Cutaneous metastasis of unknown origin: Dermatologic features and pathology

Background@#Skin metastases are rare yet crucial indicators of advanced disease. They can mimic various skin conditions, making them challenging to diagnose.@*Aims and Objectives@#To investigate the incidence rate of biopsy-confirmed cutaneous metastasis and explore the clinical presentation, workup, and diagnostic techniques for skin metastases@*Materials and Methods@#Local study involving comprehensive laboratory tests, pathological examination, and immunohistochemistry to identify primary tumors and confirm diagnoses. @*Results@#Nodules were the most common manifestation of skin metastases, particularly in breast carcinoma. The chest wall and abdomen were frequent sites of involvement. Pathological examination and immunohistochemistry played a critical role in confirming diagnoses, revealing various histopathologic patterns. Immunohistochemical markers assisted in determining tumor origin but required careful interpretation. Monitoring tumor behavior over time provided insights into nature and origins. @*Conclusion@#Comprehensive workups including laboratory testing, pathology, and immunohistochemistry are essential for accurate diagnosis and management of skin metastases. Careful monitoring of tumor behavior can provide valuable information about its nature and origins.

Presentación inusual de compromiso metastásico cutáneo por carcinoma escamocelular de cuello uterino / Unusual presentation of metastatic skin involvement in a patient with squamous cell carcinoma of the cervix: Case report

Resumen El cáncer de cuello uterino ocupa el cuarto lugar dentro de las neoplasias de origen ginecológico a nivel global, representando un 85% de los casos en países en vías de desarrollo. Las metástasis cutáneas de origen ginecológico son altamente infrecuentes, observándose con mayor frecuencia en las neoplasias malignas de ovario, seguidas del adenocarcinoma endometrial y de cuello uterino y, menos frecuentemente, las de subtipo escamocelular. En la actualidad, existen alrededor de 80 reportes de casos citados en la literatura de metástasis cutáneas secundarias a un carcinoma de cuello uterino; sin embargo, ninguno con localización en la piel del cuello que se origine de un subtipo histológico escamocelular. En Colombia, no hay casos reportados hasta la fecha. Se presenta el caso de una paciente de 43 años que consulta por sangrado vaginal, dolor abdominal y una extensa placa tumoral exofítica de aspecto metastásico en la piel del cuello y del hombro izquierdo, encontrando al examen clínico inicial una masa tumoral en el cuello uterino con confirmación histológica de un carcinoma escamocelular como neoplasia primaria. Se hace diagnóstico de Carcinoma de cuello uterino estadio IVB y se inicia un tratamiento con intención paliativa con radioterapia y posterior quimioterapia sistémica. La enfermedad metastásica de origen ginecológico a nivel cutáneo confiere un mal pronóstico, con una supervivencia reportada de 1 a 37 meses después de su diagnóstico, por lo cual se deduce que la prevención y el diagnóstico temprano, particularmente en cáncer de cuello uterino, es de vital importancia en la población general.

Abstract Cervical cancer is the fourth most common cancer among gynecological neoplasms globally, representing 85% of cases in developing countries. Cutaneous metastases of gynecological origin are very rare, observed more frequently in ovarian malignancies, followed by endometrial and cervical adenocarcinoma and less frequently those of the squamous cell subtype. Currently there are about 80 case reports cited in the literature of cutaneous metastases secondary to cervical carcinoma, however, none with localization in the skin of the neck originated from a squamous cell histological subtype. In Colombia, there are no reported cases to date. We present the case of a 43-year-old patient who consulted for abdominal pain, vaginal bleeding and an extensive exophytic tumor plaque of metastatic appearance in the skin of the neck and left shoulder, finding a tumor mass in the cervix with histological confirmation of a squamous cell carcinoma as primary tumor. A diagnosis of stage IVB cervical carcinoma is made, and treatment is initiated with palliative intention with radiotherapy and subsequent systemic chemotherapy. Cutaneous metastatic disease of gynecological origin confers a poor prognosis, with a reported survival of 1 to 37 months after its diagnosis, for which prevention and early diagnosis, particularly in cervical cancer, is of vital importance in the general population.

