1
|
Torre-Castro J, Ríos-Viñuela E, Balaguer-Franch I, Díaz de Lezcano I, Aguado-García Á, Nájera L, Suárez D, Requena L. Perineural Infiltration: A Comprehensive Review of Diagnostic, Prognostic, and Therapeutic Implications. Am J Dermatopathol 2024; 46:271-286. [PMID: 38457673 DOI: 10.1097/dad.0000000000002667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
ABSTRACT Perineural infiltration refers to a neoplastic cell involvement in, around, and through the nerves. It is considered as one of the neoplastic dissemination pathways. Thus, its identification is crucial to establish the prognosis of some malignant skin neoplasms, such as squamous cell carcinoma, and explains the locally aggressive behavior of cutaneous neoplasms, such as microcystic adnexal carcinoma. We have conducted a review of malignant and benign skin tumors in which perineural infiltration has been described, and we also discuss some histopathological findings that may simulate perineural infiltration.
Collapse
Affiliation(s)
- Juan Torre-Castro
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Elisa Ríos-Viñuela
- Department of Dermatology, Instituto Valenciano de Oncología, Escuela de Doctorado Universidad Católica de Valencia, Valencia, Spain
| | | | | | | | - Laura Nájera
- Department of Pathology, Puerta de Hierro University Hospital, Universidad Autónoma, Majadahonda, Madrid, Spain
| | - Dolores Suárez
- Department of Pathology, Puerta de Hierro University Hospital, Universidad Autónoma, Majadahonda, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| |
Collapse
|
2
|
Sagar S, Khan D, Wakankar R, Shamim SA, Kumar R. Rare Presentation of En Cuirasse Detected on 18-F FDG PET/CT in a Case of Recurrent Breast Carcinoma. Indian J Nucl Med 2024; 39:146-147. [PMID: 38989313 PMCID: PMC11232726 DOI: 10.4103/ijnm.ijnm_31_23] [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: 03/13/2023] [Accepted: 04/11/2023] [Indexed: 07/12/2024] Open
Abstract
Carcinoma en cuirasse is a type of cutaneous metastasis from different malignancies. En cuirasse although is a rare entity, most commonly occurs in cases of recurrent breast carcinoma after surgery or very rarely months or years after diagnosis of primary tumor. We report a rare case of neck carcinoma en cuirasse in a 47-year-old Indian female who is a known case of recurrent carcinoma left breast postmodified radical mastectomy, chemotherapy, and radiotherapy referred for fluorodeoxyglucose positron emission tomography-computed tomography following another six cycles of chemotherapy for response assessment.
Collapse
Affiliation(s)
- Sambit Sagar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Dikhra Khan
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ritwik Wakankar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shamim Ahmed Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
3
|
Li S, Cai X, Yu K, Pan W. Nasal Tip Cutaneous Metastasis of Hepatocellular Carcinoma: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:2893-2897. [PMID: 37869532 PMCID: PMC10590066 DOI: 10.2147/ccid.s429480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023]
Abstract
Background Cutaneous metastasis is rare in clinical practice, especially that from primary hepatocellular carcinoma (HCC), which is even rarer. Case Presentation This report describes a male patient with HCC with cutaneous metastases to the nasal tip. The patient developed a raised nodule at the nasal tip 5 years after surgery for HCC, with surface ulceration and crusting and no obvious symptoms. Abdominal computed tomography (CT) showed an obvious mass in the liver. The skin lesions on the nasal tip were confirmed to be cutaneous metastasis of HCC by histopathological and immunohistochemical examinations. Conclusion The incidence of cutaneous metastasis of HCC is extremely low, and nasal tip cutaneous metastasis of HCC has no specific clinical manifestations; therefore, it needs to be distinguished from rosacea rhinophyma, fungal and atypical mycobacterial infections, tumours of vascular origin, and tumours of skin appendages that occur in the nasal tip and is prone to misdiagnosis and missed diagnosis, thus requiring clinical dermatologists and otolaryngologists to be aware of such metastasis.
Collapse
Affiliation(s)
- Songting Li
- Department of Dermatology, Second Affiliated Hospital of Naval Medical University, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai, People’s Republic of China
| | - Xiaolan Cai
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Keyao Yu
- Department of Dermatology, Second Affiliated Hospital of Naval Medical University, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai, People’s Republic of China
| | - Weihua Pan
- Department of Dermatology, Second Affiliated Hospital of Naval Medical University, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai, People’s Republic of China
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Dumlao JKG, Cubillan ELA, Villena JPDS. Clinical and Histopathologic Profile of Patients with Cutaneous Metastasis in a Tertiary Hospital in the Philippines. Dermatopathology (Basel) 2022; 9:392-407. [PMID: 36547220 PMCID: PMC9777325 DOI: 10.3390/dermatopathology9040046] [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] [Received: 10/27/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cutaneous metastases represent 2% of skin tumors, with an overall incidence of 5.3%. Although rare, clinical presentations of cutaneous metastasis vary and can be mistaken for benign and malignant skin conditions. METHODOLOGY This was a descriptive, retrospective review of all patients diagnosed with cutaneous metastasis seen at the Department of Dermatology from January 2013 to December 2019. Clinical and histopathologic data from the patients were collated from medical records, and slides were retrieved for review. RESULTS A total of 115 patients were included and 122 slides reviewed. There were more female than males, the mean age was 52.3 ± 14.0 years of age. The most common primary cancer was the breast, and accordingly, the most common location was anterior chest. Among the 122 slides reviewed from 104 patients, the most common histologic type was adenocarcinoma (72.1%), and showed the infiltrative pattern (26.2%). Other histologic types seen were melanoma (13.1%), leukemic infiltrates (11.5%), squamous origin (2.5%), and epithelioid sarcoma (0.8%). Lymphovascular invasion and dermal sclerosis were observed. Immunohistochemical stains were performed in only 13.9% of the cases. There was a high concurrence of the clinical with the histopathologic diagnosis (95.6%). CONCLUSION Although rare, patients with cutaneous metastasis may present in dermatology clinics. Knowledge of clinical features and low threshold for doing biopsies may prove useful for these patients. Similarly, dermatopathologists should be able to recognize histologic features of cutaneous metastasis morphologically. Histologic features may be subtle and may be reminiscent of benign inflammatory conditions, hence judicious use of immunohistochemical staining is recommended.
Collapse
|
6
|
Sakai M, Kashiwagi N, Nakanishi K, Maeda N, Nakaya Y, Tanaka J, Watanabe S, Hongyo H, Tanaka Y, Yamada S, Kawata A, Toda S, Takano K, Arita H, Tomiyama N. Nonbrain metastases seen on magnetic resonance imaging during metastatic brain tumor screening. Jpn J Radiol 2022; 41:367-381. [PMID: 36374473 PMCID: PMC10066091 DOI: 10.1007/s11604-022-01362-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
AbstractAlthough metastases found during head magnetic resonance imaging (MRI) are not limited to metastatic brain tumors, the MRI is a very common method for “brain metastasis screening,” a modality that is being increasingly performed. In this review, we describe MRI findings of nonbrain metastases and discuss ways to avoid missing these lesions. Metastatic cranial bone tumors are among the most common nonbrain metastatic lesions found on head MRI, followed by leptomeningeal carcinomatosis. The other less-frequent metastatic lesions include those in the ventricle/choroid plexus, the pituitary gland and stalk, and the pineal gland. Metastases in the head and neck area, as well as cranial and intracranial lesions, should be carefully evaluated. Furthermore, direct geographical invasion, perineural spread, and double cancers should also be considered. While it is important to recognize these metastatic lesions on MRI, because they may necessitate a change in treatment strategy that could lead to an improvement in prognosis due to early introduction of therapy, nonbrain lesions should also be given greater attention, given the increasing survival of patients with cancer and advances in MRI technology, such as contrast-enhanced-3D T1-weighted imaging.
