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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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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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Sasai K, Kawamura M, Okumura K, Kawai Y. Radiation Therapy for Sister Mary Joseph's Nodule: A Review. Adv Radiat Oncol 2024; 9:101321. [PMID: 38405321 PMCID: PMC10885576 DOI: 10.1016/j.adro.2023.101321] [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] [Received: 04/04/2023] [Accepted: 07/13/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose Umbilical metastasis, known as Sister Mary Joseph's nodule (SMJN), is a manifestation of advanced malignant disease. Patients with SMJN usually require supportive care or palliative systemic chemotherapy. However, with the increasing number of older and infirm patients, radiation therapy for SMJN is needed more frequently. Therefore, we conducted this review to provide insights into radiation treatment for this rare condition. Methods and Materials We searched PubMed on October 16, 2022, and obtained 275 articles that described SMJN or metastatic tumors within or near the umbilicus, as well as 255 case reports or case series (298 patients) and 20 reviews, original articles, or other study types, 1 of which also described a case. Results The prognosis of patients with SMJN is extremely poor. However, some patients can survive for more than 2 years. The primary organs of the umbilical metastasis are mainly in the gastrointestinal tract, including the stomach, colon, and pancreas. In addition to these organs, the ovaries, uterine corpus, and breasts are the major organs affected in women. Metastasis may be divided into 4 types according to the tumor location and mechanism of the extension: within the umbilicus, not within although existing near or adjacent to the umbilicus, in the umbilical or paraumbilical hernia sac, and iatrogenic disease. Only 7 reports described patients who received radiation therapy in detail. The patients were divided into 2 groups: a relatively long course and high total dose (approximately 45 Gy) group, and a short course and low total dose group. Conclusions Umbilical metastasis, known as SMJN, is a rare disease and is divided into 4 types based on the location of the disease and extent mechanism. Although the prognosis of the disease is poor, some patients survive for more than 2 years. Only 7 case reports precisely described radiation therapy. Half of the patients were treated with a short course, whereas the other half were treated with relatively high doses of up to 45 Gy.
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Affiliation(s)
- Keisuke Sasai
- Department of Radiation Therapy, Misugikai Sato Hospital, Hirakata, Osaka, Japan
- Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Masashi Kawamura
- Department of Radiation Therapy, Misugikai Sato Hospital, Hirakata, Osaka, Japan
| | - Kenji Okumura
- Department of Surgery, Misugikai Sato Hospital, Hirakata, Osaka, Japan
| | - Yasuhiro Kawai
- Department of Surgery, Misugikai Sato Hospital, Hirakata, Osaka, Japan
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4
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Ching LM, Tran BA, Russomanno KL, Cardis MA. Skin Metastasis of Low-Grade Ovarian Serous Carcinoma: A Case Report. Cureus 2023; 15:e37401. [PMID: 37181985 PMCID: PMC10171884 DOI: 10.7759/cureus.37401] [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: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
This case report, written with the assistance of ChatGPT, describes a rare manifestation of ovarian serous carcinoma that metastasized to the skin. A 30-year-old female with a history of stage IV low-grade serous ovarian carcinoma presented for evaluation of a painful nodule on her back. Physical examination demonstrated a round, firm, mobile subcutaneous nodule on the left upper back. An excisional biopsy was performed, and histopathologic examination was consistent with metastatic ovarian serous carcinoma. This case highlights the clinical presentation, histopathology, and treatment of cutaneous metastasis of serous ovarian carcinoma. Additionally, this case highlights the value and technique of using ChatGPT to assist in writing medical case reports including outlining, referencing, summarizing studies, and formatting citations.
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Affiliation(s)
- Lauren M Ching
- Department of Dermatology, Georgetown University School of Medicine, Washington, DC, USA
| | - Benjamin A Tran
- Department of Dermatology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Kristen L Russomanno
- Department of Dermatology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Michael A Cardis
- Department of Dermatology, MedStar Washington Hospital Center, Washington, DC, USA
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Li J, Cao C, Liu P, Yan Z, Xing D, Liu A. Cutaneous metastasis of carcinomatous component of ovarian carcinosarcoma: A case report and review of the literature. Diagn Pathol 2022; 17:76. [PMID: 36199118 PMCID: PMC9533490 DOI: 10.1186/s13000-022-01256-x] [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: 08/06/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
Skin metastasis of ovarian cancer is extremely rare. We report an unusual case of ovarian carcinosarcoma with cutaneous metastasis of carcinomatous component that displayed distinct clinical manifestation. A 48-year-old woman presented to the dermatologist complaining of a new onset of erythematous, plaque-like skin rash with multiple small nodules on the left inner thigh, the area measuring 8 × 5cm. While the patient had no history of dermatologic conditions, she underwent a total hysterectomy and bilateral salpingo-oophorectomy, omentectomy, and lymph node dissection 16 months ago with a pathology confirmed stage IIIC ovarian carcinosarcoma. Of note, the carcinomatous component, mainly adenocarcinoma with hybrid features of seromucinous, endometrioid and minor high-grade serous carcinoma, involved bilateral fallopian tubes, omentum, and parametrium with extensive lymph node metastases. A skin biopsy specimen revealed an adenocarcinoma involving epidermis, dermis, and subcutaneous tissue with nodular contours, consistent with metastatic carcinomatous component of carcinosarcoma. Both carcinomatous component of primary ovarian carcinosarcoma and metastatic adenocarcinoma in the skin demonstrated Pax8, WT-1, and ER positivity and a mutation pattern of p53. The patient passed away 15 months after identification of skin metastasis. This case represents a unique example of cutaneous metastasis of ovarian carcinosarcoma with distinct clinical manifestation and detailed histopathological description. Alertness to the possibility of cutaneous metastasis, in combination with clinical history, morphological and immunohistochemical findings, is critical for a definitive classification.
