44
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Cutaneous Metastases in Ovarian Cancer. Cancers (Basel) 2019; 11:cancers11091292. [PMID: 31480743 PMCID: PMC6788186 DOI: 10.3390/cancers11091292] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 12/12/2022] Open
Abstract
Skin metastases in ovarian cancer are uncommon, but their incidence may be increasing due to improved survival rates. Skin metastases can be divided into umbilical metastases, which are known as Sister Joseph nodules (SJNs) and are associated with peritoneal metastasis, and non-SJN skin metastases, which usually develop within surgical scars and in the vicinity of superficial lymphadenopathy. As most skin metastases develop after specific conditions, recognition of preceding metastatic diseases and prior treatments is necessary for early diagnosis of skin lesions. The prognosis of skin metastases in ovarian cancer varies widely since they are heterogeneous in the site of lesion and the time of appearance. Patients with SJNs at initial diagnosis and patients with surgical scar recurrences without concomitant metastases may have prolonged survival with a combination of surgery and chemotherapy. In patients who developed skin recurrences as a late manifestation, symptoms should be treated with external beam radiotherapy and immune response modifiers. Immune checkpoint blockade can enhance anti-tumor immunity and induce durable clinical responses in multiple tumor types, including advanced chemoresistant ovarian cancer. With the use of radiation therapy, which enhances the systemic anti-tumor immune response, immune checkpoint blockade may be a promising therapeutic strategy for distant metastasis, including skin metastasis.
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45
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Chatterjee D, Kaur R, Madakshira MG, Bhattacharjee R, De D, Saikia UN. Cutaneous metastasis from solid organ cancer: A histopathological and immunohistochemical study of 74 cases from a tertiary care centre of North India. Australas J Dermatol 2019; 61:87-90. [PMID: 31397489 DOI: 10.1111/ajd.13130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Debajyoti Chatterjee
- Department of Histopathology and Dermatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajwant Kaur
- Department of Histopathology and Dermatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manoj Gopal Madakshira
- Department of Histopathology and Dermatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajsmita Bhattacharjee
- Department of Histopathology and Dermatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Dipankar De
- Department of Histopathology and Dermatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Uma Nahar Saikia
- Department of Histopathology and Dermatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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46
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Abstract
Cutaneous metastasis portends a poor prognosis. Therefore, a high clinical index of suspicion is necessary so that a clinician knows how to recognize the presentation of a cutaneous metastasis, while the pathologist must know the appropriate stains to order. In this review, the authors summarize the common and uncommon ways that these tumors will present. Frequently a metastatic cancer will present as a firm red nodule or as a plaque, ulcer, or papule. Less commonly they will present with a clinical clue that can alert a clinician to a likely diagnosis; these manifestations include alopecic, vesicular, blue color, sclerodermoid, acrochordon-, or pellagra-like.
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Affiliation(s)
- Evan Alexander Choate
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alexander Nobori
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Scott Worswick
- Department of Dermatology, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Ezralow Tower, Suite 5301, Los Angeles, CA 90033-9174, USA.
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47
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Otsuka I. Cutaneous Metastasis after Surgery, Injury, Lymphadenopathy, and Peritonitis: Possible Mechanisms. Int J Mol Sci 2019; 20:E3286. [PMID: 31277406 PMCID: PMC6651228 DOI: 10.3390/ijms20133286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 12/12/2022] Open
Abstract
Cutaneous metastases from internal malignancies are uncommon. Umbilical metastasis, also known as Sister Joseph nodule (SJN), develops in patients with carcinomatous peritonitis or superficial lymphadenopathy, while non-SJN skin metastases develop after surgery, injury, and lymphadenopathy. In this review, the possible mechanisms of skin metastases are discussed. SJNs develop by the contiguous or lymphatic spread of tumor cells. After surgery and injury, tumor cells spread by direct implantation or hematogenous metastasis, and after lymphadenopathy, they spread by extranodal extension. The inflammatory response occurring during wound healing is exploited by tumor cells and facilitates tumor growth. Macrophages are crucial drivers of tumor-promoting inflammation, which is a source of survival, growth and angiogenic factors. Angiogenesis is promoted by the vascular endothelial growth factor (VEGF), which also mediates tumor-associated immunodeficiency. In the subcutaneous tissues that surround metastatic lymph nodes, adipocytes promote tumor growth. In the elderly, age-associated immunosuppression may facilitate hematogenous metastasis. Anti-VEGF therapy affects recurrence patterns but at the same time, may increase the risk of skin metastases. Immune suppression associated with inflammation may play a key role in skin metastasis development. Thus, immune therapies, including immune checkpoint inhibitors reactivating cytotoxic T-cell function and inhibiting tumor-associated macrophage function, appear promising.
