Cutaneous metastasis from gastric cancer: Manifestation, diagnosis, treatment and prognosis

INTRODUCTION

Cutaneous metastasis from gastric cancer is very rare. The understanding of this disease is incomplete. This situation delays its diagnosis and treatment, followed by poor prognosis. Here, we first report a study based on a network to improve the diagnosis, treatment and prognosis of cutaneous metastasis from gastric cancer.

METHODS

A comprehensive search of PubMed was performed. All studies on cutaneous metastasis from gastric cancer were collected. The publication date was limited from 2000 to the present, and the language was limited to English. SPSS 26.0 was employed for statistical analysis.

RESULTS

Seventy-two patients were included. The average patient age was 60.0 ± 16.0 years. In total, 72.2 % of the patients were male. The most common manifestation was nodular skin lesions (45.8 %). The metastases generally presented as multiple lesions (61.1 %). The most common metastasis location was the thoracoabdominal wall (56.9 %). 64.7 % of the patients simultaneously had extracutaneous metastases. Most of the tumors were poorly differentiated carcinomas (87.5 %), and 66.1 % had signet ring cells. 40.8 % of the cutaneous metastases presented as primary manifestations. Only 9.6 % had their diagnosis as soon as the cutaneous metastasis emerged. Systemic chemotherapy (65.6 %) was the most common treatment strategy, followed by radical surgery (12.5 %). The median overall survival was only 6 months. The median overall survival of 5 patients with resected tumors was 48 months.

CONCLUSION

Cutaneous metastasis from gastric cancer usually manifests as an emerged nodule or erysipelas-like skin lesion. Resection of the cutaneous lesion could be helpful for patients with local metastases.

Inflammatory cutaneous metastases originating from gastric cancer: A case report

BACKGROUND

Cutaneous metastasis with gastric cancer (GC) origin is extremely rare and associated with poor prognosis. Nodular type is the most common type, while other forms are extremely rare.

CASE SUMMARY

This study describes severe skin redness, swelling, pain, and fever in a 65-year-old man diagnosed with GC, whose left chest wall, left upper limb, and left back were mainly affected. Firstly, the patient was diagnosed with "lymphangitis" and treated to promote lymphatic return. However, the symptoms were constantly deteriorating, and skin thickening and scattered small nodules gradually appeared. Finally, the skin biopsy confirmed cutaneous metastases, and the patient died 7 d later.

CONCLUSION

Our case highlights that cutaneous metastasis should be considered when skin lesions appear in patients with GC.

Long-term survival of the Sister Mary Joseph nodule originating from breast cancer: A case report

BACKGROUND

A Sister Mary Joseph nodule (SMJN) is an uncommon cutaneous metastasis found in the umbilicus, indicating an advanced malignancy. SMJNs typically originate from intra-abdominal sources, rarely from breast cancer. Diagnosis suggests a poor prognosis with a median survival of approximately 8 mo after detection. Managing patients with SMJNs is challenging, as most receive limited palliative care only. The optimal strategy for long-term survival of these patients remains unclear.

CASE SUMMARY

A 58-year-old female, previously diagnosed with right breast cancer 17 years ago and underwent breast-conserving surgery, adjuvant radiotherapy, and endocrine therapy, presented with a 2-cm umbilical nodule. Thirteen years previously, metastases were detected in the right supraclavicular, infraclavicular, hilar, and mediastinal lymph nodes. An umbilical nodule emerged four years before the date of presentation, confirmed as a skin metastasis of primary breast cancer upon excisional biopsy. Despite initial removal, the nodule recurred and grew, leading to her referral to our hospital. The patient underwent extensive excision of the umbilical tumor and immediate abdominal wall reconstruction. Endocrine therapy was continued postoperatively. Five years later, no local recurrence was observed, and the patient continued to work full-time, achieving over 9 years of survival following SMJN diagnosis.

CONCLUSION

This case study aimed to identify the optimal strategy for achieving extended survival outcomes in patients with SMJN through comprehensive treatment. We presented a case of the longest survival in a patient after undergoing a multidisciplinary treatment regimen. Our findings underscore the significance of adopting a multimodal treatment approach comprising timely and wide excision along with adjunctive therapy. This approach can control the disease, prolong survival, and improve the quality of life in patients with SMJN.

Axillary cutaneous metastasis of colon cancer with microsatellite instability-high and BRAF V600E mutation treated with curative-intent surgery: a case report

BACKGROUND

Colorectal cancer (CRC) metastasizes to various organs, while cutaneous metastases are rare. Although there have been several previous reports of axillary cutaneous metastases with other metastases of CRC, there has never been a report of axillary cutaneous metastasis of CRC that could be treated with curative-intent surgery.

CASE PRESENTATION

A 68-year-old female was diagnosed with an axillary cutaneous tumor and ascending colon cancer with invasion to the duodenum. Histopathological and immunohistochemical analysis revealed that the axillary cutaneous tumor showed adenocarcinoma and the same expression pattern for cytokeratin 7, cytokeratin 20, and CDX2 as the ascending colon cancer, and that proved to be KRAS-NRAS wild type, MSI-H, and with a BRAF V600E mutation. The patient underwent a two-stage resection with curative intent after receiving neoadjuvant chemotherapy which consisted of one cycle of modified FOLFOX6 followed by two cycles of FOLFOXIRI. During and after the two operations, the patient received a total of nine cycles of modified FOLFOX6 as adjuvant chemotherapy. Two years after the initial surgery, and 1 year and 8 months after the second surgery, the patient is alive without recurrence.

CONCLUSIONS

To the best of our knowledge, this is the first report of axillary cutaneous metastasis of CRC with microsatellite instability-high and BRAF V600E mutation that could be treated with curative-intent surgery. It is important to recognize the presence of such cases for the accurate diagnosis and treatment of CRC with cutaneous metastasis.

