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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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2
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Lopez-Trujillo E, Olmos - Alpiste F, Pujol R, Segura S. Cutaneous lymphangitis carcinomatosa: Dermoscopic and reflectance confocal microscopy features. Indian J Dermatol 2022; 67:316. [DOI: 10.4103/ijd.ijd_913_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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González-Martínez S, Pizarro D, Pérez-Mies B, Caniego-Casas T, Curigliano G, Cortés J, Palacios J. Clinical, Pathological, and Molecular Features of Breast Carcinoma Cutaneous Metastasis. Cancers (Basel) 2021; 13:5416. [PMID: 34771579 PMCID: PMC8582578 DOI: 10.3390/cancers13215416] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022] Open
Abstract
Cutaneous metastases (CMs) account for 2% of all skin malignancies, and nearly 70% of CMs in women originate from breast cancer (BC). CMs are usually associated with poor prognosis, are difficult to treat, and can pose diagnostic problems, such as in histopathological diagnosis when occurring long after development of the primary tumor. In addition, the molecular differences between the primary tumors and their CMs, and between CMs and metastases in other organs, are not well defined. Here, we review the main clinical, pathological, and molecular characteristics of breast cancer CMs. Identifying molecular markers in primary BC that predict CM and can be used to determine the molecular differences between primary tumors and their metastases is of great interest for the design of new therapeutic approaches.
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Affiliation(s)
- Silvia González-Martínez
- Clinical Researcher, Hospital Ramón y Cajal, 28034 Madrid, Spain;
- Fundación Contigo contra el Cáncer de la Mujer, 28010 Madrid, Spain
| | - David Pizarro
- Department of Pathology, Hospital Ramón y Cajal, 28034 Madrid, Spain; (D.P.); (B.P.-M.); (T.C.-C.)
| | - Belén Pérez-Mies
- Department of Pathology, Hospital Ramón y Cajal, 28034 Madrid, Spain; (D.P.); (B.P.-M.); (T.C.-C.)
- Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, 28801 Madrid, Spain
| | - Tamara Caniego-Casas
- Department of Pathology, Hospital Ramón y Cajal, 28034 Madrid, Spain; (D.P.); (B.P.-M.); (T.C.-C.)
| | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS, 20141 Milan, Italy;
- Departament of Oncology and Hematology, University of Milan, 20122 Milan, Italy
| | - Javier Cortés
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- International Breast Cancer Center (IBCC), Quironsalud Group, 08017 Barcelona, Spain
- Medica Scientia Innovation Research, 08007 Barcelona, Spain
- Medica Scientia Innovation Research, Ridgewood, NJ 07450, USA
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain
| | - José Palacios
- Department of Pathology, Hospital Ramón y Cajal, 28034 Madrid, Spain; (D.P.); (B.P.-M.); (T.C.-C.)
- Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, 28801 Madrid, Spain
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Ratzinger G, Zelger BG, Zelger BW. Bar Code Reader - an algorithmic approach to cutaneous occluding vasculopathies? part II medium vessel vasculopathies. J Dtsch Dermatol Ges 2020; 17:1115-1128. [PMID: 31765098 PMCID: PMC6899693 DOI: 10.1111/ddg.13973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 03/27/2019] [Indexed: 12/13/2022]
Abstract
Aims Classifications of occluding vasculopathies (except vasculitis [1]) may exhibit some difficulties. Firstly, classifications may follow different principles, e.g. clinicopathologic findings, etiology or pathogenesis. Secondly, authors may not distinguish between vasculitis and occluding vasculopathies. Thirdly, occluding vasculopathies are systemic diseases. Organ‐specific variations make morphologic findings difficult to compare. Moreover, subtle changes are recognized in the skin, but may be invisible in other organs. Our aim was to use the skin and subcutis as a tool and clinicopathological correlation as the basic process for classification. Methods and results We first differentiate in the skin between small and medium vessel occluding vasculopathies. Here we focus on medium vessel‐occluding vasculopathies. In the second step we differentiate the vessel subtypes. In the final step, we differentiate according to the time point of the coagulation/reorganization process and the involved inflammatory cells/stromal features. By applying the same procedure to the various entities and visualizing the findings in the style of bar codes, the overlaps and differences in the clinical picture as well as the histopathology become more apparent. Conclusions Occluding vasculopathies are often not separate entities, but reaction patterns and epiphenomena. Distinguishing them from vasculitides is crucial because of the differences in pathogenesis, therapeutic approach and prognosis.