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Affiliation(s)
- Jinhang Li
- Department of Pathology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Chen Cao
- Department of Pathology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Peng Liu
- Department of Pathology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Zhifeng Yan
- Department of Obstetrics and Gynecology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Deyin Xing
- Department of Pathology, The Johns Hopkins University School of Medicine, 21231, Baltimore, MD, USA.
| | - Aijun Liu
- Department of Pathology, The Seventh Medical Center of PLA General Hospital, 100700, Beijing, China.
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Kaminska-Winciorek G, Pilśniak A, Piskorski W, Wydmański J. Skin metastases in the clinical and dermoscopic aspects. Semin Oncol 2022; 49:160-169. [DOI: 10.1053/j.seminoncol.2022.04.005] [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: 07/04/2020] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/11/2022]
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7
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Nie X, Chen X, Jiang Y, Zhong Y, Chen T, Cheng W. Sister Mary Joseph nodule as cutaneous manifestations of metastatic ovarian cancer: A case report and review of the literature. Medicine (Baltimore) 2022; 101:e28712. [PMID: 35147092 PMCID: PMC8830813 DOI: 10.1097/md.0000000000028712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/10/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE The Sister Mary Joseph's nodule is an umbilical nodule resulting from the metastasis of malignant tumors in the pelvic and/or abdominal cavity. Sister Mary Joseph's nodules are very rare, and the morphology of the skin lesions is not specific and is easily misdiagnosed. Here, we report a case of cutaneous manifestations of metastatic ovarian cancer. PATIENT CONCERNS The patient was admitted to our hospital because of abdominal distention, and a nodule was found in the umbilicus. A computerized tomography scan of the entire abdomen showed nodular soft tissue in the subcutaneous fat space of the umbilical area and multiple pelvic masses, which were suspected metastases of peritoneal and omentum ovarian cancer. INTERVENTIONS To confirm the pathological diagnosis, posterior fornix puncture was performed. Pathological biopsy showed adenocarcinoma. Histological examination revealed a mass arising from high-grade serous carcinoma of the ovary. The patient received 2 cycles of chemotherapy with paclitaxel liposomes and carboplatin and underwent interval debulking surgery. Postoperative pathology was consistent with high-grade serous carcinoma of the ovary. Cancer involvement was observed in umbilical lesions. After the operation, the patient was given 6 cycles of chemotherapy with paclitaxel liposomes and carboplatin. OUTCOMES The patient underwent follow-up until October 2020. A computerized tomography scan of the entire abdomen showed that the lymph nodes in the abdominal cavity were larger than before, suggesting a platinum-sensitive relapse. After receiving the same regimen of chemotherapy, carbohydrate antigen 125 dropped to the normal range, and consolidated treatment was administered for 3 cycles. Owing to her BRCA1 mutations, olaparib was administered for maintenance treatment. Until now, she had been in the outpatient clinic for regular follow-up visits. LESSONS The umbilicus remains an infrequently examined area, which cannot be underestimated and warrants careful clinical follow-up and histological evaluation, as appropriate.
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Affiliation(s)
- Xianglin Nie
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xing Chen
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yi Jiang
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yi Zhong
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Ting Chen
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Wenjun Cheng
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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8
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Alves FR, Malheiro M, Ferreira A, Miranda H, Martins A. Cutaneous and Cerebral Metastases From Primary Peritoneal Clear Cell Carcinoma. Cureus 2022; 14:e21282. [PMID: 35178330 PMCID: PMC8843070 DOI: 10.7759/cureus.21282] [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: 01/16/2022] [Indexed: 11/30/2022] Open
Abstract
Peritoneal tumors are very uncommon and among them, primary peritoneal clear cell carcinoma is extremely rare and often misdiagnosed as others subtypes. There are only 13 cases of primary peritoneal clear cell carcinoma previously reported in the literature and there are no reports about cutaneous metastasis in this setting and only brain metastases were described to be associated with other primary peritoneal carcinoma subtypes. More information about this topic is needed and so we are presenting a new case of primary peritoneal clear cell carcinoma with cutaneous and cerebral metastases in a 34-year-old female.