Cutaneous metastasis from cervical cancer to the scalp and trunk: a case report and review of the literature

BACKGROUND

An estimated 119,300 new cases of cervical cancer occur annually in China, accounting for 372,00 deaths. Cutaneous metastasis from cervical cancer is a rare event, with an incidence of 0.1-1.3% and typically a preterminal occurrence. Scalp metastasis from cervical cancer is exceptionally anecdotal, with only a dozen examples well documented.

CASE PRESENTATION

The patient is a 33-year-old Chinese woman who was diagnosed with International Federation of Gynecology and Obstetrics stage IVB cervical cancer in November 2021. From December 2021 to April 2022, the patient was enrolled in the clinical trial of sintilimab combined with chemotherapy and radiotherapy for treatment of stage IV cervical cancer and underwent six cycles of immunotherapy and chemotherapy (sintilimab plus paclitaxel liposome and cisplatin). Treatment was well tolerated and led to a partial response. The masses adjacent to the spine and iliac bone was largely reduced. Thus, radiotherapy of the metastatic residues was carried out and followed by radiotherapy to the primary tumor at the cervix uteri. However, by the time of the radiotherapy completion in October 2022, the patient noticed painless nodules at the left scapular region and the right hypochondrium. The following month, more nodules occurred on the scalp and trunk, including the left axilla, anterior abdomen, and left back, along with a lesion invading the sternum that caused acute bone pain. The cutaneous masses were white, discrete with a rubbery consistency, and fixed to the skin. Several nodules increased in size and eventually ulcerated. Fine‑needle aspiration cytology of the left back swellings revealed metastatic squamous cell carcinoma, P16 positive. No visceral or brain metastasis was observed at this point.

CONCLUSIONS

Cervical cancer metastases to the scalp are extremely uncommon. When a scalp metastasis is present, it might be the only symptomatic sign of disease progression or widespread metastatic lesions. So far, there is no clear guideline regarding skin metastases treatment. Such skin lesions warrant a thorough radiologic and pathologic workup to form a comprehensive management plan.

Cutaneous Acral Metastasis from Renal Cell Carcinoma-a Case Report

Renal cell carcinomas are known to produce widespread and unpredictable metastasis due to their angioinvasive property. Cutaneous metastases from renal cell carcinomas are very rare, with a reported incidence of 1.3-3%. The sites of cutaneous metastasis from renal cell carcinomas, as per the available case reports, to the best of our knowledge, are shoulder, arm, nape of the neck, chest, face and scalp. We report a case of 63-year-old male, with renal clear cell carcinoma with lung metastasis who had cutaneous metastasis to the fingertip which was confirmed by histopathological examination. Apart from its rarity, this clinical case adds another site of renal cell carcinoma metastasis to the present literature. The skin metastasis represents a widely disseminated state of the disease with a very guarded prognosis and limited life span after its diagnosis.

Cutaneous metastasis as the first presentation of poorly differentiated renal cell carcinoma: A case report

Renal cell carcinoma (RCC) exhibits a propensity for unusual wide metastasis. Cutaneous metastasis from RCC is a rare and poorly recognized clinical entity. We present a case of cutaneous metastasis of poorly differentiated RCC in 49-year-old male patient. In the presented case, the skin lesion was the first sign of widely spread RCC. After the establishment of the diagnosis using radiological and histopathological assessments, the patient was labeled as a terminal case and was referred for pain management. He deceased after 6 months of the initial presentation.

Metastatic Adenocarcinoma of the Lung Presenting as a Presternal Cutaneous Mass: Case Report and Brief Literature Review

BACKGROUND

Cutaneous metastases from lung cancer are uncommon; they can be the presenting sign of an unknown malignancy.

CASE REPORT

We present a 53-year-old man with a presternal mass that proved to be a cutaneous metastasis revealing an underlying lung adenocarcinoma. We searched the relevant literature and present a review of the main clinical and pathological features of this type of cutaneous metastasis.

CONCLUSION

Skin metastases are a rare manifestation of an underlying lung cancer, of which they can be the initial manifestation. Recognition of these metastases is important to promptly introduce an appropriate treatment.

A single-centre experience of secondary cutaneous tumours with special reference to precocious metastases

BACKGROUND

Secondary involvement of skin by tumour comprises 2% of cutaneous neoplasia, in a small proportion of cases serving as the primary manifestation of occult disease.

METHODS

Cases of cutaneous metastases (CM) were retrieved from our pathology files between 2013 and 2018 and clinical and histopathological data reviewed.

RESULTS

There were 159 cases (median age 70). A majority of clinical presentations comprised isolated, papulonodular lesions. While the anatomic distribution of lesions often bore a proximate relationship to the primary tumour, distant sites of involvement were frequently encountered. Melanoma gave rise to the greatest number of metastases, followed by tumours of the breast, colorectum, and squamous cell carcinoma. In six cases (3.8%), CM served as the presenting feature of occult malignancy. These patients presented at a more advanced age and with distant sites of involvement. The microscopic features of CM include nodules, nests, and cords or single cell infiltrates typically in deeper compartments in the absence of overlying epidermal or adnexal precursor lesions.

CONCLUSIONS

CMs are a frequent development in the natural history of melanoma and breast tumours. In practice, a wide spectrum of tumours may give rise to CM and a small proportion more importantly, signal the existence of previously unknown neoplasia.