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Affiliation(s)
- Gudrun Ratzinger
- Department of Dermatology, Venereology and Allergology, Medical University Innsbruck, Innsbruck, Austria
| | - Bettina G Zelger
- Department of Pathology, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard W Zelger
- Department of Dermatology, Venereology and Allergology, Medical University Innsbruck, Innsbruck, Austria
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6
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Tomasini C. Cytotoxic-mediated spontaneous regression of inflammatory cutaneous metastases of breast carcinoma. J Cutan Pathol 2020; 47:758-763. [PMID: 32222990 DOI: 10.1111/cup.13694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 12/29/2022]
Abstract
Spontaneous regression (SR) of cancer is a rare but well-documented biological phenomenon, which is even rarer in the context of metastatic breast carcinoma. Different mechanisms of SR are still under debate, including immune-mediated response. We herein report a case of the SR of intralymphatic cutaneous metastases of a breast carcinoma with spontaneously-induced T-cell-mediated cytotoxic response. An 86-year-old female was diagnosed with locally advanced right breast carcinoma and axillary lymph node metastases, without distant metastases The patient refused any therapy. Six months afterwards, she developed multiple, asymptomatic purpura-like plaques with prominent teleangectasias on her right chest wall, continuous to the previous surgical scar and on her ipsilateral abdomen. Skin biopsy showed aggregates of atypical cells admixed with erythrocyte thrombi within dilated dermal lymphatic vessels. SR of the cutaneous lesions occurred within 6 months and persisted at the 15 months follow-up in the absence of therapy, whilst no signs of internal relapse were observed. Immunohistochemically, the estrogen-negative, CK7-positive, C-erb B2-positive intralymphatic metastases were associated with extensive infiltration of CD8-positive cytototoxic T lymphocytes. Factors that may have precluded the implantation of intralymphatic metastases leading to SR are discussed, with local immune surveillance being one major hypothesis.
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Affiliation(s)
- Carlo Tomasini
- IRCCS Fondazione Policlinico San Matteo, Department of Medical-Surgical, Diagnostic and Pediatric Sciences, Dermatologic Clinic, University of Pavia School of Medicine, Pavia, Italy
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7
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Can Ex Vivo Magnetic Resonance Imaging of Rectal Cancer Specimens Improve the Mesorectal Lymph Node Yield for Pathological Examination? Invest Radiol 2020; 54:645-652. [PMID: 31219996 PMCID: PMC6738635 DOI: 10.1097/rli.0000000000000581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Supplemental digital content is available in the text. The aim of this study was to use 7 T ex vivo magnetic resonance imaging (MRI) scans to determine the size of lymph nodes (LNs) in total mesorectal excision (TME) specimens and to increase the pathological yield of LNs with MR-guided pathology.
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8
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Intravascular histiocytosis: case report of a rare disease probably associated with silicone breast implant. An Bras Dermatol 2020; 95:347-350. [PMID: 32303432 PMCID: PMC7253920 DOI: 10.1016/j.abd.2019.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/01/2019] [Indexed: 12/02/2022] Open
Abstract
Intravascular histiocytosis is a rare condition characterized by the aggregate of histiocytes within dilated dermal vessels. The diagnosis is mainly histophatological and immunohistochemical. We describe a case of a 55 year-old female patient presenting erythematous/purple patches on the breasts, back and limbs. She previously presented ductal carcinoma in the right breast in 2006 which was treated with mastectomy and proceeded to silicone breast implant in 2009. Clinical hypothesis was telangiectatic metastatic carcinoma. Histopathology showed vascular ectasia, thrombosis and recanalization of upper dermis small vessels. On immunohistochemistry, intravascular cells were CD 68+ and negative for estrogen and progesterone receptors, CK7, EMA and AE1/AE3 and endothelial cells were CD64+, leading to the diagnosis of intravascular histiocytosis.