Individualized comprehensive treatment for lung adenocarcinoma with multiple skin and bilateral breast metastasis: A case report / 中南大学学报(医学版)

Lung adenocarcinoma is a malignant tumor that is prone to distant metastasis. Common metastatic sites are brain, adrenal gland, liver, bone, and so on. Skin soft tissue metastasis is unusual, and breast metastasis is even rarer. This case is a middle-aged female patient who had experienced multi-line treatments for upper limbs, abdominal skin, and bilateral breast tissue metastases.The patient's multiple metastases were susceptible to radiation therapy.Reviewing the entire treatment process of this patient can find that the rational use of individualized comprehensive treatment methods and appropriate timing of genetic testing are very important for patients with lung adenocarcinoma to prolong their survival time and improve their quality of life.

Systemic metastasis of hepatocellular carcinoma responsive to multidisciplinary treatment including debulking surgery

The lung, followed by regional lymph node and bone, is the most common site for extrahepatic metastasis of hepatocellular carcinoma (HCC). Metastatic skin lesion of HCC is rare, and it is a sign of poor prognosis, indicating the strong possibility of metastases in other regions of the body. We report the case of a 52-year-old male with multiple metastases, including skin metastasis of HCC, which were treated with multidisciplinary therapy.

Solitary Skin Metastasis of Papillary Thyroid Carcinoma

A solitary skin metastasis is a rare manifestation of papillary thyroid carcinoma (PTC). A 55-year-old woman presented with a movable subcutaneous nodule in her anterior neck for several months. Three years ago, she underwent total thyroidectomy and remnant ablation for classical PTC (pT3N0M0) and was under thyroxine suppression therapy without any evidence of recurrent disease. The subcutaneous nodule was 0.4 cm in size, firm, and movable without any change in the overlying skin. Recurrent PTC was confirmed after excision biopsy. Eight months after, she got a new nodule along the previous excision site. After punch biopsy, metastatic PTC was confirmed in the deep dermis and was re-excised with a clear resection margin. This is the first report of a case of solitary skin metastasis of PTC in Korea. Although solitary skin metastasis of PTC is rare, it should be considered in patients with a skin nodule.

Epidermal Cyst-like Skin Metastasis in Ovarian Cancer Patient / 대한피부과학회지

Cutaneous metastasis from the ovarian cancer has been found to be exceedingly rare. We report a case of a metastatic ovarian mucinous cystadenocarcinoma, which clinically manifested as the epidermal cyst-like skin nodule on the right upper quadrant of abdomen.

Cutaneous metastasis of prostate carcinoma to neck and upper chest.

Prostate adenocarcinoma is the most common urologic malignant neoplasm in men. Metastasis to skin is rarely reported and usually occurs late. The incidence and appearance of cutaneous metastasis are not well established in patients with prostate adenocarcinoma and their recognition remains poor among practicing urologists. Their clinical appearance may mimic other common dermatologic disorders. Definitive diagnosis requires a high index of suspicion. Immunohistochemical staining helps in establishing the diagnosis. We report a case of prostate adenocarcinoma presenting with widespread metastasis, including those to dermis and subcutaneous tissue of neck and upper chest.

Cutaneous Metastasis of Lung Angiosarcoma to the Scalp / 대한피부과학회지

Angiosarcoma is a rare malignant tumor of an endothelial cell derivation and it accounts for less than 2% of all sarcomas. It is a highly aggressive neoplasm with a poor prognosis and most patients die within a short period after presentation. Although angiosarcoma may occur in any location on the body, it rarely arises from major vessels, but has a decided predilection for the skin and superficial soft tissue. A 39-year-old man was referred to our department with an asymptomatic, firm, ulcerative nodule on his scalp that was noticed almost 2 months previously. He had been diagnosed with lung angiosarcoma 9 month earlier. Histopathologically, the skin specimen showed angiosarcoma. The histological findings of the metastatic skin cancer are usually the same as that of the primary cancer. Metastatic cutaneous angiosarcoma is uncommon. Based on these clinical and histopathological findings, our case seems to be skin metastasis at the scalp from the lung angiosarcoma.