Cutaneous metastasis of carcinomatous component of ovarian carcinosarcoma: A case report and review of the literature

Skin metastasis of ovarian cancer is extremely rare. We report an unusual case of ovarian carcinosarcoma with cutaneous metastasis of carcinomatous component that displayed distinct clinical manifestation. A 48-year-old woman presented to the dermatologist complaining of a new onset of erythematous, plaque-like skin rash with multiple small nodules on the left inner thigh, the area measuring 8 × 5cm. While the patient had no history of dermatologic conditions, she underwent a total hysterectomy and bilateral salpingo-oophorectomy, omentectomy, and lymph node dissection 16 months ago with a pathology confirmed stage IIIC ovarian carcinosarcoma. Of note, the carcinomatous component, mainly adenocarcinoma with hybrid features of seromucinous, endometrioid and minor high-grade serous carcinoma, involved bilateral fallopian tubes, omentum, and parametrium with extensive lymph node metastases. A skin biopsy specimen revealed an adenocarcinoma involving epidermis, dermis, and subcutaneous tissue with nodular contours, consistent with metastatic carcinomatous component of carcinosarcoma. Both carcinomatous component of primary ovarian carcinosarcoma and metastatic adenocarcinoma in the skin demonstrated Pax8, WT-1, and ER positivity and a mutation pattern of p53. The patient passed away 15 months after identification of skin metastasis. This case represents a unique example of cutaneous metastasis of ovarian carcinosarcoma with distinct clinical manifestation and detailed histopathological description. Alertness to the possibility of cutaneous metastasis, in combination with clinical history, morphological and immunohistochemical findings, is critical for a definitive classification.

Non-small cell lung cancer presenting as back cyst

Cutaneous metastasis as the presenting sign of lung cancer is rare, with a poor prognosis and a life expectancy of 3 to 5 months. We present the complicated course of a 60-year-old woman with extensive metastatic non-small cell lung cancer that presented as a back cyst. Due to the benign appearance of the cyst and the difficulty discovering the location of the primary malignancy, diagnosis and treatment were delayed. Unfortunately, once aggressive treatment was initiated at the request of the patient, she died 2 weeks later. This case highlights the importance of recognizing cutaneous lesions as a sign of internal malignancy and emphasizes multidisciplinary discussion that focuses on the patient's quality of life.

Cutaneous metastasis from esophageal squamous cell carcinoma: A case report

BACKGROUND

Esophageal cancer is a common cause of cancer-related death worldwide. Cutaneous metastasis of esophageal squamous cell carcinoma is rare, particularly in diffuse skin metastasis.

CASE SUMMARY

In this case report, we describe an 82-year-old male who was diagnosed with esophageal squamous cell carcinoma. The tumor was staged as T4N3M1 (Stage IVB). The pathological findings revealed poorly differentiated squamous cell carcinoma of the esophagus. Four months after diagnosis, the patient began chemotherapy, and symptoms were relieved after four cycles of chemotherapy. After that, the patient returned home without a systematic physical examination. One year after diagnosis, the patient realized that the skin of the abdominal wall was hard and rough without pain, and the color became darker than normal skin. Thirteen months after diagnosis, a biopsy of the patient's abdominal lesion revealed that the skin metastasis was derived from the esophagus. Then the patient received two cycles of apatinib combined with docetaxel, but the abdominal lesion worsened. Two cycles of nivolumab were administered, but the patient eventually died of multiple organ failure.

CONCLUSION

This report highlights cutaneous metastasis as a late and untreatable metastasis of esophageal cancer.

Gastric carcinoma's primary presentation as multiple cutaneous nodules throughout the body

Cutaneous metastasis resulting from internal primary tumors remains a rare phenomenon. The prompt recognition of these metastases is important, as they are an indicator of advanced disease and poor prognosis. We report the case of a 44-year-old Caucasian man presenting with a four-month history of multiple cutaneous nodules on the face, trunk, and upper extremities. Results from skin biopsy revealed strands and cords of atypical cells concerning for poorly differentiated metastatic carcinoma. An esophagogastroduodenoscopy was performed and a poorly differentiated signet-ring type invasive adenocarcinoma at the lesser curvature of the stomach was found. As the cancer had already metastasized to the skin and bones, the patient was started on chemotherapy with an oxaliplatin-based regimen and denosumab for the bone metastases, with resultant objective response and diagnostic control for greater than one year to the present date.

Cutaneous metastasis of bladder urothelial carcinoma; A rare conditions

Cutaneous is an extremely rare metastatic area of bladder urothelial carcinoma. Pure cutaneous metastasis without systemic metastasis is very rare and less than ten cases have been reported in the literature. Our patient had various lymphatic fistulas to her skin due to pelvic lymphadenectomy and radiotherapy in her previous cervical cancer. We believe that the most probable mechanism underlying our patient's cutaneous metastasis is a lymphatic spread via those lymphatic fistulas. Immunotherapy is a very important option for patients who cannot receive cisplatin. This is the second case in the literature to apply immunotherapy in the setting of cutaneous metastasis of bladder cancer.

Solitary lower limb cutaneous metastasis in a case of esophageal adenocarcinoma: a rare presentation

Esophageal cancer is the ninth most common cancer all over the world and is sixth in the list of cancer-related mortality. Here in this report, we present an elderly male with solitary subcutaneous metastasis to right thigh 2 years following esophagectomy for esophageal adenocarcinoma. Operative notes revealed inadequate margins on frozen section analysis during initial resection, which were subsequently revised. Postoperative histopathology showed ypT3N0M0 Grade 3 mucin-secreting adenocarcinoma. A wedge biopsy from the thigh growth revealed metastatic mucinous adenocarcinoma. Positron Emission Tomography (PET) was done, which showed a higher tracer uptake in the ulcero-proliferative lesion arising from the subcutaneous plane in the right thigh with no evidence of any other metastasis or recurrence at the primary site. As the reported incidence of distant unexpected metastases is growing, careful physical examination with a preoperative PET-CT is indispensable. Further knowledge on options on treatment of such isolated cutaneous metastasis needs to be studied by the scientific community.

Paraneoplastic focal segmental glomerulosclerosis associated with gastrointestinal stromal tumor with cutaneous metastasis: A case report

BACKGROUND

Gastrointestinal stromal tumor (GIST) with cutaneous metastasis is very rare. As a result, cutaneous GISTs have not been well characterized. Focal segmental glomerulosclerosis (FSGS) is also a rare symptom among paraneoplastic nephritic syndromes (PNS).

