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Vernaci GM, Meroni M, Dieci MV, Saibene T, Montesco MC, Orvieto E, Cattelan A, Ghiotto C, Miglietta F, Guarneri V, Cagol M. Postsurgical Pyoderma Gangrenosum in a Breast Cancer Patient: A Case Report and Literature Review. Case Rep Oncol 2021; 14:160-164. [PMID: 33776698 PMCID: PMC7983549 DOI: 10.1159/000509745] [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: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 11/19/2022] Open
Abstract
Pyoderma gangrenosum is a rare skin necrotizing disease that can arise on a site of surgical trauma. Its pathogenesis has recently been related to dysregulation of the immune system, with inflammatory bowel disease representing the most commonly underlying systemic conditions. Several authors have also reported an association with solid malignancies (especially gastrointestinal and breast cancer). We describe the case of a 39-year-old patient diagnosed with a locally advanced, triple-negative breast cancer who developed a pyoderma gangrenosum on the surgical wound after a CVC implant with systemic complications. As the diagnosis and management of postsurgical pyoderma gangrenosum can be challenging for clinicians, underlying conditions as autoimmune disease and solid tumors have to be considered in order to guide treatment.
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Affiliation(s)
- Grazia Maria Vernaci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Muzio Meroni
- Anaesthesiology Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Tania Saibene
- Breast Surgery Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | | | - Enrico Orvieto
- Department of Pathology, Azienda Ospedaliera di Rovigo, Rovigo, Italy
| | - Annamaria Cattelan
- Unit of Infectious Disease, Department of Internal Medicine, Azienda Ospedaliera Universitaria di Padova, Padua, Italy
| | - Cristina Ghiotto
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Matteo Cagol
- Breast Surgery Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
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Wesolow JT. A Rare Case of Pyoderma Gangrenosum in a Patient With Pancreatic Neuroendocrine Tumor. Cureus 2020; 12:e12343. [PMID: 33520538 PMCID: PMC7837650 DOI: 10.7759/cureus.12343] [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] [Indexed: 11/05/2022] Open
Abstract
Pyoderma gangrenosum is a rare inflammatory skin disease usually associated with an underlying internal condition. Diseases most commonly linked with pyoderma gangrenosum are inflammatory bowel disease (ulcerative colitis and Crohn’s disease), rheumatoid arthritis, and hematologic malignancies such as leukemia and lymphoma. In rare instances, it can occur as a type of paraneoplastic syndrome in patients with cancer. The most common cancers associated with pyoderma gangrenosum are breast cancer followed by rectal, gastric, renal, and lung cancers. There are scarce reports of neuroendocrine tumors associated with pyoderma gangrenosum. We discuss a case of a pancreatic neuroendocrine cancer patient afflicted with pyoderma gangrenosum.
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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: 7] [Impact Index Per Article: 1.8] [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.
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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
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Shah M, Sachdeva M, Gefri A, Jfri A. Paraneoplastic pyoderma gangrenosum in solid organ malignancy: a literature review. Int J Dermatol 2019; 59:154-158. [DOI: 10.1111/ijd.14637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/27/2019] [Accepted: 08/08/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Monica Shah
- Faculty of Medicine University of Toronto Toronto ON Canada
| | | | - Amnah Gefri
- Department of Dermatology Al‐Noor Specialist Hospital Makkah Saudi Arabia
| | - Abdulhadi Jfri
- Division of Dermatology McGill University Health Centre Montreal QC Canada
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Gobert J, Mercuzot A, Sergent F. [A new pyoderma gangrenosum case revealing breast cancer]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2017; 45:54-55. [PMID: 28238319 DOI: 10.1016/j.gofs.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Affiliation(s)
- J Gobert
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Sud, CHU Amiens-Picardie, avenue René-Laënnec, 80054 Amiens cedex 1, France.
| | - A Mercuzot
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Sud, CHU Amiens-Picardie, avenue René-Laënnec, 80054 Amiens cedex 1, France; Faculté de médecine, université de Picardie-Jules-Verne, 1-3, rue des Louvels, 80036 Amiens, France
| | - F Sergent
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Sud, CHU Amiens-Picardie, avenue René-Laënnec, 80054 Amiens cedex 1, France; Faculté de médecine, université de Picardie-Jules-Verne, 1-3, rue des Louvels, 80036 Amiens, France
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Padhi T, Pradhan S, Pradhan K, Kumar SK. Pyoderma gangrenosum associated with mantle cell lymphoma. Indian Dermatol Online J 2016; 7:332-4. [PMID: 27559522 PMCID: PMC4976427 DOI: 10.4103/2229-5178.185467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tanmay Padhi
- Department of Dermatology, Venereology and Leprosy, Veer Surendra Sai Medical College, Burla, Odisha, India
| | - Swetalina Pradhan
- Department of Dermatology, Venereology and Leprosy, Veer Surendra Sai Medical College, Burla, Odisha, India
| | - Krupasindhu Pradhan
- Department of Dermatology, Venereology and Leprosy, Veer Surendra Sai Medical College, Burla, Odisha, India
| | - Suresh K Kumar
- Department of Dermatology, Venereology and Leprosy, Veer Surendra Sai Medical College, Burla, Odisha, India
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Gameiro A, Pereira N, Cardoso JC, Gonçalo M. Pyoderma gangrenosum: challenges and solutions. Clin Cosmet Investig Dermatol 2015; 8:285-93. [PMID: 26060412 PMCID: PMC4454198 DOI: 10.2147/ccid.s61202] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare disease, but commonly related to important morbidity. PG was first assumed to be infectious, but is now considered an inflammatory neutrophilic disease, often associated with autoimmunity, and with chronic inflammatory and neoplastic diseases. Currently, many aspects of the underlying pathophysiology are not well understood, and etiology still remains unknown. PG presents as painful, single or multiple lesions, with several clinical variants, in different locations, with a non specific histology, which makes the diagnosis challenging and often delayed. In the classic ulcerative variant, characterized by ulcers with inflammatory undermined borders, a broad differential diagnosis of malignancy, infection, and vasculitis needs to be considered, making PG a diagnosis of exclusion. Moreover, there are no definitively accepted diagnostic criteria. Treatment is also challenging since, due to its rarity, clinical trials are difficult to perform, and consequently, there is no “gold standard” therapy. Patients frequently require aggressive immunosuppression, often in multidrug regimens that are not standardized. We reviewed the clinical challenges of PG in order to find helpful clues to improve diagnostic accuracy and the treatment options, namely topical care, systemic drugs, and the new emerging therapies that may reduce morbidity.
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Affiliation(s)
- Ana Gameiro
- Dermatology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Neide Pereira
- Dermatology Department, Centro Hospitalar Cova da Beira, Covilhã, Portugal
| | | | - Margarida Gonçalo
- Dermatology Department, Coimbra University Hospital, Coimbra, Portugal
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Haines S, Hickey B, Wilson C. Pyoderma gangrenosum mimicking an infected foot. ANZ J Surg 2015; 87:E153-E154. [PMID: 25763769 DOI: 10.1111/ans.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Samuel Haines
- Trauma and Orthopaedics, University Hospital of Wales, Cardiff, UK
| | - Ben Hickey
- Trauma and Orthopaedics, University Hospital of Wales, Cardiff, UK
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