Collapse
Affiliation(s)
- Mio Sakai
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan.
| | - Nobuo Kashiwagi
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Katsuyuki Nakanishi
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Noboru Maeda
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Yasuhiro Nakaya
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Junichiro Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Shinichiro Watanabe
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Hidenari Hongyo
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Yu Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Sawaka Yamada
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Atsushi Kawata
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Sou Toda
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Koji Takano
- Department of Neurosurgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Hideyuki Arita
- Department of Neurosurgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| |
Collapse
|
7
|
Newcomer JB, Durbin A, Wilson C. Cutaneous Metastasis of Lung Adenocarcinoma: Initially Mimicking and Misdiagnosed as Keloids. Cureus 2022; 14:e27285. [PMID: 36039229 PMCID: PMC9406242 DOI: 10.7759/cureus.27285] [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: 07/26/2022] [Indexed: 11/05/2022] Open
Abstract
Cutaneous metastases have distinct morphologic features that can aid in making the diagnosis clinically even prior to biopsy. Lesions often have a nodular appearance and are firm, fixed, and range from flesh-colored to reddish-purple. A 73-year-old female with a history of lung adenocarcinoma status-post neoadjuvant chemotherapy and lobectomy 20 months prior was referred to our dermatology clinic for evaluation and treatment of suspected keloids on the left flank. The lesions were firm, plum-colored, fibrotic nodules, and were diagnosed clinically in the office as cutaneous metastases of internal malignancy. Punch biopsy was performed and revealed a proliferation of atypical epithelial cells arranged in cords and strands, with neoplastic cells positive for CK7 and TTF-1, confirming the diagnosis of metastatic adenocarcinoma. The patient was referred for chemotherapy and is still alive nine months following the prompt clinical diagnosis of cutaneous metastasis. Cutaneous metastasis signifies a poor prognosis, but knowledge of the clinical characteristics of these lesions can lead to earlier detection and more prompt initiation of treatment.
Collapse
|
8
|
Vernemmen AIP, Li X, Roemen GMJM, Speel EJM, Kubat B, Hausen AZ, Winnepenninckx VJL, Samarska IV. Cutaneous metastases of internal malignancies: a single-institution experience. Histopathology 2022; 81:329-341. [PMID: 35758186 PMCID: PMC9544513 DOI: 10.1111/his.14705] [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: 03/31/2022] [Revised: 05/24/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Abstract
Aims Cutaneous metastases of internal malignancies occur in 1–10% of cancer patients. The diagnosis can sometimes be challenging, especially in cases with an unknown primary cancer. Materials and methods A retrospective case review was performed including all cases of skin metastases from primary internal malignancies diagnosed at the Department of Pathology at the Maastricht University Medical Centre+ from 2007 to 2021. The clinicopathological data were collected and immunohistochemical and molecular diagnostic tests were performed to confirm the primary origin of the metastases. Results We identified 152 cases (71 female; 31 male patients) of cutaneous metastases of internal malignancies. 28 patients (20 women and 8 men) were diagnosed with multiple cutaneous metastases. Among the female patients, the most common primary tumour was breast cancer (50% of the cases), followed by lung (13.6%), gynaecological (7.3%), and gastrointestinal origin (7.3%). Among the male patients, the most common primary sites were gastrointestinal and lung origin (altogether, 50% of the cases). In 19 patients, the cutaneous metastasis was the first presentation of a clinically silent internal malignancy (18.6%), of which most (78.9%) represented metastatic lung carcinomas. Finally, metastasizing patterns were different across tumour types and gender. Conclusion Breast, lung, gastrointestinal, and gynaecologic cancers are the most common primary tumours demonstrating skin metastases. Infrequently, cutaneous metastases can be the first clinically visual manifestation of an underlying not yet diagnosed internal malignancy; therefore, occasional broad immunohistochemical profiling, molecular clonal analysis, and a continuous high level of awareness are necessary for a precise diagnosis of cutaneous metastases of internal malignancies.
Collapse
Affiliation(s)
- Astrid I P Vernemmen
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Xiaofei Li
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Guido M J M Roemen
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ernst-Jan M Speel
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Bela Kubat
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Axel Zur Hausen
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Véronique J L Winnepenninckx
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Iryna V Samarska
- Department of Pathology, GROW-School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
9
|
Sutedja EK, Rizqandaru T, Ruchiatan K, Sutedja E. Cutaneous Metastases from Thymic Carcinoma Primary Tumor: A Rare Case. Int Med Case Rep J 2022; 15:293-298. [PMID: 35734095 PMCID: PMC9207123 DOI: 10.2147/imcrj.s369726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022] Open
Abstract
Cutaneous metastases (CM) are neoplastic lesions of the skin originating from a primary tumor elsewhere. CM originating from primary thymic carcinoma is rare, and its incidence remains uncertain. A case of CM from thymic carcinoma in a 57-year-old man was reported. The patient complained about lumps on the skin of the chest, right shoulder and neck that appeared eleven months before the diagnosis of thymic carcinoma was established. Physical examination revealed tumors on the chest, right shoulder and neck. Histopathological examination results were consistent with CM. An immunohistochemical (IHC) examination was performed to determine the primary tumor, with a positive result for CK7. The diagnosis of thymic carcinoma was established based on the results of enhanced chest CT-scan and immunohistochemistry on lymph node biopsies. The patient was treated with a chemotherapy regimen of cyclophosphamide, doxorubicin, and carboplatin scheduled for six cycles. However, the patient did not survive his third cycle of chemotherapy. Establishing the diagnosis and managing CM are challenging for clinicians. This requires careful historical and physical examination, supported by histopathological examination and specific immunohistochemical marker in accordance with the suspected tumor.
Collapse
Affiliation(s)
- Eva Krishna Sutedja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
- Correspondence: Eva Krishna Sutedja, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +62 8122014300, Email
| | - Trustia Rizqandaru
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Kartika Ruchiatan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Endang Sutedja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| |
Collapse
|
10
|
Huppert LA, Green MD, Kim L, Chow C, Leyfman Y, Daud AI, Lee JC. Tissue-specific Tregs in cancer metastasis: opportunities for precision immunotherapy. Cell Mol Immunol 2022; 19:33-45. [PMID: 34417572 PMCID: PMC8752797 DOI: 10.1038/s41423-021-00742-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/28/2021] [Indexed: 12/27/2022] Open
Abstract
Decades of advancements in immuno-oncology have enabled the development of current immunotherapies, which provide long-term treatment responses in certain metastatic cancer patients. However, cures remain infrequent, and most patients ultimately succumb to treatment-refractory metastatic disease. Recent insights suggest that tumors at certain organ sites exhibit distinctive response patterns to immunotherapy and can even reduce antitumor immunity within anatomically distant tumors, suggesting the activation of tissue-specific immune tolerogenic mechanisms in some cases of therapy resistance. Specialized immune cells known as regulatory T cells (Tregs) are present within all tissues in the body and coordinate the suppression of excessive immune activation to curb autoimmunity and maintain immune homeostasis. Despite the high volume of research on Tregs, the findings have failed to reconcile tissue-specific Treg functions in organs, such as tolerance, tissue repair, and regeneration, with their suppression of local and systemic tumor immunity in the context of immunotherapy resistance. To improve the understanding of how the tissue-specific functions of Tregs impact cancer immunotherapy, we review the specialized role of Tregs in clinically common and challenging organ sites of cancer metastasis, highlight research that describes Treg impacts on tissue-specific and systemic immune regulation in the context of immunotherapy, and summarize ongoing work reporting clinically feasible strategies that combine the specific targeting of Tregs with systemic cancer immunotherapy. Improved knowledge of Tregs in the framework of their tissue-specific biology and clinical sites of organ metastasis will enable more precise targeting of immunotherapy and have profound implications for treating patients with metastatic cancer.
Collapse
Affiliation(s)
- Laura A Huppert
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael D Green
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Luke Kim
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Christine Chow
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Yan Leyfman
- Penn State College of Medicine, Hershey, PA, USA
| | - Adil I Daud
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - James C Lee
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.
| |
Collapse
|
11
|
Yu D, Yang DX, Li Y, Guan B, Ming Q, Li Y, Zhu YP, Chen LQ, Luo WX. Nano-Silver Medical Antibacterial Dressing Combined with High-Flow Oxygen Therapy Facilitates Ulcer Wound Healing of Superficial Malignant Tumors. Cancer Manag Res 2021; 13:9007-9013. [PMID: 34908876 PMCID: PMC8664651 DOI: 10.2147/cmar.s341448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background Due to the poor healing of superficial malignant tumor ulcer wounds, patients suffer great pain and significantly reduced quality of life. Related research shows that oxygen therapy can reduce wound bleeding and promote wound healing. Objective This study aims to explore the therapeutic effect of nano-silver antibacterial dressing combined with high-flow oxygen therapy on surface malignant tumor ulcers. Methods In this retrospective analysis, 64 patients with superficial malignant tumors and ulcer infection were included and divided into the research group and the control group, with 32 cases in each group. After conventional debridement, the control group was treated with vaseline dressing, while the research group was treated with nano-silver medical antibacterial dressing combined with high-flow oxygen therapy. Both groups were treated for 7 days. The frequency of dressing change and the number of times of blood oozing between the two groups after treatment were recorded. The pain, clinical efficacy, and levels of procalcitonin (PCT) and C-reactive protein (CRP) were compared between the two groups before and after treatment. Results The dressing changes and blood oozing were less frequent in the research group compared with the control group. The pain score and the levels of PCT and CRP in the research group were lower than those in the control group. The overall response rate was significantly higher in the research group as compared to the control group. All the above differences were statistically significant (P<0.05). Conclusion Nano-silver medical antibacterial dressing combined with high-flow oxygen therapy can reduce the frequency of dressing changes in patients, relieve pain, reduce inflammation, and accelerate the healing of superficial malignant tumor ulcer wounds.