CASE SUMMARY

In this case report, we describe a patient with cutaneous metastatic GIST accompanied by nephrotic syndrome occurring as a malignancy-associated PNS, for whom symptomatic treatment was ineffective, but clinical remission was achieved after surgery. Moreover, the patient has a missense mutation in NPHP4, which can explain the occurrences of GIST and FSGS in this patient and indicates that the association is not random.

CONCLUSION

This is the first reported case of a GIST with cutaneous metastasis accompanied by nephrotic syndrome manifesting as a PNS.

Cutaneous metastasis of cecum cancer with MSI-high and BRAFV600E mutation: a case report

Background

Cutaneous metastases of colorectal cancer (CRC) are rare, occurring in 0.7% to 5% of cancer patients. Furthermore, the molecular subtypes of cutaneous metastasis of CRC are unclear. Here, we present a rare case of cutaneous metastasis of high-frequency microsatellite instability (MSI-high)/BRAFV600E-mutant cecum cancer.

Case presentation

A 77-year-old woman presented at the outpatient clinic with a subcutaneous mass on her left back. An excisional biopsy was performed and metastatic cutaneous adenocarcinoma was diagnosed. A computed tomography scan of the thorax and abdomen showed thickening of the cecum wall, the presence of pericolic lymph nodes, multiple masses in the liver, and a single nodule in the right lung. Right colectomy with D2 lymphadenectomy and functional end-to-end anastomosis was performed because of the almost-complete intestinal obstruction. The expression of KRAS wild type, BRAFV600E mutation, and MSI-high was detected in the cecum cancer using molecular pathological examination. She received chemotherapy with XELOX + BEV regimen (capecitabine + oxaliplatin + bevacizumab). After four administrations, a computed tomography scan showed reduction of distant metastases, which suggested partial response.

Conclusions

We encountered a rare case of cutaneous metastasis of MSI-high and BRAFV600E-mutant cecum cancer. In the future, it will be necessary to accumulate more cases to identify clinical features and more effective treatments for CRCs with cutaneous metastasis.

Extensive cutaneous metastasis of recurrent gastric cancer: A case report

BACKGROUND

Cutaneous metastasis is a rare event associated with poor prognosis for gastric cancer and has been rarely reported in the literature.

CASE SUMMARY

A 69-year-old male patient who had undergone salvage gastrectomy and a few courses of adjuvant chemotherapy 3 mo earlier for recurrent gastric cancer developed widespread cutaneous metastases. Due to the patient’s intolerance to further adjuvant chemotherapy, he was placed in hospice care and expired 1 mo later. In the literature, gastric cancers are rarely reported as the primary malignancies for cutaneous metastasis. We, thus, provide an update on a case review published in 2014 by reviewing 10 more case reports dated from 2014 to 2020. The average age for the new group of patients was 59.4 ± 18.88-years-old. Thirty percent of the patients presented with cutaneous lesions and advanced gastric cancer synchronously while 70% developed cutaneous metastases 1.3 years to 14 years after the initial treatment for primary gastric cancer. Eighty percent of the patients received either local excision or chemo ± radiation therapy to treat their cutaneous metastases.

CONCLUSION

This report highlights cutaneous metastasis as a late and untreatable metastasis of gastric cancer.

Cutaneous metastasis as a first sign of breast carcinoma

Unlike visceral, lymphonodal or bone metastases, skin metastases are rare and their identification portends of a bad prognosis. They may appear as the first sign revealing the primary tumour, synchronous or developing late in the course of neglected primary cancer. We report a case of 86 year-old women witch belongs to this rare group of patients in whom cutaneous metastasis were identified before the primary cancer. This case showed the interest of biopsy and imaging in the confirmation of the diagnosis.

Urothelial carcinoma of the bladder with cutaneous metastases after robot-assisted radical cystectomy. Case report

Bladder cancer is one of the common urologic malignant diseases.

Cutaneous metastasis of bladder cancer is rare, with only a few case reports. The pattern of metastasis from bladder cancer is not well described.

We report a patient with muscle-invasive bladder cancer who developed skin metastases after neoadjuvant chemotherapy and robot-assisted laparoscopic radical cystoprostatectomy. Skin metastases were confirmed histopathologically by skin biopsy.

This case reminds us of the need to consider the possibility of skin metastasis in the differential diagnosis of skin symptoms in patients with malignant diseases.

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We reported a patient developed skin metastases after neoadjuvant chemotherapy and robot-assisted laparoscopic radical cystoprostatectomy.

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This is the first documented case of skin metastases of bladder cancer after robot-assisted radical cystectomy.

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This case reminds the necessity of taking into account skin metastasis in patients with malignant diseases.

Recurrent renal cell carcinoma presenting as a cutaneous metastasis: A case report and review of the literature

Renal cell carcinoma (RCC) is a common urological malignancy. Despite early detection and surgical treatment, some lesions recur late at distant sites. The most common dissemination sites are lung, bone, and liver. Skin metastases are not common, and the incidence and clinical manifestations are poorly established in the literature. We report here the case of a male patient with an isolated scalp cutaneous metastase of RCC, 7 years after radical nephrectomy. An excisional biopsy was performed and confirmed metastatic RCC.

Late metastasis of renal cell carcinoma cloaked in a non-healing foot ulcer: A very rare presentation

A 67-year-old male who underwent right radical nephrectomy 15 years prior to current diagnosis for pT2bN0M0 ccRCC presented with an isolated purulent ulcer on left foot. Data was collected from records, radiological scans and histological reviews. The non-healing ulcer did not respond to antibiotic therapy and surgical debridement. Biopsy and histology confirmed a ccRCC metastasis. Late cutaneous ulcer is an aggressive and rare presentation of ccRCC metastasis. Awareness of a non-healing skin ulcer on a background history of ccRCC is important in order to avoid misdiagnosis and mistreatment.

Cutaneous metastasis from esophageal basaloid squamous cell carcinoma: A case report

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Cutaneous metastasis of esophageal cancer is rare.

