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Filizoglu N, Ozguven S. Skin and Subcutaneous Tissue Metastases of the Pulmonary Carcinoid Tumor on 68 Ga-DOTATATE PET/CT. Clin Nucl Med 2023; 48:e554-e555. [PMID: 37796157 DOI: 10.1097/rlu.0000000000004840] [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: 10/06/2023]
Abstract
ABSTRACT Pulmonary carcinoid tumors are a very rare type of neuroendocrine tumor, accounting for only 1% to 2% of all primary lung cancers. Pulmonary carcinoids most commonly metastasize to the mediastinal lymph nodes, liver, and bones. Metastasis of pulmonary carcinoids to the skin and subcutaneous tissue is extremely rare and has been reported in only a small number of cases. We presented 68 Ga-DOTATATE PET/CT findings of an exceptional case of a pulmonary carcinoid tumor with extensive skin, subcutaneous, thyroid, and intramuscular metastases.
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Affiliation(s)
- Nuh Filizoglu
- From the Department of Nuclear Medicine, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital
| | - Salih Ozguven
- Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
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2
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Paolino G, Pampena R, Grassi S, Mercuri SR, Cardone M, Corsetti P, Moliterni E, Muscianese M, Rossi A, Frascione P, Longo C. Alopecia neoplastica as a sign of visceral malignancies: a systematic review. J Eur Acad Dermatol Venereol 2019; 33:1020-1028. [PMID: 30767283 DOI: 10.1111/jdv.15498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 01/18/2019] [Indexed: 12/11/2022]
Abstract
Alopecia neoplastica (AN) from visceral tumours is a rare form of cutaneous metastasis in which internal malignancies spread to the scalp. The diagnosis of AN may be very challenging, especially when its onset precedes the diagnosis of the primary tumour. We aimed to improve the knowledge on AN, highlighting that in case of scarring localized alopecia, a differential diagnosis with metastasis should always be considered. We performed a systematic review to describe the main demographic and clinical features associated with AN from visceral malignancies; a survival analysis was also performed. In 118 reports, accounting for 123 patients, we found that women were more affected by AN than men (53.7% vs. 46.3%). The most frequent site of the primary tumour was the gastrointestinal tract (24.4%), followed by breast (17.9%), kidney (8.1%), lung (7.3%), thyroid (7.3%), uterus (6.5%), central nervous system (6.5%), liver (3.3%) and other anatomic areas for 18.7% of cases. Furthermore, in more than half of the cases (66.1%), AN lesions were single and were mainly diagnosed after the primary visceral tumour (71.5%). Finally, survival analysis highlighted a lower progression-free survival in men; while, no significant differences in overall survival were reported among genders. In conclusion, metastatic skin disease should always be taken into consideration when dealing with patients with localized scarring alopecia.
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Affiliation(s)
- G Paolino
- Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy.,Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - R Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Grassi
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - S R Mercuri
- Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy
| | - M Cardone
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - P Corsetti
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - E Moliterni
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - M Muscianese
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - A Rossi
- Department of Dermatology, La Sapienza University of Rome, Rome, Italy
| | - P Frascione
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - C Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Dermatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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3
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Case of Solitary Peritoneal Metastasis From Atypical Bronchopulmonary Carcinoid on 18F-FDG PET/CT. Clin Nucl Med 2019; 44:e154-e157. [DOI: 10.1097/rlu.0000000000002441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Panse G, Cowper SE, Leffell DJ, Pulitzer M, Ko CJ. Well-differentiated neuroendocrine tumors in skin: Terminology and diagnostic utility of cytokeratin 5/6 and p63. J Cutan Pathol 2018; 44:557-562. [PMID: 28417484 DOI: 10.1111/cup.12952] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Well-differentiated neuroendocrine tumors (WDNETs) in skin include metastases from visceral primary sites and very uncommonly, primary cutaneous carcinoid tumors. Cutaneous WDNET may present a diagnostic challenge and in particular can be mistaken for a benign skin adnexal tumor. In contrast to cutaneous adnexal tumors, metastatic adenocarcinomas to the skin are cytokeratin 5/6 (CK5/6) and p63 negative in the majority of cases. It is unclear if failure to stain with CK5/6 and p63 would be helpful in differentiating WDNETs from cutaneous adnexal neoplasms. METHODS We reviewed 10 cases of cutaneous WDNETs (8 cases of metastatic disease and 2 presumed primary carcinoid tumors of the skin) and performed immunohistochemical stains for CK5/6 and p63 on all cases. RESULTS All 10 cases were negative with both CK5/6 and p63. CONCLUSION Negative staining for CK5/6 and p63 can be helpful to distinguish WDNETs from cutaneous adnexal neoplasms. It is important to consider WDNETs in the differential diagnosis of cutaneous adnexal neoplasms as low-grade tumors may be the first sign of aggressive metastatic disease.