Collapse
Affiliation(s)
- Dan Yu
- Department of Otolaryngology and Hepatobiliary, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, People's Republic of China
| | - Di-Xiao Yang
- Nursing Department, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, People's Republic of China
| | - Yao Li
- Intensive Care Unit, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, People's Republic of China
| | - Bi Guan
- Nursing Department, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, People's Republic of China
| | - Qian Ming
- Nursing Department, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, People's Republic of China
| | - Yan Li
- Nursing Department, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, People's Republic of China
| | - Yi-Ping Zhu
- Department of Oncology, Chengdu Wenjiang District People's Hospital, Chengdu, 611130, Sichuan, People's Republic of China
| | - Li-Qing Chen
- Department of Otolaryngology and Hepatobiliary, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, People's Republic of China
| | - Wei-Xiang Luo
- Department of Nursing, Shenzhen People's Hospital (2nd Clinical Medical College of Jinan University, First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, 518020, Guangdong, People's Republic of China
| |
Collapse
|
12
|
Neglected malignant neoplasms with cutaneous involvement. Postepy Dermatol Alergol 2021; 38:916-920. [PMID: 34849146 PMCID: PMC8610055 DOI: 10.5114/ada.2021.108457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022] Open
|
13
|
Lubin D, Jafroodifar A, Seth R, Zaccarini D. Subcutaneous Soft Tissue Metastases in Lung Adenocarcinoma: A Surprising Initial Presentation on Bone Scintigraphy. Clin Nucl Med 2021; 46:e538-e540. [PMID: 34319964 DOI: 10.1097/rlu.0000000000003826] [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: 11/25/2022]
Abstract
ABSTRACT Initial disease presentations are often surprising compared with expected clinical trajectories. We present a case of metastatic lung adenocarcinoma where the initial presentation was masquerading as a musculoskeletal soft tissue mass. Initial concern was for a hematoma after light trauma, but due to a pacemaker, MRI was contraindicated. Workup included a 99mTc-MDP bone scan where the lesion demonstrated activity. Further workup imaging was serendipitous, revealing a left upper lobe mass. Biopsy demonstrated poorly differentiated adenocarcinoma of lung origin. Soft tissue metastasis can occur with lung adenocarcinoma, and although it constitutes a less frequent metastatic route, it is nevertheless clinically important.
Collapse
|
14
|
Betlloch-Mas I, Soriano-García T, Boira I, Palazón JC, Juan-Carpena G, Sancho-Chust JN, Chiner E. Cutaneous Metastases of Solid Tumors: Demographic, Clinical, and Survival Characteristics. Cureus 2021; 13:e19970. [PMID: 34984130 PMCID: PMC8714347 DOI: 10.7759/cureus.19970] [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] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cutaneous metastasis (CM), while uncommon, is usually an indicator of poor prognosis. With cancer patients living longer, the incidence of CM has increased, which justifies its analysis. OBJECTIVES The objective of this study was to carry out a descriptive study of CM diagnosed for 18 years in a dermatology department of a tertiary care hospital and to assess the epidemiological, clinical, and histological variables that condition them, as well as data on their survival and prognosis. METHODS We performed a descriptive study of cases of CM diagnosed over 18 years in the dermatology department of a tertiary referral hospital analyzing the following variables: patient age and sex, site of primary neoplasm, pathochronology, survival time, histological findings, immunohistochemical markers, the anatomical area affected, the clinical appearance of the metastasis, therapeutic plan, and existence of metastases in other regions. We checked normal distribution using the Kolmogorov-Smirnov test and then compared the quantitative variables using the Student's t-test (unpaired samples), Mann-Whitney test (non-normal distribution), analysis of variance (ANOVA; for more than two groups), and categorical variables using the chi-square or Fisher's exact test. RESULTS We included 37 cases (20 men and 17 women), of whom 32 had died. The mean age was 62 ± 15 years. CM detection was defined early in 8% of cases, synchronous in 32%, and metachronous in 60%. The most frequent primary tumor sites were lungs (24%), breasts (21%), and bladders (11%). Most metastases were solitary. The most frequent locations for CM were the scalp, trunk, armpits, and groin. Most lesions had a nodular presentation (81%). Squamous cell carcinoma and adenocarcinoma showed the same frequency in lung cancer CM. Breast cancer leading to CM was the most common invasive ductal carcinoma. The most aggressive cases, with the worst survival, originated in lung neoplasms. Therapeutic management for most patients involved surgery in combination with other procedures. The only difference detected between the lung and breast cancer CM was the predominance of lung tumors in men (89%) and breast tumors in women compared with metastases from other sites; breast cancer CM manifested more frequently as plaques and less frequently as nodules (p < 0.05) and was less frequently associated with multisystemic metastasis. In lung cancer CM, time from tumor diagnosis to CM occurrence was shorter (p < 0.01) and multisystemic metastasis was more frequent than in CM of other tumors. CONCLUSIONS CM tends to affect patients aged above 60 years and arises predominantly from lung cancer in men and breast cancer in women. The most typical locations are the chest and scalp, and the appearance is usually nodular. Survival after CM detection is low, particularly in lung cancer CM.
Collapse
Affiliation(s)
| | | | - Ignacio Boira
- Pulmonology, Hospital Universitario San Juan Alicante, Alicante, ESP
| | | | | | | | - Eusebi Chiner
- Pulmonology, Hospital Universitario San Juan Alicante, Alicante, ESP
| |
Collapse
|
15
|
An interesting case of metastatic papillary thyroid carcinoma to the face. Am J Otolaryngol 2021; 42:103110. [PMID: 34273710 DOI: 10.1016/j.amjoto.2021.103110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022]
|
16
|
Martínez-Gregorio H, Rojas-Jiménez E, Mejía-Gómez JC, Díaz-Velásquez C, Quezada-Urban R, Vallejo-Lecuona F, de la Cruz-Montoya A, Porras-Reyes FI, Pérez-Sánchez VM, Maldonado-Martínez HA, Robles-Estrada M, Bargalló-Rocha E, Cabrera-Galeana P, Ramos-Ramírez M, Chirino YI, Alonso Herrera L, Terrazas LI, Frecha C, Oliver J, Perdomo S, Vaca-Paniagua F. The Evolution of Clinically Aggressive Triple-Negative Breast Cancer Shows a Large Mutational Diversity and Early Metastasis to Lymph Nodes. Cancers (Basel) 2021; 13:5091. [PMID: 34680239 PMCID: PMC8534164 DOI: 10.3390/cancers13205091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
In triple-negative breast cancer (TNBC), only 30% of patients treated with neoadjuvant chemotherapy achieve a pathological complete response after treatment and more than 90% die due to metastasis formation. The diverse clinical responses and metastatic developments are attributed to extensive intrapatient genetic heterogeneity and tumor evolution acting on this neoplasm. In this work, we aimed to evaluate genomic alterations and tumor evolution in TNBC patients with aggressive disease. We sequenced the whole exome of 16 lesions from four patients who did not respond to therapy, and took several follow-up samples, including samples from tumors before and after treatment, as well as from the lymph nodes and skin metastases. We found substantial intrapatient genetic heterogeneity, with a variable tumor mutational composition. Early truncal events were MCL1 amplifications. Metastatic lesions had deletions in RB1 and PTEN, along with TERT, AKT2, and CCNE1 amplifications. Mutational signatures 06 and 12 were mainly detected in skin metastases and lymph nodes. According to phylogenetic analysis, the lymph node metastases occurred at an early stage of TNBC development. Finally, each patient had three to eight candidate driving mutations for targeted treatments. This study delves into the genomic complexity and the phylogenetic and evolutionary development of aggressive TNBC, supporting early metastatic development, and identifies specific genetic alterations associated with a response to targeted therapies.