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9
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Queirós CS, Filipe PL, Soares de Almeida L. Cutaneous metastases from solid neoplasms in the 21st century: a retrospective study from a Portuguese tertiary care center. J Eur Acad Dermatol Venereol 2020; 34:1218-1224. [PMID: 31788857 DOI: 10.1111/jdv.16120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/12/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Cutaneous metastases account for 2% of all skin cancers and are usually associated with widespread disease. The main of this retrospective study was to describe and illustrate clinicopathological features of cutaneous metastases diagnosed in our centre since the beginning of this century. METHODS All cases of cutaneous metastases from solid neoplasms diagnosed in our Dermatopathology Department from January 2000 to December 2018 were included. Statistical analysis was performed with SPSS. RESULTS A total of 164 patients were included, with a female to male ratio of 3:2. Malignancies that most commonly metastasized to the skin were melanoma (N = 58), breast cancer (N = 54) and lung cancer (N = 13). Immunohistochemical study was performed in 99 patients (60.4%). Time diagnosis of the primary tumour and appearance of cutaneous metastases was significantly higher in breast cancer, followed by melanoma and then by lung cancer (P < 0.05). Median survival after diagnosis of cutaneous metastases was 8 months. Survival after diagnosis of cutaneous metastases was also influenced by age of the patient, both at diagnosis of the primary tumour and at diagnosis of the cutaneous metastasis. DISCUSSION Clinical presentation of cutaneous metastases is highly variable and non-specific, being easily mistaken for other dermatological conditions. Histopathological examination is essential in this setting, and the judicious use of an immunohistochemistry panel considered the appropriate morphologic and clinical context. Survival after the diagnosis of cutaneous metastases is influenced not only by the location of the tumour but also by the age of the patient. Dermatologists should therefore be to these clinical pictures, and a high degree of suspicion is, along with a careful clinical history and physical examination. Although being limited by its retrospective nature, we describe one of the largest European series of cutaneous metastases, with findings with most of the available literature.
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Affiliation(s)
- C S Queirós
- Serviço de Dermatologia, Hospital de Santa Maria, Centro Hospitalar e Universitário de Lisboa Norte, Lisboa, Portugal
| | - P L Filipe
- Serviço de Dermatologia, Hospital de Santa Maria, Centro Hospitalar e Universitário de Lisboa Norte, Lisboa, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - L Soares de Almeida
- Serviço de Dermatologia, Hospital de Santa Maria, Centro Hospitalar e Universitário de Lisboa Norte, Lisboa, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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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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11
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Ratzinger G, Zelger BG, Zelger BW. Barcodeleser – ein algorithmischer Ansatz für okkludierende kutane Vaskulopathien? Teil 2: Vaskulopathien mittelgroßer Gefäße. J Dtsch Dermatol Ges 2019; 17:1115-1130. [PMID: 31765089 DOI: 10.1111/ddg.13973_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 03/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Gudrun Ratzinger
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Bettina G Zelger
- Institut für Pathologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Bernhard W Zelger
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
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12
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Isoherranen K, O'Brien JJ, Barker J, Dissemond J, Hafner J, Jemec GBE, Kamarachev J, Läuchli S, Montero EC, Nobbe S, Sunderkötter C, Velasco ML. Atypical wounds. Best clinical practice and challenges. J Wound Care 2019; 28:S1-S92. [DOI: 10.12968/jowc.2019.28.sup6.s1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kirsi Isoherranen
- Helsinki University Central Hospital and Helsinki University, Wound Healing Centre and Dermatology Clinic, Helsinki, Finland
| | | | - Judith Barker
- Nurse Practitioner - Wound Management, Rehabilitation, Aged and Community Care., Adjunct Associate Professor, University of Canberra, Canberra, Australia
| | - Joachim Dissemond
- University Hospital of Essen, Department of Dermatology, Venerology and Allergology, Hufelandstraße 55, Essen, Germany
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Jivko Kamarachev
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Severin Läuchli
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | | | - Stephan Nobbe
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland Department of Dermatology, Cantonal Hospital of Frauenfeld, Switzerland
| | - Cord Sunderkötter
- Chair, Department of Dermatology and Venerology, University and University Hospital of Halle, Ernst-Grube-Strasse 40, Halle, Germany
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario De La Princesa, Madrid, Spain
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14
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15
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Shiraishi K, Sayama K. Atypical case of telangiectatic metastatic breast carcinoma presenting as purpura. JAAD Case Rep 2017; 3:316-318. [PMID: 28752119 PMCID: PMC5517836 DOI: 10.1016/j.jdcr.2017.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ken Shiraishi
- Correspondence to: Ken Shiraishi, MD, PhD, Department of Dermatology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.Department of DermatologyEhime University Graduate School of MedicineToonEhimeJapan
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Karas L, Vangipuram R, Zahiruddin S, Sharghi KG, Peranteau AJ, Tyring SK. A Bumpy Course: Nodules Along a Mastectomy Scar. Am J Med 2017; 130:539-541. [PMID: 28159604 DOI: 10.1016/j.amjmed.2017.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/18/2017] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | | | | | - Stephen K Tyring
- Center for Clinical Studies, Houston, Tex; University of Texas Health Science Center at Houston.