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Basaloid squamous cell carcinoma (BSCC) of the esophagus is a relatively rare histologic variant of squamous cell carcinoma.

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We reported a case of cutaneous metastasis from esophageal BSCC and was successfully treated with multidisciplinary treatment.

Introduction and importance

Basaloid squamous cell carcinoma (BSCC) of the esophagus is a relatively rare histologic variant of squamous cell carcinoma. Here, we reported a case of solitary cutaneous metastasis as the first symptom of esophageal BSCC and was successfully treated with multidisciplinary treatment.

Case presentation

A 67-year-old man visited a local hospital with symptoms of dysphagia and cutaneous nodules on his left shoulder. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed hypermetabolic accumulations in the middle thoracic esophagus, right recurrent laryngeal nerve lymph node, and epidermis of the left shoulder. Esophagogastroscopy revealed an ulcerative and infiltrating type tumor in the middle thoracic esophagus. Based on histopathologic examination of the endoscopic biopsy and the resected cutaneous tumor, the patient was diagnosed as esophageal BSCC with cutaneous metastasis. The patient was treated with chemotherapy followed by chemoradiotherapy. The therapeutic effect was a complete response, which was sustained for 39 months.

Clinical discussion

Review of previous literature in the PubMed database revealed only been two case reports on cutaneous metastasis of BSCC. Advanced BSCC of the esophagus with distant metastasis has a poor prognosis. Therefore, in our case, future careful follow-up is required.

Conclusion

Esophageal BSCC with cutaneous metastasis can be successfully managed by multidisciplinary treatment, including local resection of the cutaneous metastasis, systemic chemotherapy, and chemoradiotherapy.

Cutaneous metastatic seeding as a sequela of nephrostomy catheter placement

Urothelial carcinoma and nephrolithiasis are a common cause of obstructive uropathy which can be relieved by percutaneous nephrostomy catheter placement. A rare, but known complication of this procedure is iatrogenic seeding of tumor cells along the nephrostomy tract. We describe a case of 68-year-old-female with cutaneous metastasis of high-grade urothelial carcinoma with seeding of tumor cells along the percutaneous nephrostomy catheter tract 8 months after the removal of the catheter. Given its severity, interventional radiologists should be mindful of the number of percutaneous access attempts, exchanges, and catheter manipulations in patients with urothelial carcinoma due to the risk of metastatic seeding along the percutaneous tract or to nearby tissues.

Atypical localization of colorectal cancer metastasis one case and literature review

INTRODUCTION

colorectal cancer is a public health challenge in France. Cutaneous metastases are rare but they give evidence of poor prognosis.

PRESENTATION OF CASE

88 years old female patient, with a previous history of hysterectomy, venous thrombosis outcomes of ankle fracture and stable multiple sclerosis without treatment. She came to emergency with peritonitis. CT scan showed a pneumoperitoneum, and a transverse colonic mass. A laparotomy was performed. This revealed a perforation of caecum, and an obstructive tumor of transverse colon. An extended right semi-colectomy was performed to remove both the perforate caecum and the tumor. The patient was discharged on the 7th post-operative day. Examination confirm an adenocarcinoma pT3N0Mx. At follow up, a nodule was found on her forehead. The biopsy showed a metastasis of colon adenocarcinoma. A surgical resection was performed. To date the patient is well with no evidence of recurrent disease.

CONCLUSION

Cutaneous metastases are rare and there are no recommendations for their treatment. Surgical resection is the best choice, but radiotherapy may be an alternative.

Generalized herpes zoster and cutaneous metastasis during chemotherapy for non-small cell lung cancer: A case report

Although herpes zoster is known to occur in some patients with lung cancer, generalized (disseminated) herpes zoster is an uncommon form whereby hematogenous dissemination of the virus occurs and leads to the development of widespread cutaneous lesions. Similarly, skin is an uncommon site of metastasis in patients with lung cancer. Here, we report a clinical case of a 53‐year‐old male patient who developed generalized herpes zoster during chemotherapy for non‐small cell lung cancer (squamous cell carcinoma) and subsequently developed cutaneous metastasis of lung cancer after generalized herpes zoster was cured by treatment with intravenous aciclovir. The coincidence of these two conditions, generalized herpes zoster and cutaneous metastasis, in the patient during lung cancer treatment might be associated with an impaired or dysregulated immune system partly due to repeated chemotherapy, indicating a poor prognosis. Close observation and accurate diagnosis of changes in the skin of patients with lung cancer are important when evaluating their immune status and considering their therapy and prognosis.

Bellini duct carcinoma revealed by cutaneous metastasis: A case report

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Cutaneous metastasis of renal cell carcinoma is rare.

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Bellini carcinoma is a very rare type of carcinoma of renal cell origin with a very poor prognosis.

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Multiple skin metastases from an asymptomatic Bellini's carcinoma are exceptional.

Introduction

Cutaneous metastasis of renal cell carcinoma is rare and the majority of these metastases are asynchronous. The scalp and face are the major sites of metastases, followed by the chest and abdomen. However, the entire body surface can be affected. When diagnosed, patients are multi-metastatic in 50–80% of cases during follow-up post nephrectomy.

Case presentation

We report here a patient who consulted a dermatologist for multiple skin nodules that appeared 3 months prior. A skin biopsy of a nodule was performed and the pathological examination and immunohistochemistry profile confirmed a metastasis of Bellini Carcinoma, which is a renal cell carcinoma of the collecting duct. A thoraco-abdomino-pelvic scan showed a left renal tumor locally advanced with lung and liver metastases. Chemotherapy was indicated and the patient died four months after diagnosis.

Discussion

Bellini carcinoma is a very rare type of carcinoma of renal cell origin with a very poor prognosis as it is diagnosed already at a metastatic state in the vast majority of cases. After analysis of the data from the literature, our case is the second reported case of a Bellini carcinoma revealed by cutaneous metastases. The peculiarity of our observation is metastases occurred on all four limbs and at the trunk level, and the asymptomatic characteristic of Bellini's carcinoma, which is a rare situation.