Collapse
Affiliation(s)
- Héctor Martínez-Gregorio
- Posgrado en Ciencias Biológicas de la Universidad Nacional Autonóma de Mexico, Facultad de Estudios Superiores Iztacala, UNAM, Mexico City 54090, Mexico;
- Laboratorio Nacional en Salud, Diagnóstico Molecular y Efecto Ambiental en Enfermedades Crónico-Degenerativas, Facultad de Estudios Superiores Iztacala, Tlalnepantla 54090, Mexico; (E.R.-J.); (C.D.-V.); (R.Q.-U.); (F.V.-L.); (L.I.T.)
- Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla 54090, Mexico; (A.d.l.C.-M.); (Y.I.C.)
| | - Ernesto Rojas-Jiménez
- Laboratorio Nacional en Salud, Diagnóstico Molecular y Efecto Ambiental en Enfermedades Crónico-Degenerativas, Facultad de Estudios Superiores Iztacala, Tlalnepantla 54090, Mexico; (E.R.-J.); (C.D.-V.); (R.Q.-U.); (F.V.-L.); (L.I.T.)
- Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla 54090, Mexico; (A.d.l.C.-M.); (Y.I.C.)
| | - Javier César Mejía-Gómez
- Division of Breast Cancer, Department of Medical Oncology, Mt. Sinai Hospital, University of Toronto, Toronto, ON M5G 1X5, Canada;
| | - Clara Díaz-Velásquez
- Laboratorio Nacional en Salud, Diagnóstico Molecular y Efecto Ambiental en Enfermedades Crónico-Degenerativas, Facultad de Estudios Superiores Iztacala, Tlalnepantla 54090, Mexico; (E.R.-J.); (C.D.-V.); (R.Q.-U.); (F.V.-L.); (L.I.T.)
| | - Rosalía Quezada-Urban
- Laboratorio Nacional en Salud, Diagnóstico Molecular y Efecto Ambiental en Enfermedades Crónico-Degenerativas, Facultad de Estudios Superiores Iztacala, Tlalnepantla 54090, Mexico; (E.R.-J.); (C.D.-V.); (R.Q.-U.); (F.V.-L.); (L.I.T.)
- Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla 54090, Mexico; (A.d.l.C.-M.); (Y.I.C.)
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Fernando Vallejo-Lecuona
- Laboratorio Nacional en Salud, Diagnóstico Molecular y Efecto Ambiental en Enfermedades Crónico-Degenerativas, Facultad de Estudios Superiores Iztacala, Tlalnepantla 54090, Mexico; (E.R.-J.); (C.D.-V.); (R.Q.-U.); (F.V.-L.); (L.I.T.)
- Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla 54090, Mexico; (A.d.l.C.-M.); (Y.I.C.)
| | - Aldo de la Cruz-Montoya
- Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla 54090, Mexico; (A.d.l.C.-M.); (Y.I.C.)
| | - Fany Iris Porras-Reyes
- Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (F.I.P.-R.); (V.M.P.-S.); (H.A.M.-M.); (E.B.-R.); (P.C.-G.); (M.R.-R.); (L.A.H.)
| | - Víctor Manuel Pérez-Sánchez
- Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (F.I.P.-R.); (V.M.P.-S.); (H.A.M.-M.); (E.B.-R.); (P.C.-G.); (M.R.-R.); (L.A.H.)
| | - Héctor Aquiles Maldonado-Martínez
- Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (F.I.P.-R.); (V.M.P.-S.); (H.A.M.-M.); (E.B.-R.); (P.C.-G.); (M.R.-R.); (L.A.H.)
| | | | - Enrique Bargalló-Rocha
- Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (F.I.P.-R.); (V.M.P.-S.); (H.A.M.-M.); (E.B.-R.); (P.C.-G.); (M.R.-R.); (L.A.H.)
| | - Paula Cabrera-Galeana
- Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (F.I.P.-R.); (V.M.P.-S.); (H.A.M.-M.); (E.B.-R.); (P.C.-G.); (M.R.-R.); (L.A.H.)
| | - Maritza Ramos-Ramírez
- Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (F.I.P.-R.); (V.M.P.-S.); (H.A.M.-M.); (E.B.-R.); (P.C.-G.); (M.R.-R.); (L.A.H.)
| | - Yolanda Irasema Chirino
- Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla 54090, Mexico; (A.d.l.C.-M.); (Y.I.C.)
| | - Luis Alonso Herrera
- Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (F.I.P.-R.); (V.M.P.-S.); (H.A.M.-M.); (E.B.-R.); (P.C.-G.); (M.R.-R.); (L.A.H.)
- Instituto Nacional de Medicina Genómica, Mexico City 14610, Mexico
- Unidad de Investigación Biomédica en Cáncer, Instituto de Investigaciones Biomédicas—Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Luis Ignacio Terrazas
- Laboratorio Nacional en Salud, Diagnóstico Molecular y Efecto Ambiental en Enfermedades Crónico-Degenerativas, Facultad de Estudios Superiores Iztacala, Tlalnepantla 54090, Mexico; (E.R.-J.); (C.D.-V.); (R.Q.-U.); (F.V.-L.); (L.I.T.)
- Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla 54090, Mexico; (A.d.l.C.-M.); (Y.I.C.)
| | - Cecilia Frecha
- Unidad de Producción Celular del Hospital Regional Universitario de Málaga—IBIMA—Málaga, 29010 Málaga, Spain;
| | - Javier Oliver
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Institute of Biomedical Research in Malaga, CIMES, University of Málaga, 29010 Málaga, Spain;
| | - Sandra Perdomo
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, 69372 Lyon, France;
| | - Felipe Vaca-Paniagua
- Laboratorio Nacional en Salud, Diagnóstico Molecular y Efecto Ambiental en Enfermedades Crónico-Degenerativas, Facultad de Estudios Superiores Iztacala, Tlalnepantla 54090, Mexico; (E.R.-J.); (C.D.-V.); (R.Q.-U.); (F.V.-L.); (L.I.T.)
- Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla 54090, Mexico; (A.d.l.C.-M.); (Y.I.C.)
- Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (F.I.P.-R.); (V.M.P.-S.); (H.A.M.-M.); (E.B.-R.); (P.C.-G.); (M.R.-R.); (L.A.H.)
| |
Collapse
|
17
|
Kwon HM, Kim GY, Shin DH, Bae YK. Clinicopathologic features of cutaneous metastases from internal malignancies. J Pathol Transl Med 2021; 55:289-297. [PMID: 34225447 PMCID: PMC8353133 DOI: 10.4132/jptm.2021.05.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/24/2021] [Indexed: 12/29/2022] Open
Abstract
Background Cutaneous metastasis (CM) is the spread of cancer cells from a primary site to the skin and is rarely the first sign of silent cancer. We investigated the clinicopathological characteristics of CM from internal malignancies in Korean patients treated at our institution over 20 years. Methods The clinicopathological findings of 112 patients (62 females, 50 males) with CM diagnosed at Yeungnam University Hospital between 2000 and 2020 were retrospectively reviewed. Results Mean patient age was 58.6 years (range, 26 to 87 years), and the most common primary cancer site was breast (74.2%) in women and lung (36.0%) in men. Ninety-six patients (85.7%) presented with CM after primary tumor diagnosis. CM from the lung or biliary tract usually occurred within 2 years of primary tumor diagnosis, whereas metastases from the breast and kidney occurred several years later. The chest, abdomen, and scalp were common sites of CM. Breast cancer usually metastasized to chest skin, while gastrointestinal tract cancers commonly metastasized to the abdomen. The scalp was a common location for CM from various tumors. The most common dermatologic presentations were nodules and masses. Immunohistochemical studies helped identify underlying malignancies when primary tumors were unknown. Conclusions The relative frequency of CM parallels the overall incidence of primary malignant tumors, and CMs usually occur at anatomic sites close to the primary tumor. CM can be diagnosed based on clinical, radiological, and histological features; however, immunohistochemical study is required in some cases.