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Affiliation(s)
- Gauri Panse
- Department of Dermatology, Division of Dermatopathology, Yale School of Medicine, New Haven, Connecticut
| | - Shawn E Cowper
- Department of Dermatology, Division of Dermatopathology, Yale School of Medicine, New Haven, Connecticut.,Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - David J Leffell
- Department of Dermatology, Division of Dermatopathology, Yale School of Medicine, New Haven, Connecticut
| | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christine J Ko
- Department of Dermatology, Division of Dermatopathology, Yale School of Medicine, New Haven, Connecticut.,Department of Pathology, Yale School of Medicine, New Haven, Connecticut
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Amorim GM, Quintella D, Cuzzi T, Rodrigues R, Ramos-E-Silva M. Cutaneous Metastasis of Neuroendocrine Carcinoma with Unknown Primary Site: Case Report and Review of the Literature. Case Rep Dermatol 2015; 7:263-74. [PMID: 26557073 PMCID: PMC4637521 DOI: 10.1159/000440661] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a new case of neuroendocrine carcinoma for which it was not possible to find the primary site until now. The recent medical literature about skin metastasis of neuroendocrine carcinoma (neuroendocrine tumor) is discussed.
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Affiliation(s)
- Gustavo Moreira Amorim
- Sector of Dermatology and Post-Graduation Course, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Danielle Quintella
- Sector of Pathology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tullia Cuzzi
- Sector of Pathology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosangela Rodrigues
- Sector of Dermatology and Post-Graduation Course, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Ramos-E-Silva
- Sector of Dermatology and Post-Graduation Course, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
Primary carcinoid tumor of the skin (PCTS) is an uncommon indolent neoplasm, with 10 cases described in the literature. The tumors affect patients in the sixth to ninth decades of life (mean = 66.3 years) with an equal gender distribution and predilection for the head and trunk. They present as slowly enlarging nodules of variable duration, ranging from 1 to 60 years (mean = 11.4 years). PCTS is characterized by architectural, cytomorphologic, ultrastructural, and immunohistochemical features typical of a low-grade neoplasm with neuroendocrine differentiation. PCTS typically follows a benign clinical course and therefore has to be distinguished from cutaneous metastases of visceral carcinoid tumors, which herald dissemination of malignancy and poor prognosis. While the distinction from other histologically similar entities can be achieved by histopathological examination, PCTS can be distinguished from a visceral metastasis only by a judicious clinicopathologic correlation. Herein we describe the clinical presentation, histological appearance, and management of these tumors.
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Affiliation(s)
- Jaroslaw Jedrych
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Jedrych J, Busam K, Klimstra DS, Pulitzer M. Cutaneous metastases as an initial manifestation of visceral well-differentiated neuroendocrine tumor: a report of four cases and a review of literature. J Cutan Pathol 2013; 41:113-22. [PMID: 24218988 DOI: 10.1111/cup.12263] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 10/21/2013] [Accepted: 11/03/2013] [Indexed: 12/28/2022]
Abstract
Well-differentiated neuroendocrine tumors metastasize to the skin uncommonly, and only 35 cases are reported in the literature. In only five of these patients, cutaneous metastases were the presenting symptom of malignancy; herein, we report four such cases. Two patients were female and two male, aged 50-74 years (mean: 64.5 years), each with a solitary painless, slowly enlarging, non-ulcerated cutaneous nodule of 3-12 months duration (mean: 9 months). The lesions were on the scalp (n = 3) and trunk (n = 1), and ranged in greatest dimension from 0.5 to 2.5 cm. The distinction from other microscopically similar entities, and the interpretation of origination from gastrointestinal, pancreatic or respiratory system primaries, was made clinically, or was based on the morphological features and the immunohistochemical profile. One patient died of the disease progression after 36 months whereas two patients are alive with significant disease progression after 24 and 60 months. Metastatic neuroendocrine tumor should be considered in the differential diagnosis of cutaneous tumors with neuroendocrine morphology even in patients with no known history of visceral malignancy.
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Affiliation(s)
- Jaroslaw Jedrych
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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8
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Donati P, Panetta C, Cota C, Paolino G, Muscardin L. Carcinoid metastasis of the skin appearing as painful tumor. J Dermatol 2013; 40:415-7. [PMID: 23414140 DOI: 10.1111/1346-8138.12084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Koehler JW, Weiss RC, Aubry OA, Smith AN, Hathcock JT, Brawner WR. Nasal tumor with widespread cutaneous metastases in a Golden Retriever. Vet Pathol 2011; 49:870-5. [PMID: 21878681 DOI: 10.1177/0300985811417250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An intact, 8-year-old, male Golden Retriever dog was presented for evaluation of a nasal mass and approximately 30 firm, raised, variably ulcerated dermal and subcutaneous masses. Histopathology of both nasal and multiple skin masses revealed multiple nonencapsulated, infiltrative masses comprising clusters, anastomosing trabeculae, and packets of neoplastic, round to ovoid, hyperchromatic cells with marked nuclear molding. Surrounding the neoplastic cells was a marked stromal response in which many of the spindle-shaped cells expressed muscle-specific actin and had ultrastructural features consistent with myofibroblasts. A literature search indicates that this is the first report in a peer-reviewed journal of cutaneous metastasis of a nasal neuroendocrine tumor in any domestic animal species.
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Affiliation(s)
- J W Koehler
- Auburn University College of Veterinary Medicine, Department of Pathobiology, Auburn, Alabama, USA.
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