Conclusion

The originality of this observation is based on the mode of presentation of a rare renal tumor by an even rarer metastasis of the skin.

A perianal subcutaneous metastasis as the presenting sign for lung cancer

Metastases to soft tissues are rarely reported in the initial presentation and diagnosis of lung cancer. We report a case of a 77-year-old white man who presented with a 9-day history of a painful, rapidly growing mass on his left buttock in the gluteal cleft. The deep dermal location of the neoplasm and the lack of epidermal involvement led to suspicion of a metastatic carcinoma. Imaging showed a lung lesion suspected to be a primary malignancy with distant liver and gastric fundus metastases. Lung pathology showed primarily adenocarcinoma with squamous differentiation, whereas the skin biopsy showed poorly differentiated squamous cell carcinoma. Clinically, we concluded the skin carcinoma was a metastasis of a primary lung adenocarcinoma with squamous differentiation. This case highlights the importance of appropriate preventative screening.

Embolization of an Exophytic Posterior Neck Mass Secondary to a Cutaneous Renal Cell Carcinoma Metastasis

Renal cell carcinoma (RCC) commonly metastasizes to the lung, liver, bones, and brain; however, cutaneous metastases remain rare with few reported cases. Since RCCs have the propensity to metastasize to highly vascular areas, the scalp and skin of the head and neck region are likely locations for cutaneous metastases. We report a rare case of a large, exophytic, cauliflower-like, hemorrhagic, metastatic mass of the posterior neck. This is the first reported case of a head and neck cutaneous RCC metastasis treated with endovascular embolization prior to surgical resection. Due to the increased vascularity of RCCs and risk of excessive hemorrhage during resection, adjunctive embolization of cutaneous head and neck metastasis may have a role. Essential characteristics to our treatment strategy are discussed with a review of pertinent literature.

Skin Metastasis of Renal Cell Carcinoma

Renal cell carcinoma (RCC) accounts for around 3% of all cases of skin metastasis. In these patients, solitary metastasis from RCC shows a favorable prognosis. A 68-year-old woman was found to have a right renal tumor in 2009, and the pathological diagnosis was pathological T3 and grade 3 right clear cell RCC. Left-sided RCC developed and was resected in 2018. She subsequently noticed a cutaneous nodule on her abdomen. We performed surgical resection, and the pathological diagnosis was skin metastasis of RCC. We herein report a case of skin metastasis of RCC that developed 11 years after the initial diagnosis that was successfully treated by surgical resection.

Cutaneous Metastasis from Cervical Spinal Chordoma: Case Report and Literature Review

BACKGROUND

Chordomas are rare primary tumors of the bone that arise from embryonic notochord. They are locally aggressive tumors with a high tendency for postsurgical recurrence. On the other hand, distant metastases are rare. When they occur, they involve lungs, liver, lymph nodes, and bones. Skin and subcutaneous tissue involvement is even rarer and usually occurs by direct extension of the primary tumor or by local recurrence. Distant cutaneous metastasis from chordoma is an exceptional finding, with fewer than 20 cases reported in the literature. All the cutaneous metastases described derive from sacral chordomas, except for 2 cases in which the source of metastasis is skull-base chordomas.

CASE DESCRIPTION

We report the case of a 55-year-old man with skin metastasis from a cervical chordoma.

CONCLUSIONS

Metastasis has to be taken into account in the differential diagnosis when a new skin lesion appears in a patient with a past medical history of chordoma. To the best of our knowledge, this is the first case of cutaneous metastasis from spinal cervical chordoma. A systematic literature review was performed.

Breast cancer cutaneous metastases are associated to uMUC1 and sialyl Lewis x and to highly malignant primary tumors

Breast cancer spreading to different organs have been related to different molecules and mechanisms, but cutaneous metastasis remains unexplored. Increasing evidence showed that MUC1 and some of its carbohydrate associated antigens may be implicated in breast cancer metastasis. In this study we analyzed these tumor markers in order to identify breast cancer cutaneous metastatic profiles. A cohort of 26 primary tumors from breast cancer patients with cutaneous metastases were included; also, cutaneous and lymphatic node metastatic samples and primary tumors from breast cancer patients without metastases were analysed. Immunohistochemical (IHC) studies demonstrated that both underglycosylated MUC1 (uMUC1) and sialyl Lewis x (sLex) to be positively associated with cutaneous metastatic primary tumors (p < 0.05). Notably, a high percentage of tumors with cutaneous metastases were characterized as triple negative and Her2+ tumors (37.5 % and 29 %, respectively). Some discordant results were found between primary tumors and their matched cutaneous metastases. To determine if MUC1 variants may be carriers of carbohydrate antigens, subcellular fractions from a cutaneous metastatic lesion were obtained, immunoprecipitated and analyzed by Western blot. We found that the isolated uMUC1 with a molecular weight of>200 kDa was also the site for binding of anti-sLex MAb; in coincidence, a high correlation of positive IHC expression of both markers was observed. Our findings confirm that breast cancer cutaneous metastases were associated to highly malignant primary tumors and sustain the hypothesis that u-MUC1 and sLe x may drive breast cancer cutaneous metastases.