Presentacion clínica inusual de metástasis cutánea de carcinoma mamario: A propósito de un caso / Inusual Clinical Presentation Of Cutaneous Metastasis From Breast Carcinoma: A Case Report

Las Metástasis Cutáneas (MC) son entidades clínicas destacadas pues representan entre el 1% al 5 % de las lesiones cutáneas observadas en Dermatología, adquieren mayor importancia ya que pueden ser el primer o único signo clínico de un tumor oculto. Pueden ser únicas o múltiples, asintomáticas y de aspecto clínico variado. Eventualmente cualquier neoplasia maligna puede metastatizar en la piel, pero en la mujer el origen mamario es el más frecuente y en el hombre ese lugar está ocupado por los tumores pulmonares, luego se encuentran las provenientes del tracto gastrointestinal, riñón y cavidad oral. El objetivo de este trabajo es informar un caso de MC de origen mamario con una forma clínica de presentación inusual.

Cutaneous metastasis (CM) are prominent clinical entities; they represent almost 1% to 5% of skin lesions observed in Dermatology, also can be the first clinical sign of a hidden tumor. They are usually multiple, painless, and its clinical presentation is varied. Eventually any malignancy can spread to the skin but as a direct relationship between the origin of the MC and the frequency of tumors. In women in the foreground is the origin breast (in man that place is occupied by lung tumors), then find those from the gastrointestinal tract, kidney and oral cavity. The aim of this paper is to report a case of metastatic breast carcinoma origin with unusual clinical presentation.

One case of vulva metastasis from cervical squamous cell carcinoma / 대한산부인과학회지

Metastasis to the skin occurs rarely in gynecologic cancer. Although carcinoma of the cervix is the fifth most common malignancy in Korean women, cutaneous involvement originating from cervical cancer is unusual. Common pattern of occurrence is multiple nodule in abdomen, vulva, lower extremities. We report a case of metastasis from squamous cell carcinoma of cervix to vulva. The patient was diagnosed with cervical cancer IIA. The extensive skin lesion on the vulva occurred 3 months after neoadjuvant chemotherapy, radical hysterectomy and concurrent chemoradiation. We have experienced such a case and report the case with brief review of literatures.

A Case of Carcinoma of Ampulla of Vater Metastasized to the Finger / 대한피부과학회지

Skin metastasis from internal malignancy is relatively rare. Skin metastasis from biliary tract cancer is known to be extremely uncommon (around 0.4~0.7%). In most cases, biliary tract cancer metastasizes into neighboring organs or other internal organs, but rarely into the skin. The authors have experienced a case of skin metastasis into a finger of a patient with carcinoma of Ampulla of Vater. This is thought to be the first case reported in Korea.

Skin Metastasis of Neuroendocrine Carcinoma Arising in the Uterine Cervix / 대한피부과학회지

Neuroendocrine carcinoma is known to have features of neuroendocrine and epithelial differentiation through immunochemical and biochemical investigation and Merkel cell carcinoma is a rare primary malignancy of the skin belonging to the broad spectrum of tumors of the neuroendocrine system. Small cell carcinoma of uterine cervix, also a kind of neuroenodcrine carcinoma, is rarely reported and it is much more exceptional in the world that cervical carcinoma metastases to distant skin. Further more this may be the first case of a uterine neuroendocrine carcinoma metastasizing to the skin in Korean medical literature. We report a case of 74-year-old woman who presented with a somewhat fixed subcutaneous nodule measuring 2.5 cmX0.8 cm on the left side of forehead. A biopsy of the nodule revealed a poorly differentiated carcinoma under the muscle without involvement of upper structures and it showed neuroendocrine differentiation by immunohistologic studies. Before appearing as cutaneous manifestation 2 months ago, she had showed a history of abnormal vaginal bleeding and diagnosed as a cervical neuroendocrine carcinoma, especially small cell carcinoma histologically.

Two Cases of Cutaneous Metastasis from Small Cell Lung Cancer / 대한피부과학회지

Cutaneous metastasis from lung cancer, especially small cell type is rarely seen in dermatologic clinics. In general, lung cancer, which spreads to brain, bone, liver, and adrenal glands, is responsible for the majority of skin metastasis in men and is the second only to breast cancer as the source of skin metastasis in women. Clinically, lung cancer may be signaled only by cutaneous metastasis which reflects the progression of the primary malignancy and often portends a fatal outcome. Herein we report two cases of skin metastasis from small cell lung cancer.