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9
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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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10
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Coco D, Leanza S. Cutaneous Metastasis in Ovarian Cancer: Case Report and Literature Review. MAEDICA 2020; 15:552-555. [PMID: 33603917 PMCID: PMC7879348 DOI: 10.26574/maedica.2020.15.4.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background: Cutaneous metastasis (CM) is a rare manifestation of cancer. The estimated rate of CM in ovarian cancers is about 3.5%, with a median survival of about four months after the occurrence of CM. Case report: We report the case of a 65-year-old woman with stage IA G3 adenocarcinoma clear cells (WT1+,estr-) of the ovary presenting with umbilical CM after laparoscopic incisional hernia repair. Conclusion: A primary tumour spread to the skin typically occurs late in the course of the disease. The overall incidence of CM from visceral neoplasia is 5.3% and 3%-4% from ovarian cancer.
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Affiliation(s)
- Danilo Coco
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Silvana Leanza
- Department of General Surgery, Carlo Urbani Hospital, Jesi, Ancona, Italy
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11
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Stien S, Loget J, Soibinet P, Durlach A, Fleury C, Viguier M. [Ovarian cancer revealed by mammary skin metastases and cutaneous lymphangitis]. Ann Dermatol Venereol 2019; 146:663-665. [PMID: 31522828 DOI: 10.1016/j.annder.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/15/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022]
Affiliation(s)
- S Stien
- Service de dermatologie-vénéréologie, université Reims-Champagne-Ardenne, hôpital Robert-Debré, 51100 Reims, France
| | - J Loget
- Service de dermatologie-vénéréologie, université Reims-Champagne-Ardenne, hôpital Robert-Debré, 51100 Reims, France
| | - P Soibinet
- Service d'oncologie, institut Jean-Godinot, 51100 Reims, France
| | - A Durlach
- Service d'anatomopathologie, université Reims-Champagne-Ardenne, hôpital Maison Blanche, 51100 Reims, France
| | - C Fleury
- Service d'anatomopathologie, institut Jean-Godinot, 51100 Reims, France
| | - M Viguier
- Service de dermatologie-vénéréologie, université Reims-Champagne-Ardenne, hôpital Robert-Debré, 51100 Reims, France.
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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: 11] [Impact Index Per Article: 2.2] [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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13
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Thomakos N, Diakosavvas M, Machairiotis N, Fasoulakis Z, Zarogoulidis P, Rodolakis A. Rare Distant Metastatic Disease of Ovarian and Peritoneal Carcinomatosis: A Review of the Literature. Cancers (Basel) 2019; 11:cancers11081044. [PMID: 31344859 PMCID: PMC6721345 DOI: 10.3390/cancers11081044] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/09/2019] [Accepted: 07/22/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Although metastases of ovarian and peritoneal carcinomatosis are most commonly found within the peritoneal cavity, there is a number of other rare distant sites that have been reported. Our goal is to provide an evidence-based summary of the available literature considering the rare distant metastatic sites of ovarian and peritoneal carcinomatosis. Methods: A comprehensive search of the literature was conducted, with Medline/PubMed being searched for cases of rare metastatic disease originated from primary ovarian and peritoneal cancer with related articles up to 2019 including terms such as "ovarian cancer", "metastases", "peritoneal" and others. Results: The most common mechanism of ovarian cancer metastases consists of primarily dissemination within the peritoneal cavity, while, rare and distant sites can either occur at the beginning or during the course of the disease and they are usually associated with hematogenous route and lymphatic invasion, having poor prognosis, with the least common sites being skin, bone, CNS, eye, placenta, central airways, rare lymph nodes, intra-abdominal organs, heart and breast. Conclusions: The occurrence of metastatic sites described in this review represents the most common rare distant metastatic sites, and even though their patterns of metastases are still not fully clarified due to the rarity of the reports, they offer valuable information considering the pathophysiology of the disease.
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Affiliation(s)
- Nikolaos Thomakos
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens 115 28, Greece
| | - Michail Diakosavvas
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens 115 28, Greece
| | - Nikolaos Machairiotis
- Department of Obstetrics & Gynecology, Department of Obstetrics-Gynaecology, Royal Oldham Hospital, Pennine Accute Trust, Oldham OL12JH, UK.
| | - Zacharias Fasoulakis
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens 115 28, Greece
| | - Paul Zarogoulidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki 546 36, Greece
| | - Alexandros Rodolakis
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens 115 28, Greece
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14
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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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15
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Siemon J, Nguyen DM, Pinto A, Schlumbrecht M. Rare metastatic patterns after malignant transformation of serous borderline tumor of the ovary. J Surg Oncol 2019; 119:814-816. [DOI: 10.1002/jso.25380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/05/2019] [Indexed: 11/08/2022]
Affiliation(s)
- John Siemon
- Division of Gynecologic OncologySylvester Comprehensive Cancer Center, University of Miami Miller School of MedicineMiami Florida
| | - Dao M Nguyen
- Division of Thoracic Surgical OncologyUniversity of Miami Miller School of MedicineMiami Florida
| | - Andre Pinto
- Department of PathologySylvester Comprehensive Cancer Center, University of Miami Miller School of MedicineMiami Florida
| | - Matthew Schlumbrecht
- Division of Gynecologic OncologySylvester Comprehensive Cancer Center, University of Miami Miller School of MedicineMiami Florida
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