A Case of Rare Cutaneous Metastasis from Advanced Pancreatic Cancer

A 71-year-old woman presented to a nearby hospital with an occipital scalp ulcer with exudate. Thoracoabdominal enhanced computed tomography (CT) was performed due to suspected cancer. The imaging results showed tumors in the pancreatic tail and at multiple sites in the lung, whereupon she was referred to our hospital for further investigation. Histological analysis of the occipital scalp ulcer and the pancreatic tumor led to the diagnosis of pancreatic adenocarcinoma with cutaneous metastasis and multiple lung metastases. Combination chemotherapy (gemcitabine and nab-paclitaxel) was started, and about 4 months later the patient experienced right lower back pain. Abdominal CT showed partial sclerosis of the right iliac bone and multiple spinal lesions, which were diagnosed as multiple bone metastases. Narcotic analgesia was started for the right lower back pain. Since then, FOLFIRINOX has been introduced as second-line chemotherapy against tumor growth, and treatment has been ongoing for 10 months since the initial chemotherapy. Pancreatic cancer is a rapidly growing cancer and can show early metastasis to other organs, lymph node metastasis, and peritoneal dissemination; therefore, the prognosis of pancreatic cancer is very poor. Cutaneous metastasis from pancreatic cancer is rare, and only a few cases have been reported. Here, we report an unusual case of pancreatic adenocarcinoma with cutaneous metastasis and multiple lung and bone metastases.

Cutaneous Metastasis of Signet Cell Gastric Carcinoma

Gastric cancer is the fourth most commonly diagnosed cancer and the second most common cause of cancer-related death worldwide. Cutaneous metastases of signet-ring cell gastric carcinoma are uncommon. Here, we report a metastatic gastric adenocarcinoma, which manifested itself as an asymptomatic scar-like lesion on the epigastric area and histopathological features of the cutaneous lesion showing signet-ring cell.

[Cutaneous metastases from genitourinary malignancies.]

OBJECTIVE

To show and report two new cases of urological cutaneous metastasis.

METHODS

We describe two skin metastases cases. The first patient corresponds to a renal tumor and the other to a urothelial tumor.

RESULTS

52-year-old female with stage IV renal tumor,which is treated with Sunitinib. 34 months later, she refers ajaw angle skin ulcer, considered metastasis.75-year-old male with stage IV mixed urothelial carcinoma,which is treated with cystoprostatectomy and adjuvantchemotherapy. 9 months later, he showed 5 skin lesionsin his thorax. A core biopsy was diagnostic of urothelialcutaneous metastases.

CONCLUSIONS

Genitourinary skin metastasis are rareand have poor prognosis. The largest incidence is in renaltumors, followed by bladder and prostate malignancies.

A Case Report of Locally Advanced Anal Cancer with Solitary Cutaneous Nodular Metastasis in the Ipsilateral Labia Majora Treated with Definitive Chemoradiotherapy

Cutaneous metastasis from anal cancer is rare at the initial diagnosis. There is a dearth of information on definitive treatment for anal cancer with cutaneous metastasis. We report the case of a 63-year-old female with locally advanced anal cancer and solitary cutaneous nodular metastasis in the right labia majora identified at the initial diagnosis that was successfully treated with definitive chemoradiotherapy. She arrived at our hospital with complaints of an enlarging perineal itching nodule. Genital and rectal examination detected an anal tumor with perineal and rectal invasion. The biopsy specimen indicated it was a squamous cell carcinoma that was accompanied by right inguinal and external iliac lymph nodal metastases and solitary cutaneous nodular metastasis in the ipsilateral labia majora. She was diagnosed with anal cancer, clinical T3N1M1, stage IV (UICC-TNM 7th). She had good performance status and effective organ function. She received definitive chemoradiotherapy with irradiation fields that included the primary tumor, pelvic lymph nodal metastases, and solitary cutaneous genital metastasis. After completing the planned treatment, all tumors vanished without recurrences at 42 months after treatment. In conclusion, patients with locally advanced anal cancer may suffer genital cutaneous metastasis that develops with lymphatic drainage from the anus to the inguinal lymph nodes. Anal cancer with solitary genital cutaneous nodular metastasis can be considered as a local-regional disease and can be treated with chemoradiotherapy. Chemoradiotherapy achieved a cure in our case.

An Unusual Presentation and Aggressive Course of Metastatic Myoepithelial Carcinoma

Myoepithelial carcinomas are rare tumors that make up 1 to 2 percent of all salivary gland neoplasms. We present a case of a 55-year-old man with myoepithelial carcinoma that developed into widespread cutaneous, lung, and brain metastases refractory to treatment, including newer immunotherapies. Newer strategies or treatments are needed for the future benefit of patients with advanced disease.

Clinical silence of pulmonary lymphoepithelioma-like carcinoma with subcutaneous metastasis: a case report

BACKGROUND

Dissemination of lung cancer to cutaneous sites usually results in a poor prognosis. Pulmonary lymphoepithelioma-like carcinoma (PLELC) is a rare tumor, and no therapeutic strategy for it has yet been established. We present herein an extremely rare case of a long-term surviving patient with PLELC showing subcutaneous metastasis.

CASE PRESENTATION

A 76-year-old woman was diagnosed unexpectedly as having PLELC based on a nodule on her back. After surgical resection of the primary and metastatic lesions, she has remained alive with no recurrence for over 5 years without any additional therapy.

CONCLUSION

Even in the case of PLELC with subcutaneous metastasis, surgical management may afford a prognosis of long-term survival.

[Metástasis cutánea de cáncer de colon: una forma de presentación inusual y tardía a tener en cuenta]

Introducción

El cáncer colorrectal es un gran problema de salud por su alta incidencia y mortalidad. Las metástasis cutáneas son raras, con una incidencia < 5%.

Caso clínico

Varón con antecedente de colectomía por neoplasia de colon que 6 años después presenta una lesión cutánea. La biopsia informa de metástasis colónica, por lo que se realiza resección quirúrgica radical. La anatomía patológica confirma un adenocarcinoma moderadamente diferenciado compatible con metástasis colónica.

Discusión y conclusiones

Las metástasis cutáneas son raras y cuando aparecen nos indican una enfermedad avanzada, por lo que es importante un alto índice de sospecha en pacientes de riesgo para un diagnóstico precoz.

Introduction

Colorectal cancer is a big health problem due to its high incidence and mortality. Cutaneous metastases are rare with an incidence < 5%.

