Squamous syringometaplasia associated with docetaxel

Paclitaxel-induced cutaneous change mimicking malignancy in a previous cutaneous eruption

Taxanes are antineoplastic drugs that can cause dermatotoxicity which can mimic an intraepidermal carcinoma. A 65-year-old woman presented with a cutaneous eruption suggestive of a paraneoplastic syndrome. Imaging studies showed multiple peritoneal nodules and associated ascites. A sample taken from the greater omentum revealed an adenocarcinoma. Clinical data and family history pointed to a gynecological origin of the tumor and the patient was treated with carboplatin and paclitaxel. A new cutaneous biopsy showed that the epidermis was acanthotic with atypical keratinocytes, abundant mitoses, and apoptotic figures, arising concerns of malignancy. According to the Plummer and Shea criteria, the lesion was ultimately interpreted as reactive cutaneous hyperplasia and expression of the taxane effect. We report, for the first time, paclitaxel-induced histologic changes on a previous cutaneous eruption. Pathologists should be aware of the profound cytopathic effects of taxane therapy in order to interpret skin biopsies of patients undergoing this treatment.

Intravesicular taxane-induced dermatotoxicity in a 78-year-old man with urothelial carcinoma and primary cutaneous anaplastic large cell lymphoma

Patients treated with intravesical bacillus Calmette-Guérin therapy for urothelial carcinoma often become refractory and experience recurrent disease, thus necessitating alternative intravesical treatment modalities if the patient is to be spared the morbidities associated with radical cystectomy. Intravesical treatment with taxane-based chemotherapy, such as docetaxel, has gained traction in urologic oncology, proving to be an effective salvage therapy in such patients. Systemic taxane-based chemotherapeutic regimens have long been used in several advanced malignancies, and their systemic side-effects and associated histologic correlates have been extensively documented. In contrast to adverse effects associated with systemic administration, intravesical taxane administration has thus far proven to be well-tolerated, with little to no systemic absorption. To our knowledge, features of taxane-induced systemic effects have not been reported in this setting. Herein, we report a case of a patient with recurrent urothelial carcinoma treated with intravesical docetaxel, along with primary cutaneous anaplastic large cell lymphoma, who developed characteristic dermatotoxic histologic findings associated with intravenous taxane administration. As such histopathologic findings often represent close mimickers of neoplastic and infectious etiologies, knowledge of the potential for systemic manifestations of taxane therapy in patients treated topically may prevent potentially costly diagnostic pitfalls.

Eccrine squamous syringometaplasia secondary to cutaneous extravasation of docetaxel: report of three cases

Eccrine squamous syringometaplasia is characterized by the metaplasia of cuboidal epithelial cells of the eccrine sweat ducts into squamous epithelial cells. It has been associated with several conditions including chemotherapy-related bilateral dermatitis, an entity that can take place in body areas rich in eccrine glands, as well as in acral erythema related to chemotherapy. Only a few cases because of cutaneous extravasation of chemotherapy have been previously reported. We report three cases of eccrine squamous syringometaplasia secondary to extravasation of docetaxel.

Vincristine-induced eccrine squamous syringometaplasia

Eccrine squamous syringometaplasia is a histologic finding associated with chemotherapy administration and other cutaneous diseases. Concentration of the chemotherapeutic agents is believed to effect toxic changes in these epithelial structures. We report the first case of vincristine-induced eccrine squamous syringometaplasia in a 12-year-old patient undergoing treatment for rhabdomyosarcoma.

Chemotherapeutic agents and the skin: An update

Chemotherapeutic agents give rise to numerous well described adverse effects that may affect the skin, hair, mucous membranes, or nails. The mucocutaneous effects of longstanding agents have been extensively studied and reviewed. Over the last 2 decades, a number of new molecular entities for the treatment of cancer have been approved by the United States Food and Drug Administration (FDA). This article reviews the cutaneous toxicity patterns of these agents. It also reviews one drug that has not received FDA approval but is in use outside the United States and is important dermatologically. Particular emphasis is placed on the novel signal transduction inhibitors as well as on newer literature pertaining to previously described reactions.

LEARNING OBJECTIVES

At the completion of this learning activity, participants should able to list the newer chemotherapeutic agents that possess significant mucocutaneous side effects and describe the range of reactions that are seen with each drug. In addition, they should be able to formulate appropriate management strategies for these reactions.

Neutrophilic eccrine hidradenitis in non-small cell lung cancer

A 75-year-old man was treated for non-small cell lung cancer (NSCLC) (stage IIIb) with three-cycle chemotherapy (cisplatin and paclitaxel) for 3 weeks. No skin lesions were observed during the first and second chemotherapy cycles. After the third chemotherapy cycle, he developed slightly pruritic skin eruptions on the anterior chest. He was treated for 1 month with topical steroid without improvement, and was referred to our dermatologic department. Skin examination revealed slightly elevated, dusky, erythematous, edematous patches on the anterior chest in a bilateral distribution (Fig. 1). Histologic examination of a biopsy specimen taken from the cutaneous lesions showed a neutrophilic infiltrate surrounding the secretory eccrine glands. The epithelial cells of the eccrine ducts and coils were not affected. There was a mild superficial perivascular infiltrate of mainly lymphocytes. These changes were consistent with a diagnosis of neutrophilic eccrine hidradenitis (Fig. 2). He was treated with dapsone, 50 mg/day, and methylprednisolone, 8 mg/day, for 2 weeks, and his skin lesions improved. Two months later the erythematous eruptions recurred on the chest, back, and extremities without the use of any chemotherapeutic agent, and were treated effectively with the same drugs.