Collapse
Affiliation(s)
- Hyeong Mok Kwon
- Department of Dermatology, Yeungnam University College of Medicine, Daegu, Korea
| | - Gyu Yeong Kim
- Yeungnam University College of Medicine, Daegu, Korea
| | - Dong Hoon Shin
- Department of Dermatology, Yeungnam University College of Medicine, Daegu, Korea
| | - Young Kyung Bae
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
| |
Collapse
|
18
|
Fu Y, Zheng C, Huang J, Wu S, Dai Y. Duodenal adenocarcinoma with skin metastasis as initial manifestation: A case report. Open Life Sci 2021; 16:395-398. [PMID: 33981846 PMCID: PMC8082472 DOI: 10.1515/biol-2021-0029] [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: 10/19/2020] [Revised: 12/22/2020] [Accepted: 01/05/2021] [Indexed: 11/15/2022] Open
Abstract
Background Duodenal adenocarcinoma (DA) with skin metastasis as initial manifestation is clinically rare. In this study, we report a rare case of skin metastasis of DA. Case presentation An 84-year-old male patient developed multiple ecchymoses on the trunk and lower extremities. Physical examination showed that the ecchymosis was dark red and had a hard texture, but showed no bulging, rupture, or tenderness. The skin biopsy implied skin metastatic adenocarcinoma. After an endoscopic duodenal biopsy, the patient was finally diagnosed with DA with skin metastasis. The patient received two courses of oral treatment of Tegafur (40 mg, bid d1–d14). However, the patient stopped taking Tegafur because of its poor effect and received Chinese medicine as a replacement treatment. Unfortunately, he was lost to follow-up. Conclusions Early diagnosis of DA metastasis is of significant importance as prognosis of these patients is poor.
Collapse
Affiliation(s)
- Yixiao Fu
- Department of Hematology, Dingli Clinical Medical School of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.,Department of Hematology, Wenzhou Central Hospital, Dingli Clinical Medical School of Wenzhou Medical University, No. 252, Baili East Road, Lucheng District, Wenzhou 32500, Zhejiang Province, China
| | - Cuiping Zheng
- Department of Hematology, Wenzhou Central Hospital, Dingli Clinical Medical School of Wenzhou Medical University, No. 252, Baili East Road, Lucheng District, Wenzhou 32500, Zhejiang Province, China
| | - Jian Huang
- Department of Hematology, Wenzhou Central Hospital, Dingli Clinical Medical School of Wenzhou Medical University, No. 252, Baili East Road, Lucheng District, Wenzhou 32500, Zhejiang Province, China
| | - Shenghao Wu
- Department of Hematology, Wenzhou Central Hospital, Dingli Clinical Medical School of Wenzhou Medical University, No. 252, Baili East Road, Lucheng District, Wenzhou 32500, Zhejiang Province, China
| | - Yanyan Dai
- Department of Pathology, Wenzhou Central Hospital, Dingli Clinical Medical School of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| |
Collapse
|
19
|
Abstract
Pathologists use histological features to classify tumors and assign site of origin for metastasis. How and why tumors organize the way they do and recreate their histological organization during metastasis is unknown. Here, I discuss the concept of "histostasis" conferring tumors a histological memory and hypothesize its implications for metastasis.
Collapse
Affiliation(s)
- Senthil K Muthuswamy
- Cancer Research Institute, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| |
Collapse
|
20
|
Cutaneous Metastasis vs. Isolated Skin Recurrence of Invasive Breast Carcinoma after Modified Radical Mastectomy. Case Rep Dermatol Med 2021; 2021:6673289. [PMID: 33643670 PMCID: PMC7902130 DOI: 10.1155/2021/6673289] [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: 01/02/2021] [Revised: 01/20/2021] [Accepted: 01/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Five to ten percent of the patients with operable breast cancer develop a chest wall recurrence within 10 years following the mastectomy. One of the most distressing presentations of locally recurrent breast cancer is the appearance of cutaneous metastases. To the best of authors' knowledge, there is no study distinguishing skin metastasis from local recurrence, so the main aim of this report was to elucidate if these two features are important in the prognosis and management of the disease. Case Presentation. A 51-year-old woman referred to the breast clinic due to a painful mass in the left breast. The patient underwent the modified radical mastectomy (MRM) and left axillary lymph node dissection followed by 30 sessions of radiotherapy and 8 sessions of chemotherapy (T3N1M0, ER−, and HER2+). About 15 months after the surgery, she presented with redness and eruptive lesions over the mastectomy scar that increased in size within a three-month follow-up. Conclusion Mastectomy is not an absolute cure in the treatment of an invasive breast cancer because almost always, there is a recurrence risk and possibility of metastasis. It is vital to differentiate between local recurrence and skin metastasis because it would alter the overall treatment decision, prognosis, and patient outcomes.
Collapse
|
21
|
Droubi S, Aqsa A, Rehan M, Dhar M. Rapid Response of Breast Cancer Cutaneous Metastasis to Single-Agent Palbociclib: A Case Report. Chemotherapy 2021; 65:1-3. [PMID: 33540405 DOI: 10.1159/000512499] [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: 07/30/2020] [Accepted: 10/17/2020] [Indexed: 11/19/2022]
Abstract
Palbociclib is a cyclin-dependent kinase (CDK) 4/6 inhibitor. Palbociclib combined with endocrine therapy has shown promising results in hormone-receptor-positive (HR+) and human epidermal growth factor receptor-negative (HER-2-) breast cancer progression. We present a case of a woman with a history of infiltrating lobular cancer of the left breast, status post modified radical mastectomy 6 years prior, presenting with nodular erythematous lesions on the left arm and back. Histopathological examination confirmed the diagnosis of recurrent metastatic breast adenocarcinoma. She had complete resolution of cutaneous metastasis with 1 cycle of Palbociclib. We believe our case is unique as the resolution of cutaneous metastasis with 1 cycle of single-agent Palbociclib is rare. Furthermore, it highlights the importance of considering cutaneous metastasis as a possibility in patients with prior history of primary internal malignancy.
Collapse
Affiliation(s)
- Sami Droubi
- Department of Internal Medicine, Staten Island University Hospital, New York, New York, USA,
| | - Anum Aqsa
- Department of Internal Medicine, Staten Island University Hospital, New York, New York, USA
| | - Maryam Rehan
- Department of Hematology-Oncology, Staten Island University Hospital, New York, New York, USA
| | - Meekoo Dhar
- Department of Hematology-Oncology, Staten Island University Hospital, New York, New York, USA
| |
Collapse
|
22
|
Iacconi C, Vatteroni G. Unknown Case: An Older Woman with a Periareolar Violet Nodule. JOURNAL OF BREAST IMAGING 2021; 3:124-126. [PMID: 38424832 DOI: 10.1093/jbi/wbaa029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Indexed: 03/02/2024]
Affiliation(s)
- Chiara Iacconi
- Azienda U.S.L. Toscana Nord-Ovest, Department of Radiology, Carrara, Italy
| | - Giulia Vatteroni
- Azienda U.S.L. Toscana Nord-Ovest, Department of Radiology, Carrara, Italy
| |
Collapse
|
23
|
Wang X, Wang H, Jia B, He F, Yuan Y, Zhang W. Cutaneous Metastasis as the First Presentation of Non-Small-Cell Lung Cancer with a BRAF Mutation: A Case Report. Onco Targets Ther 2021; 13:13143-13149. [PMID: 33380804 PMCID: PMC7767729 DOI: 10.2147/ott.s282593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
Cutaneous metastasis from a primary visceral malignancy is a relatively uncommon clinical manifestation that occurs as an initial presentation in 1% to 12% of patients with internal malignancies. Additionally, cutaneous metastases are often late signs of an internal malignancy, and in very rare cases they may occur at the same time or before the primary cancer has been detected. Metastasis to the skin has a poor prognosis and is often a sign of widespread malignant tumors. In the present study, we report a 72-year-old male who presented with multiple rapidly growing subcutaneous nodules. Positron emission tomography-computed tomography (PET-CT) revealed a hypermetabolic concentration of radiotracer in the left lower lung and multiple organ metastases associated with multiple skin masses. Biopsy of one of the skin nodules and gene detection indicated metastatic adenocarcinoma consistent with a primary lung origin with a BRAF mutation. BRAF mutations are emerging therapeutic targets in non-small-cell lung cancer (NSCLC), as they are present in 2–4% of NSCLC cases. To the best of our knowledge, this is the first case report to show that BRAF-mutant lung adenocarcinoma can be associated with cutaneous metastasis. Early diagnosis and individualized treatment strategies may prolong patient survival.