Clinical case

A male with a history of colectomy due to colon cancer, who 6 years later presented a cutaneous lesion. The biopsy reported colonic metastasis, so radical surgical resection was performed. The pathological anatomy confirmed a moderately differentiated adenocarcinoma compatible with colonic metastasis.

Discussion and conclusion

Cutaneous metastases are rare and when they appear they indicate an advanced disease, for that reason is important a high index of suspicion in patients at risk, for an early diagnosis.

Epidemiologic and Histopathologic Characterization of Cutaneous Metastases in Patients Who Visited 2 Hospitals in Santiago de Chile Between 2005 and 2017

BACKGROUND AND OBJECTIVE

Cutaneous metastases (CMs) account for 2% of skin tumors and their incidence varies between 0.7% and 9% in patients with cancer. The objective of this study was to describe and analyze the demographic, clinical, and histopathologic characteristics of CM in patients who visited 2 hospitals in the Santiago de Chile metropolitan region.

MATERIAL AND METHOD

We performed a retrospective, descriptive, analytical, observational, cross-sectional study. We reviewed the pathology reports, patient records, pathology slides, and dates of death for diagnosed cases of CM from the anatomic pathology departments of 2 hospitals in the Santiago de Chile metropolitan region between 2015 and 2017.

RESULTS

Ninety-six patients with CM were included in the study; 60.42% were women and 39.58% were men. The mean (SD) age was 67.95 (13.74) years, with a range of 28 to 96 years. The most common primary tumor was melanoma in 27.08% of cases (n=26), followed by breast cancer (18.75%, n=18), and adenocarcinoma (15.63%, n=15). The median time between diagnosis of the tumor and cutaneous metastasis was 9 months. Patients with CM of melanoma had a higher survival rate than patients with metastasis of other primary tumors (P<.05). A histopathologic study of 91 slides showed that diffuse infiltration of the tissue with tumor cells was the most common pattern and vascular invasion was rare.

CONCLUSIONS

The results are similar to those found worldwide. CM is a rare manifestation of internal tumors. It presents mainly at an advanced age and is equally prevalent in both sexes.

[Cutaneous metastases on the extremities]

BACKGROUND

Cutaneous metastases (CM) on the extremities are rare complication of cancer with poor prognosis. In general, lesions simulate an infection. Herein, we report two new cases with atypical presentation.

PATIENTS AND METHODS

Case no 1: a 71-year-old man consulted for suspicion of left hand pyogenic granuloma present for 3 months. His history revealed two treated squamous-cell carcinomas (tongue and lung). On physical examination, he presented three budding and foul-smelling lesions on his left hand. Histopathology showed metastasis of squamous-cell carcinoma. Radiographic examination revealed spread of pulmonary nodules with suspicion of metastasis. Case no 2: a 68-year-old man was hospitalized for indurated edema of the right leg present for several months. Six months earlier, he had undergone surgery for left pulmonary adenocarcinoma without metastasis. Physical examination revealed an indurated edema on the right foot. Histopathology showed metastasis from adenocarcinoma. A scan revealed several osteolytic lesions in the right foot as well as lymphadenopathy.

DISCUSSION

Herein, we report two original cases of CM of the extremities diagnosed as tumor progression. This is a rare complication of variable clinical presentation and impacts both cancer management and prognosis. It is important to consider the diagnosis when distal cutaneous lesions persist, particularly where there is a history of cancer.

Acrocutaneous metastasis - A rare presentation

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Cutaneous metastasis from head and neck cancer is uncommon. Acrocutaneous metastasis from the base of tongue is relatively rare.

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These are most commonly seen in pre-terminal patients with wide-spread disseminated disease and indicates poor prognosis.

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They may be the first presentation of occult silent cancer, mimicking a benign condition

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Fine needle aspiration cytology (FNAC) or biopsy from the lesions should be considered and metastasis should be ruled out, even if it clinically appears to be benign in nature.

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When they are located on the fingers, treatment is palliative and includes surgical resection or amputation.

Introduction

Cutaneous metastasis from head and neck cancer is uncommon and it is seen from laryngeal cancer. Acrocutaneous metastasis from the base of tongue is relatively rare.

Case Report

We present a case of a 84-year-old male, previously diagnosed to have moderately differentiated squamous carcinoma of the base of tongue with lung and liver metastases and received palliative chemoradiation. He, now presented with ulcero-proliferative growth over the right 5th finger. In the present case, the patient initially presented with a nodule which later ulcerated and increased in size. There was associated discharge. There was clinical suspicion of underlying osteomyelitis. Hence right 5th finger amputation upto the middle phalanx was done. The histopathology report of the specimen was moderately differentiated squamous cell carcinoma. This is a case of skin metastasis from squamous carcinoma of the base of Tongue is rare at a short span of time following the completion of treatment. This case has highlighted the probable presence of occult skin metastasis at the time of diagnosis, which became apparent after the completion of treatment.

Conclusion

Fine needle aspiration cytology should be done in cutaneous nodules associated with head and neck cancers to rule out malignancy, even if it clinically appears to be benign in nature.

Cutaneous lymphangitic carcinomatosis: A rare metastasis from cervical cancer

Skin metastases are a rare event in patients with cervical cancer. One form of such metastasis is carcinomatous lymphangitis, which is a rare presentation of skin metastases. Here we report a woman with cervical cancer diagnosed cutaneous lymphangitic carcinomatosis.

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Cervical cancer is the most common gynecologic malignancy in developing countries

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Skin metastasis of cervical cancer is a rare entity, more often seen with adenocarcinoma

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The management of skin metastases in patients with cervical cancer depends on the mode of presentation

A case of cutaneous metastasis mimicking herpes zoster rash

Cutaneous metastasis is a rare occurrence and often is confused with infectious etiology most commonly herpes zoster rash. We present a case 49 year old male with history of metastatic colon cancer with persistent dermatomal vesicular rash that thought to be due to herpes zoster. A skin biopsy eventually revealed malignant cells.