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Affiliation(s)
- Isao Otsuka
- Department of Obstetrics and Gynecology, Kameda Medical Center, Kamogawa 296-8602, Japan.
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48
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Mendonça-Sanches M, Rolim I, Cabeçadas J, Rafael M. An Unusual Presentation of Metastatic Breast Carcinoma. Eur J Case Rep Intern Med 2019; 6:001089. [PMID: 31139586 PMCID: PMC6499091 DOI: 10.12890/2019_001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 11/14/2022] Open
Abstract
Cutaneous metastasis from a carcinoma is a relatively uncommon phenomenon. Prompt diagnosis is crucial, as it will have future implications, particularly regarding prognosis and treatment. Skin metastases can be suspected and recognized earlier through physical examination than metastases in other organs or systems. However, they can be a diagnostic challenge due to the variable clinical presentation. This case highlights the importance of having a high index of suspicion for cutaneous metastases, especially in patients with a previous history of cancer.
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Affiliation(s)
| | - Inês Rolim
- Pathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - José Cabeçadas
- Pathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Margarida Rafael
- Dermatology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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49
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Katiyar V, Araujo T, Majeed N, Ree N, Gupta S. Multiple recurrences from cervical cancer presenting as skin metastasis of different morphologies. Gynecol Oncol Rep 2019; 28:61-64. [PMID: 30911593 PMCID: PMC6416670 DOI: 10.1016/j.gore.2019.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/22/2022] Open
Abstract
Skin metastasis is an infrequent manifestation in oncology, with reported incidence of about 1.3% in cervical cancer. When present, it usually signals advanced disease with very limited, mostly palliative treatment options. Here we present a patient who was diagnosed with cervical cancer at an early stage and later recurred twice with skin lesions of different morphologies. Biopsy should be considered for skin lesions in patients with cervical cancer Skin metastasis may be the presenting symptom in cervical cancer recurrence No specific morphology is pathognomonic of cutaneous spread of cervical cancer
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Affiliation(s)
- Vatsala Katiyar
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, United States of America
| | - Tiago Araujo
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, United States of America
- Corresponding author.
| | - Nasma Majeed
- Department of Pathology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, United States of America
| | - Nicholas Ree
- Department of Pathology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, United States of America
| | - Shweta Gupta
- Department of Hematology-Oncology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, United States of America
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50
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Koyama R, Maeda Y, Minagawa N, Shinohara T, Hamada T. Late Cutaneous Metastasis Originating from Gastric Cancer with Synchronous Metastasis. Case Rep Gastroenterol 2019; 13:95-101. [PMID: 31043935 PMCID: PMC6477463 DOI: 10.1159/000497099] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/20/2019] [Indexed: 12/23/2022] Open
Abstract
An 89-year-old man was diagnosed with late cutaneous metastasis in the right axilla 6 years after undergoing a surgery for gastric cancer with synchronous cutaneous metastasis in the same site. The patient became aware of small reddish nodules in the right axilla, and computed tomography imaging showed an irregular thickening of the right axillary skin. No other sign of recurrence was observed. By en-bloc resection, the nodules were diagnosed as late cutaneous metastasis from gastric cancer. The patient received no additional postoperative chemo- or radiotherapy and was only carefully observed. Cutaneous metastases from gastric cancer have a high recurrence rate even if total resection with no residual cancer is achieved. Therefore, meticulous follow-up, including routine visual inspection, is required for the early detection of late cutaneous metastases.
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Affiliation(s)
- Ryota Koyama
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
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