Collapse
Affiliation(s)
- Xuejun Wang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Hongmei Wang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Baochang Jia
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Fang He
- Department of Radiation Oncology, Zhongshan City People's Hospital, Zhongshan, Guangdong Province, People's Republic of China
| | - Yawei Yuan
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Weijun Zhang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| |
Collapse
|
24
|
Dong X, Lv S, Zhang X, Li Q. Subcutaneous Recurrences of Thyroid Cancer After Conventional Transcervical Thyroidectomy: A Case Report. Front Surg 2020; 7:586106. [PMID: 33251243 PMCID: PMC7674202 DOI: 10.3389/fsurg.2020.586106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/14/2020] [Indexed: 12/02/2022] Open
Abstract
Metastatic subcutaneous implantation of the follicular variant of papillary thyroid cancer is very rare. We present a 62-year-old woman with a history of follicular variant of papillary thyroid cancer, who developed multiple asymptomatic subcutaneous nodules, after 5 years of initial thyroidectomy. Eventually, the subcutaneous nodules were diagnosed as tumor recurrence and completely excised. She has reportedly lived for more than 1 year, without signs of disease progression or recurrence. This case emphasizes the need for surgeons to take into account the tumor-free concept during the operation, and to a great extent prevent the occurrence of implantation recurrence.
Collapse
Affiliation(s)
- Xubin Dong
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shihui Lv
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaohua Zhang
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Quan Li
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
25
|
Milam EC, Rangel LK, Pomeranz MK. Dermatologic sequelae of breast cancer: From disease, surgery, and radiation. Int J Dermatol 2020; 60:394-406. [PMID: 33226140 DOI: 10.1111/ijd.15303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 01/24/2023]
Abstract
The care of breast cancer patients is important to dermatologists. Breast cancer's initial presentation, clinical progression, and its associated treatments can result in a variety of cutaneous complications. Dermatologists may be the first to identify a breast cancer diagnosis, as a subset of patients first present with direct extension of an underlying tumor or with a cutaneous metastasis. The surgical treatment of breast cancer also begets a variety of skin sequelae, including postoperative lymphedema, soft tissue infections, seromas, pyoderma gangrenosum, and scarring disorders. Moreover, breast cancer radiation treatment commonly results in skin changes, which can range from mild and temporary dermatoses to chronic and disfiguring skin ulceration, fibrosis, and necrosis. Radiation may also precipitate secondary malignancies, such as angiosarcoma, as well as rarer dermatologic diseases, such as radiation-induced morphea, lichen planus, and postirradiation pseudosclerodermatous panniculitis. Finally, breast cancer is also associated with an array of paraneoplastic phenomena, including Sweet's syndrome and the rarer intralymphatic histiocytosis. Herein, we review the dermatological manifestations of breast cancer, including conditions associated with its presentation, progression, and treatment sequelae. Chemotherapy-induced cutaneous side effects are beyond the scope of this review. This article provides a comprehensive review for dermatologist to be able to identify, diagnose, and manage breast cancer patients from initial presentation to treatment monitoring and subsequent follow-up.
Collapse
Affiliation(s)
- Emily C Milam
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lauren K Rangel
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Miriam K Pomeranz
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
26
|
Mack E, Houghton J, McCourt C. An unusual cause of forehead ulceration. Int J Dermatol 2020; 60:e179-e180. [PMID: 33107022 DOI: 10.1111/ijd.15277] [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: 06/08/2020] [Revised: 08/17/2020] [Accepted: 09/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Emma Mack
- Dermatology Department, Level 4 South, Belfast City Hospital, Belfast, UK
| | - Joe Houghton
- Dermatology Department, Level 4 South, Belfast City Hospital, Belfast, UK
| | - Collette McCourt
- Dermatology Department, Level 4 South, Belfast City Hospital, Belfast, UK
| |
Collapse
|
27
|
Cutaneous Metastasis in the Setting of Both Colon and Breast Primary Malignancies. Case Rep Gastrointest Med 2020; 2020:8852459. [PMID: 33062353 PMCID: PMC7542512 DOI: 10.1155/2020/8852459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/17/2020] [Indexed: 11/21/2022] Open
Abstract
Colorectal cancer (CRC) is the third most diagnosed cancer in the United States, and many patients unfortunately have metastases at the time of their diagnosis. Cutaneous metastases of CRC have been reported in few journals and primarily as case reports due to their rarity. Here, we present the case of an 83-year-old woman with recently resected colon cancer, T4aN1bMx stage IIIB. She presented to our clinic for evaluation of a right midback mass, and a punch biopsy revealed dermal involvement by invasive, poorly differentiated carcinoma with epidermoid features. The mass was excised, and we ordered a PET scan in search of the primary tumor, which at that time was suspected to be of skin cancer origin. Surprisingly, this revealed a second malignancy triple-negative invasive ductal carcinoma of the left breast. The back mass stained positive for CK20, which was compatible with a metastasis from a colonic primary. After initially declining adjuvant therapy, the patient completed one cycle of capecitabine and oxaliplatin, which she tolerated poorly. She continued to further decline, developed widespread cutaneous metastases, and went home on hospice. Cutaneous lesions are an exceedingly rare site of metastasis for colon adenocarcinoma, and their clinical presentation can vary widely. It is important for providers to investigate any new skin lesion in a patient with a recent or remote history of malignancy, even if there were no sites of distant metastasis at initial diagnosis.
Collapse
|
28
|
Cutaneous Cholangiocarcinoma: An Interesting Presentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2980. [PMID: 32983762 PMCID: PMC7489731 DOI: 10.1097/gox.0000000000002980] [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: 04/15/2020] [Accepted: 05/23/2020] [Indexed: 11/26/2022]
Abstract
This is a case of a 64-year-old white man with a history of CCA, originally diagnosed in May 2018 and returning in November 2019 with growing cutaneous nodules. These were removed for cosmetic and functional purposes. Pathologic findings of the lesions showed likely metastatic disease from his original CCA. This represents a relatively rare presentation of metastatic disease in the setting of CCA. In cases of CCA with metastatic spread, treatment is not curative and should be focused on measures to improve the patient’s quality of life. This includes acceptable cosmesis, as well as factors aiding in completing activities of daily living.
Collapse
|
29
|
Williams J, Feldman S, Teague DJ. A rare case of anal squamous cell carcinoma metastasizing to the scrotum. JAAD Case Rep 2020; 6:743-746. [PMID: 32715068 PMCID: PMC7369511 DOI: 10.1016/j.jdcr.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Josiah Williams
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daniel J Teague
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
30
|
Papadopoulos I. Unique Skin Metastasis from Recurrent Cancer. Case Report. Clin Cosmet Investig Dermatol 2020; 13:415-417. [PMID: 32606879 PMCID: PMC7308115 DOI: 10.2147/ccid.s259244] [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: 04/21/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Abstract
Introduction Cutaneous metastasis is defined as the dissemination of malignant cells from a primary tumor to the skin. Skin may be affected by tumors, either through direct invasion from an adjacent organ or by cutaneous metastasis from an internal organ malignancy. We report a case of a 75-year-old female patient with skin metastasis 8 years after the initial treatment of primary breast cancer. Patient Concern The patient presented only with papules and nodular skin lesions in the left lateral abdominal area, without any other clinical manifestations. Diagnosis All laboratory tests were normal. Histological examinati revealed the infiltration of the dermis by tumor cells. Interventions/Outcome After the diagnosis of skin metastasis, she was treated with chemotherapy with complete remission of skin lesions. Conclusion Skin metastasis from internal organs is rarely the first sign. In this case, skin metastasis was the only clinical sign and the only diagnostic tool to drive to the correct diagnosis of a recurrent cancer after 8 years. Dermatologists might be the first doctors to facilitate the diagnosis of skin metastasis.