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17
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Breast Cancer Metastasis Misdiagnosed as an Angiokeratomatous Eruption. An Infrequent Presentation. Case Report. Am J Dermatopathol 2016; 38:302-4. [PMID: 26999341 DOI: 10.1097/dad.0000000000000487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cutaneous metastases represent 2% of all metastases. Breast cancer is the most common cause of skin metastases. Schwartz described 8 types of cutaneous breast metastases; one uncommon form is carcinoma telangiectodes (CT), which may resemble angiosarcoma or lymphangioma circumscriptum. However, there are no reports of CT misdiagnosed as eruptive angiokeratomas. CASE REPORT The authors describe the clinical, histopathologic, and immunohistochemical features of a unique case of CT. Clinical examination revealed an itchy, dark blue-reddish scaly papular eruption that resembled angiokeratomas. The papules were grouped in a zosteriform pattern on the right chest. A biopsy of the papules revealed intravascular thrombi of neoplastic cells and erythrocytes. The neoplastic cells were pleomorphic and with mitotic figures. Immunohistochemical analysis revealed expression of HER-2-neu in neoplastic cells but negative for estrogen and progesterone receptors. The involved vessels were positive for CD31 and negative for podoplanin. This immunoprofile demonstrated intravascular spread of aggressive breast carcinoma. CONCLUSION CT is an uncommon form of cutaneous metastasis from breast carcinoma with less than 10 cases described in the literature. There are no previous reported cases of CT mimicking angiokeratomas, although lymphangioma circumscriptum-like lesion may occasionally resemble angiokeratomas. A unique clinical presentation of CT is described.
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Ulrich J, Gräfe R, Hildebrandt U. Acquired generalized asymptomatic livid erythema and telangiectasia. J Dtsch Dermatol Ges 2015; 13:249-51. [PMID: 25706298 DOI: 10.1111/ddg.12455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jens Ulrich
- Department of Dermatology and Allergology, Harzklinikum Dorothea Christiane Erxleben, Quedlinburg, Germany
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Skin lesions after prophylactic mastectomy and immediate reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 1:e82. [PMID: 25289276 PMCID: PMC4174102 DOI: 10.1097/gox.0000000000000009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/10/2013] [Indexed: 11/27/2022]
Abstract
SUMMARY Metastatic breast carcinoma can mimic benign cutaneous lesions. Breast surgeons should be aware of skin manifestations to be able to distinguish them and set a proper therapeutic strategy. A clinical case of cutaneous lesion after breast cancer is presented. A 41-year-old woman with a history of left breast cancer underwent a prophylactic right nipple-sparing mastectomy with immediate breast implant reconstruction. After surgery, she attended our service due to a right periareolar rash resistant to medical treatment, accompanied by cutaneous induration and fixed axillary adenopathy. A differential diagnosis of skin metastases was considered. Cutaneous metastases should be the first diagnosis of skin lesions in oncological patients due to the implications in terms of treatment and prognosis. However, differential diagnoses have to be discussed.