Collapse
Affiliation(s)
- Iordanis Papadopoulos
- Department of Aesthetics and Cosmetology, Alexander Technological Educational Foundation, Thessaloniki, Greece
| |
Collapse
|
31
|
Padden S, Abraham E, Viscosi E, Habin K, Lundquist D. Cutaneous Metastases: A Case Study on Clinical Care for Patients. Clin J Oncol Nurs 2020; 24:320-323. [DOI: 10.1188/20.cjon.320-323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
32
|
Kar S, Sawant A, Patrick S, Gangane N. Puzzling Papules on the neck: Cutaneous metastasis from the breast. JOURNAL OF CANCER RESEARCH AND PRACTICE 2020. [DOI: 10.4103/jcrp.jcrp_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
33
|
Janowska A, Dini V, Oranges T, Iannone M, Loggini B, Romanelli M. Atypical Ulcers: Diagnosis and Management. Clin Interv Aging 2019; 14:2137-2143. [PMID: 31849457 PMCID: PMC6911347 DOI: 10.2147/cia.s231896] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/16/2019] [Indexed: 01/22/2023] Open
Abstract
Atypical ulcers show atypical clinical features, histology, localization, and resistance to standard therapies. The persistence of a chronic ulcer despite treatment with standard therapies requires a more specific diagnostic investigation. Diagnosis involves obtaining the history and performing clinical examination and additional tests. A skin biopsy is frequently used to confirm unclear diagnosis. In difficult cases, microbiological and immunohistochemical examinations, laboratory blood tests, or instrumental tests should be evaluated. The treatment of atypical wounds is characterized by local systemic therapy and pain control. Our results highlight the need for early diagnosis, and standardized and targeted management by a multidisciplinary wound healing center.
Collapse
Affiliation(s)
- Agata Janowska
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Teresa Oranges
- Department of Dermatology, University of Pisa, Pisa, Italy.,Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | | | | | | |
Collapse
|
34
|
Tambe A, Ramadas P, Williams M, Gambhir HS, Naous R. Pulmonary sarcomatoid carcinoma presenting as subcutaneous nodules. Proc (Bayl Univ Med Cent) 2019; 33:67-68. [PMID: 32063775 DOI: 10.1080/08998280.2019.1670326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022] Open
Abstract
Subcutaneous nodules secondary to metastasis can be a presenting symptom of lung cancer. Underlying cancer must be ruled out in patients presenting with multiple subcutaneous nodules with suspicious history, physical, and radiological findings. Prognosis is extremely poor with limited treatment options.
Collapse
Affiliation(s)
- Ajay Tambe
- Department of Internal Medicine, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Poornima Ramadas
- Department of Internal Medicine, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Michael Williams
- Department of Pathology, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Harvir Singh Gambhir
- Department of Internal Medicine, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Rana Naous
- Department of Pathology, State University of New York Upstate Medical UniversitySyracuseNew York
| |
Collapse
|
35
|
Nevo N, Ghanem S, Crispel Y, Tatour M, Cohen H, Kogan I, Ben-Arush M, Nadir Y. Heparanase Level in the Microcirculation as a Possible Modulator of the Metastatic Process. THE AMERICAN JOURNAL OF PATHOLOGY 2019; 189:1654-1663. [DOI: 10.1016/j.ajpath.2019.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/01/2019] [Accepted: 04/25/2019] [Indexed: 02/07/2023]
|
36
|
Bohli M, Tebra S, Bouaouina N. Nasopharyngeal carcinoma with cutaneous metastases. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:409-411. [PMID: 31000368 DOI: 10.1016/j.anorl.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Cutaneous metastases from nasopharyngeal carcinoma are extremely rare and associated with a poor prognosis. CASE REPORTS We retrospectively reviewed 820 patients with nasopharyngeal carcinoma treated over a 20-year period in the radiotherapy department of Farhat Hached hospital in Sousse and Ibn Khaldoun Medical centre, Hammam Sousse. Two of these patients presented cutaneous metastases. The skin lesions appeared during radiotherapy and 3 months after treatment of the primary tumour. Cutaneous metastases present as multiple painless nodules and erythematous plaques. Cutaneous metastases were associated with other metastatic sites (liver, bone). One patient received chemotherapy. Both patients died in a context of rapidly progressive disease. DISCUSSION Nasopharyngeal carcinoma with cutaneous metastases is a rapidly fatal disease. In the light of these two cases and a review of the literature, patients with this disease are aged between 30 and 63 years with a marked male predominance. Cutaneous metastases are correlated with a more advanced primary tumour. The main sites are the trunk and scalp. There is no standard treatment modality for this disease and survival does not exceed 9 months.
Collapse
Affiliation(s)
- M Bohli
- Department of radiotherapy, Farhat Hached hospital, Sousse, Tunisia.
| | - S Tebra
- Department of radiotherapy, Farhat Hached hospital, Sousse, Tunisia
| | - N Bouaouina
- Department of radiotherapy, Farhat Hached hospital, Sousse, Tunisia
| |
Collapse
|
37
|
Genovese G, Gianotti R, Coggi A, Passoni E, Nazzaro G, Guanziroli E, Del Gobbo A, Veraldi S. Cutaneous metastasis from breast carcinoma clinically mimicking pyogenic granuloma. GIORN ITAL DERMAT V 2019; 154:95-96. [PMID: 30616336 DOI: 10.23736/s0392-0488.17.05667-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giovanni Genovese
- Unit of Dermatology, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Raffaele Gianotti
- Unit of Dermatology, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Antonella Coggi
- Unit of Dermatology, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Emanuela Passoni
- Unit of Dermatology, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gianluca Nazzaro
- Unit of Dermatology, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, Milan, Italy - .,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Elena Guanziroli
- Unit of Dermatology, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessandro Del Gobbo
- Division of Pathology, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, Milan, Italy
| | - Stefano Veraldi
- Unit of Dermatology, Ca' Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
38
|
Habermehl G, Ko J. Cutaneous Metastases: A Review and Diagnostic Approach to Tumors of Unknown Origin. Arch Pathol Lab Med 2018; 143:943-957. [PMID: 30605024 DOI: 10.5858/arpa.2018-0051-ra] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Cutaneous metastases from a distant malignancy are a diagnostic challenge for pathologists. Secondary involvement of the skin by a metastatic process portends a much worse clinical prognosis than any primary cutaneous malignant mimickers. Immunohistochemical staining methods continue to evolve and are of paramount importance in diagnosis. OBJECTIVE.— To review the clinical, histopathologic, and immunohistochemical staining patterns for commonly encountered entities and discuss potential pitfalls in diagnosis. A practical guide useful in approaching cutaneous metastases of unknown primary is outlined. DATA SOURCES.— An extensive search and review of literature in PubMed was performed, processed, and condensed. CONCLUSIONS.— Cutaneous metastases have broad histopathologic patterns. They are nearly always dermal based, with an overall foreign appearance. They can be single papules/nodules or multiple in number, mimicking an inflammatory or infectious process. Ultimately, immunohistochemistry remains an essential diagnostic tool, and clinical correlation is paramount in the workup of these entities.
Collapse
Affiliation(s)
- Gabriel Habermehl
- From the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer Ko
- From the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
39
|
Kelati A, Gallouj S. Dermoscopy of skin metastases from breast cancer: two case reports. J Med Case Rep 2018; 12:273. [PMID: 30241571 PMCID: PMC6151035 DOI: 10.1186/s13256-018-1803-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 08/15/2018] [Indexed: 11/16/2022] Open
Abstract
Background Cutaneous metastatic breast cancer is the most common cutaneous metastatic malignancy in women. The assessment of cutaneous metastatic disease can be perplexing because the clinical presentation appears similar to other skin malignancies like angiosarcoma or melanoma, or benign diseases like cellulitis and lymphedema. To date, only a limited number of dermoscopic images of cutaneous metastatic solid tumors, especially breast cancer, have been published. Case presentation The authors report two Moroccan cases highlighting dermoscopy as a quick tool to recognize skin metastasis of breast cancer in two different clinical presentations. A 51-year-old Moroccan woman presented with nodules of various sizes on and around a mastectomy scar, and a 65-year-old Moroccan woman presented with cellulitis-like lesions on her chest wall and her back. Dermoscopic features were similar in the two cases with findings of yellow central areas, polymorphic vessels, whitish bright lines, whitish structureless areas, and linear irregular fissure-like depressions on a pink-orange background. Conclusions The recognition of dermoscopic patterns of cutaneous metastasis of breast cancer is not only useful to facilitate diagnosis at an early stage and to rule out other differentials, especially in difficult presentations such as cellulitis-like lesions or lymphedema, but it may also be used by physicians in monitoring mastectomy scars.