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20
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Körner R, Koschorreck L, Paredes BE. [Recent developed lesions on the right upper arm]. Hautarzt 2012; 64:52-4. [PMID: 23212679 DOI: 10.1007/s00105-012-2521-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R Körner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Kirrberger Str., 66421, Homburg/Saar, Deutschland.
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Cutaneous metastases from internal malignancies: a clinicopathologic and immunohistochemical review. Am J Dermatopathol 2012; 34:347-93. [PMID: 22617133 DOI: 10.1097/dad.0b013e31823069cf] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Skin metastases occur in 0.6%-10.4% of all patients with cancer and represent 2% of all skin tumors. Skin metastases from visceral malignancies are important for dermatologists and dermatopathologists because of their variable clinical appearance and presentation, frequent delay and failure in their diagnosis, relative proportion of different internal malignancies metastasizing to the skin, and impact on morbidity, prognosis, and treatment. Another factor to take into account is that cutaneous metastasis may be the first sign of clinically silent visceral cancer. The relative frequencies of metastatic skin disease tend to correlate with the frequency of the different types of primary cancer in each sex. Thus, women with skin metastases have the following distribution in decreasing order of frequency of primary malignancies: breast, ovary, oral cavity, lung, and large intestine. In men, the distribution is as follows: lung, large intestine, oral cavity, kidney, breast, esophagus, pancreas, stomach, and liver. A wide morphologic spectrum of clinical appearances has been described in cutaneous metastases. This variable clinical morphology included nodules, papules, plaques, tumors, and ulcers. From a histopathologic point of view, there are 4 main morphologic patterns of cutaneous metastases involving the dermis, namely, nodular, infiltrative, diffuse, and intravascular. Generally, cutaneous metastases herald a poor prognosis. The average survival time of patients with skin metastases is a few months. In this article, we review the clinicopathologic and immunohistochemical characteristics of cutaneous metastases from internal malignancies, classify the most common cutaneous metastases, and identify studies that may assist in diagnosing the origin of a cutaneous metastasis.
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Yun SJ, Park HY, Lee JS, Park MH, Lee JB, Won YH. Clinicopathological correlation of cutaneous metastatic breast carcinoma using lymphatic and vascular markers: lymphatics are mainly involved in cutaneous metastasis. Clin Exp Dermatol 2012; 37:744-8. [PMID: 22329727 DOI: 10.1111/j.1365-2230.2011.04306.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Precise clinicopathological correlations of the clinical features of metastatic breast carcinoma with lymphatic-specific markers are rare. We classified 28 patients with metastatic breast carcinoma according to their clinical features. Immunohistochemical staining was performed using D2-40, CD31 and CD34. Of the 28 patients, 8 (28.6%) had inflammatory metastatic carcinoma, 6 (21.4%) had the telangiectatic type, 5 had the nodular type, 3 had the en cuirasse type, 3 had alopecia neoplastica, and 3 had a combination of features. D2-40 staining revealed dilated lymphatic channels (lymphangiectasia) in the upper dermis of all patients; in addition, 13 patients (46.4%) had intralymphatic tumour-cell emboli, which were common in those with the inflammatory and telangiectatic types. Intratumoral lymphatic invasion in the main tumour nodule was seen in 12 patients (42.9%). Our results suggest that cutaneous metastatic breast carcinomas have various clinical presentations, and that lymphatic vessels play an important role in all types of cutaneous metastasis.
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Affiliation(s)
- S J Yun
- Departments of Dermatology Pathology General surgery, Chonnam National University Medical School, Gwangju, Korea.
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Kong JH, Park YH, Kim JA, Kim JH, Yun J, Sun JM, Won YW, Lee S, Kim ST, Cho EY, Ahn JS, Im YH. Patterns of skin and soft tissue metastases from breast cancer according to subtypes: relationship between EGFR overexpression and skin manifestations. Oncology 2011; 81:55-62. [PMID: 21934337 DOI: 10.1159/000331417] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/25/2011] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We evaluated whether skin changes and soft tissue infiltration patterns reflect breast cancer subtypes based on the breast hormonal receptor (HR) and human epidermal growth factor receptor 2 (HER2) status at the time of skin metastasis. METHODS We retrospectively reviewed the patients' medical records with radiologic imaging studies. RESULTS The numbers of patients of each subtype were as follows: HR positive (HR+ve) 53 (42.4%), HER2 enriched 43 (34.4%), and triple negative (TN) 29 (23.2%). The presence of skin ulceration was found more commonly in the HR+ve group than in the others (57.1% for HR+ve vs. 25% for HER2 enriched vs. 15.4% for TN, p = 0.019). Erythematous infiltrations were shown predominantly in the TN group (19.0 vs. 54.2 vs. 84.6%, respectively, p < 0.000). On CT scans, soft tissue infiltration appeared to be more common in the HER2-enriched and TN groups than in the HR+ve group (24.5 vs. 41.9 vs. 48.3%, respectively, p = 0.013). Erythematous infiltrative lesions were more common in patients with epidermal growth factor receptor overexpression (p = 0.036). CONCLUSION The patterns of skin involvement including surrounding soft tissue infiltration may reflect breast cancer subtype. Prospective evaluation is necessary to confirm their influential effect on breast cancer subtypes.
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Affiliation(s)
- Jee Hyun Kong
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea
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Müller CS, Körner R, Takacs FZ, Solomayer EF, Vogt T, Pfoehler C. Metastatic breast carcinoma mimicking a sebaceous gland neoplasm: a case report. J Med Case Rep 2011; 5:428. [PMID: 21888625 PMCID: PMC3180416 DOI: 10.1186/1752-1947-5-428] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 09/02/2011] [Indexed: 11/10/2022] Open
Abstract
Introduction Breast cancer is common in women and its metastases involve the skin in approximately one quarter of patients. Accordingly, metastatic breast cancer shown to be cutaneous through histology must be distinguished from a wide variety of other neoplasms as well as the diverse morphologic variants of breast cancer itself. Case presentation We report the case of a 61-year-old Caucasian woman with cutaneous metastases of a bilateral ductal breast carcinoma that in histopathological examination mimicked an adnexal neoplasm with sebaceous differentiation. Conclusion Against the background of metastatic breast carcinoma, dermatopathological considerations of sebaceous differentiation of skin lesions are presented and discussed focusing on the rare differential diagnosis of sebaceous carcinoma of the breast.
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Affiliation(s)
- Cornelia Sl Müller
- Department of Dermatology, Saarland University Hospital, 66421 Homburg/Saar, Germany.
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Park JJ, Choi YD, Lee JB, Kim SJ, Lee SC, Won YH, Yun SJ. Telangiectatic cutaneous metastasis from lung adenocarcinoma. J Am Acad Dermatol 2011; 64:798-9. [DOI: 10.1016/j.jaad.2009.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 08/10/2009] [Accepted: 08/10/2009] [Indexed: 10/18/2022]
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Metastatic breast cancer after delayed deep inferior epigastric perforator flap reconstruction. Ann Plast Surg 2011; 66:233-4. [PMID: 21263292 DOI: 10.1097/sap.0b013e3181ee70b2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Locoregional breast cancer recurrence is a relatively rare event, occurring more frequently in patients diagnosed with more advanced stages of cancer and those with inflammatory features. While typical signs of recurrence after reconstruction include the development of a mass in the native skin or deep chest wall, oncologic relapse may also rarely be heralded by subtle cutaneous changes. This article describes a patient with inflammatory breast cancer who underwent neoadjuvant chemotherapy, mastectomy, radiation therapy, and hormonal therapy followed by delayed reconstruction with a deep inferior epigastric artery perforator flap and subsequently presented with a recurrence manifest as a localized rash over the upper abdomen. Surgeons who perform breast reconstruction should be attuned to both common and uncommon recurrence symptoms, as they may be the first to diagnose recrudescent disease.
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Schwartz RA, Rothenberg J. Metastatic adenocarcinoma of breast within a benign melanocytic nevus in the context of cutaneous breast metastatic disease. J Cutan Pathol 2009; 37:1251-4. [DOI: 10.1111/j.1600-0560.2009.01480.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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