Collapse
Affiliation(s)
- Awatef Kelati
- Department of Dermatology, University Hospital of Fez, Fez, Morocco.
| | - Salim Gallouj
- Department of Dermatology, University Hospital of Fez, Fez, Morocco
| |
Collapse
|
40
|
Nassri R, Muftah M, Nassri A, Alkhasawneh A, Corak J. Pure Testicular Choriocarcinoma with Dermatological, Brain, and Gastrointestinal Metastases. Cureus 2018; 10:e3083. [PMID: 30324039 PMCID: PMC6168053 DOI: 10.7759/cureus.3083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/01/2018] [Indexed: 01/18/2023] Open
Abstract
Testicular choriocarcinoma is a non-seminomatous germ cell tumor (NSGCT) and is the rarest of all testicular cancers. Nearly all choriocarcinomas can be classified as either pure choriocarcinoma or as a component of a mixed germ cell tumor. Pure testicular choriocarcinoma is extremely aggressive and metastasizes early and extensively. We present a case of testicular cancer that metastasized to the skin, gastrointestinal tract, and brain, and discuss the case in light of the available literature.
Collapse
Affiliation(s)
- Rama Nassri
- Department of Medicine, Alfaisal University School of Medicine, Dhahran, SAU
| | - Mayssan Muftah
- Department of Internal Medicine, Emory University School of Medicine, Atlanta , USA
| | - Ammar Nassri
- Department of Medicine, University of Florida-Jacksonville, Jacksonville, USA
| | - Ahmad Alkhasawneh
- Department of Pathology, University of Florida College of Medicine-Jacksonville, Jacksonville, USA
| | - Jadranko Corak
- Department of Internal Medicine, Dell Seton Medical Center at The University of Texas, Austin, USA
| |
Collapse
|
41
|
Prodinger CM, Koller J, Laimer M. Scalp tumors. J Dtsch Dermatol Ges 2018; 16:730-753. [DOI: 10.1111/ddg.13546] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/10/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Christine Maria Prodinger
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
| | - Josef Koller
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
| | - Martin Laimer
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
| |
Collapse
|
42
|
Prodinger CM, Koller J, Laimer M. Tumoren der Kopfhaut. J Dtsch Dermatol Ges 2018; 16:730-754. [DOI: 10.1111/ddg.13546_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Christine Maria Prodinger
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
| | - Josef Koller
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
| | - Martin Laimer
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
| |
Collapse
|
43
|
Toquica A, Rueda X, Cervera S, Reina A, Pozzobon C, Morales SD, Parra-Medina R. Ewing's sarcoma metastatic to skin: a case report and review of the literature. Int J Dermatol 2018; 57:1365-1368. [PMID: 29732544 DOI: 10.1111/ijd.14031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/25/2018] [Accepted: 04/08/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Alejandra Toquica
- Department of Dermatology Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Xavier Rueda
- Department of Dermatology Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Sergio Cervera
- Department of Breast and Soft Tissues Surgery, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Adriana Reina
- Department of Dermatology Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Carolina Pozzobon
- Department of Dermatology Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Samuel D Morales
- Department of Pathology, Instituto Nacional de Cancerología, Bogotá, Colombia.,Department of Pathology, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Rafael Parra-Medina
- Department of Pathology, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.,Research Institute, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| |
Collapse
|
44
|
|
45
|
Skin metastases in ovarian clear cell adenocarcinoma: a case report and a review of the literature. Obstet Gynecol Sci 2017; 60:593-597. [PMID: 29184869 PMCID: PMC5694735 DOI: 10.5468/ogs.2017.60.6.593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 11/25/2022] Open
Abstract
Epithelial ovarian carcinoma is a high mortality neoplasm in gynecologic malignancy. It usually can metastasize to distant organs such as pleura, liver, lung, and lymph nodes. However, the skin metastases are not common and related to very poor prognosis. Here we report a 54-year-old patient with ovarian clear cell carcinoma with skin metastases on the anterior chest at 11 months after initial diagnosis. Although she received palliative chemotherapy, she expired due to disease progression 2 months later after the diagnosis of skin metastases.
Collapse
|
46
|
Scalp metastasis as an initial presentation of lung adenocarcinoma : A case report and literature review. Int J Surg Case Rep 2017; 41:327-331. [PMID: 29136605 PMCID: PMC5683037 DOI: 10.1016/j.ijscr.2017.10.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/29/2017] [Indexed: 11/23/2022] Open
Abstract
A careful skin examination can provide valuable clues to internal malignancy. Solitary scalp metastasis as the first sign of an occult non-small-cell lung cancer is an extremely rare occurrence. Despite its rarity, metastatic skin disease should always be considered in the differential diagnosis in patients with a history of smoking or lung cancer presenting with cutaneous nodules. Increased awareness of this rare entity is needed for early recognition and initiation of the appropriate treatment. Moreover, it helps in appropriate staging, altering therapy and a better estimation of prognosis. We also conclude that a cutaneous metastases is the most common dermatological manifestation of lung cancer.
Introduction Cutaneous metastasis from primary visceral malignancy is a relatively uncommon clinical entity, with a reported incidence of 0.22%–10% among various series. However, the presence of cutaneous metastasis as the first sign of a clinically silent visceral cancer is exceedingly rare. Presentation of case We describe here a case of an asymptomatic male patient who presented with a solitary scalp metastasis as the initial manifestation of an underlying lung cancer. Diagnostic evaluation revealed advanced disease. Discussion The report emphasizes that physicians should be aware of this rare clinical entity, and appropriate investigation should be arranged for early diagnosis and initiation of the appropriate treatment. The occurrence of skin lesions in lung cancer announces an ominous prognosis. Conclusion We conclude that the possibility of metastatic skin disease should always be considered in the differential diagnosis in patients with a history of smoking or lung cancer presenting with cutaneous nodules.
Collapse
|
47
|
Mok ZR, Yong AMY, Leung AJ, Tan KB, Aw DCW. Cutaneous metastasis: experience from a tertiary healthcare institution in Singapore. Int J Dermatol 2017; 56:1497-1498. [PMID: 28833072 DOI: 10.1111/ijd.13650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 04/09/2017] [Accepted: 04/13/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Zhun R Mok
- National University Hospital, Singapore City, Singapore
| | | | - An J Leung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Kong B Tan
- National University Hospital, Singapore City, Singapore
| | | |
Collapse
|
48
|
Liu Y, Luo H, Chen J, Elbendary A, Wu F, Xu M. Multiple distant painful subcutaneous nodules in a healthy young non-smoker. Australas J Dermatol 2017; 58:e273-e275. [PMID: 28718872 DOI: 10.1111/ajd.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yeqiang Liu
- Shanghai Skin Disease Hospital, Tongji University, Shanghai, China
| | - Hao Luo
- Shanghai Skin Disease Hospital, Tongji University, Shanghai, China
| | - Jia Chen
- Shanghai Skin Disease Hospital, Tongji University, Shanghai, China
| | - Amira Elbendary
- Department of Dermatology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Fei Wu
- Shanghai Skin Disease Hospital, Tongji University, Shanghai, China
| | - Minyuan Xu
- Shanghai Skin Disease Hospital, Tongji University, Shanghai, China
| |
Collapse
|
49
|
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.
| |
Collapse
|
50
|
Bansal A, Dalal V, Kaur M, Siraj F. Periampullary Carcinoma: Unusual Sites of Metastasis. Ochsner J 2017; 17:426-429. [PMID: 29230130 PMCID: PMC5718458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Periampullary neoplasms include carcinomas of the duodenum, ampulla of Vater, distal common bile duct, and pancreas. The aggressive course of these neoplasms is attributable to the delay in diagnosis, as patients have no symptoms until advanced stages of the disease. More than half of patients have distant metastasis at the time of diagnosis. The most frequent sites of metastasis are the liver, lymph nodes, peritoneum, lung, bone, kidney, and, rarely the skin. CASE REPORT We report the case of a 45-year-old female patient with adenocarcinoma of the ampulla of Vater metastasizing to the right parietal skull with overlying cutaneous involvement 1 year after a Whipple procedure. CONCLUSION Cutaneous and skull metastasis of periampullary neoplasms is unusual, but early recognition of such metastatic disease is important because it indicates a poor prognosis for the patient.
Collapse
Affiliation(s)
- Anju Bansal
- National Institute of Pathology, Indian Council of Medical Research, Safdarjung Hospital, New Delhi, India
| | - Varsha Dalal
- National Institute of Pathology, Indian Council of Medical Research, Safdarjung Hospital, New Delhi, India
| | - Manveen Kaur
- National Institute of Pathology, Indian Council of Medical Research, Safdarjung Hospital, New Delhi, India
| | - Fouzia Siraj
- National Institute of Pathology, Indian Council of Medical Research, Safdarjung Hospital, New Delhi, India
| |
Collapse
|