A Case of Skin Metastasis from Uterine Cervical Cancer / 대한부인종양콜포스코피학회잡지

Skin metastasis from carcinoma of uterine cervix is extremely rare and its incidence is reported as 0.1~1.3%. Common pattern of occurrence is multiple nodules in abdomen, external genitalia, or lower extremeties. It is believed that the pathogenesis of skin metastasis is a result of retrograde spread of the tumor secondary to lymphatic obstruction. Treatment of skin metastasis may consist of surgical excision, local irradiation, or chemotherapy, but the prognosis is very poor and median survival is about 3 months. We have experienced such a case and report the case with brief review of literatures.

Clinicopathologic Studies of 7 Cases with Cutaneous Metastatic Carcinomas from Lung Cancers / 대한피부과학회지

BACKGROUND: Cancer that tends to metastasize to other internal organs also involves the skin with various clinical features. OBJECTIVE: We studied the clinical and histopathological findings of metastatic skin cancer and primary lung cancer. METHODS: We reviewed the clinical features and histopathological findings in 7 patients with metastatic skin cancer from the lung cancer. We performed routine hematoxylin-eosin stain and immunohistochemical staining with monoclonal antibody to cytokeratin, neuron specific enolase, S-100, leukocyte common antigen, and epithelial membrane antigen using the formalin-fixed paraffin embedded skin tissue of cutaneous metastatic and primary lung cancer. RESULTS: All patients are men ranging from 44 to 72 years in age(mean, 63.0 years). Cutaneous lesions were nodule, tumor, and sclerotic plaque. Skin lesions appeared on all parts of body. The neck, chest, and scalp were the most common locations of metastases. Pathologic findings were squamous cell carcinoma in 5 patients, adenosquamous cell carcinoma in 2 patients. We found some different immunophenotypes in cutaneous metastatic lesion and lung cancer. Mean survival time from the diagnosis of lung cancer was 10.4 months, and 8.4 months from the diagnosis of skin metastasis. CONCLUSION: We conclude that patients with cutaneous metastasis of lung cancer reflect progressive, terminal stage, and poor prognosis of the disease.

A Case of Gastric Adenocarcinoma Appearing as Skin Metastasis / 대한소화기내시경학회지

The skin is an uncommon site of distant metastasis from any internal malignancy, and the incidence of metastatic skin lesions as the first symptom of disease is only 0.8% in patients with all systemic malignancies. Furthermore, cutaneous metastasis from adenocarcinoma of the stomach has been found to be extremely rare. A 35-year-old female patient was admitted due to multiple cutaneous nodules in her chest, abdomen, and back. A gastroendoscopic examination and biopsy was made according to the results of skin pathologic findings. Stomach and skin biopsy results revealed a signet ring cell type of adenocarcinoma. A case of gastric adenocarcinoma in which metastatic skin nodules appeared as the first sign of disease, is here in reported with a review of related literature.

Skin Metastasis of Adenoid Cystic Carcinoma of Parotid Gland / 대한피부과학회지

Adenoid cystic carcinoma is known to be a neoplasm of the major and minor salivary glands but it also occurs in the lacrimal gland, external auditory canal, easphagus, breast and skin. Adenoid cystic carcinoma of salivary gland is a slow-growin nalignant tumor. Although metastasis of this tumor clevelnps in about half the cases, its meta taes to the overlying skin is not common, moreover the skin metastasis to the remote site is raely found. Primary cutaneous adenoid cystic carcinoma is rare and histologically indistingisl able from skin metastasis of adenoid cystic carcinoma of the salivary gland. A 53 year-old man presented a solitary, well defined, erythen at us, 1.3 x 1.3cm sized nodule on the vertex of the scalp, which revealed the typical histopatholog ndings of adenoid cystic carcinoma. One and half years ago, a tumor of the parotid gland va removed and proved to be a cribriform pattern of adenoid cystic carcinoma. The skin lesion was diaghosed as a skin metastasis of the alenoid cystic carcinoma of parotid gland rather than a primary cutaneous adenoid cystic carcinona because a similar pattern of adenoid cystic carcinorom had been discovered on the parotidg an l although it developed on the scalp, the usual site of primary cutaneous adenoid cystic carcinama.

A Case of Skin Metastasis Manifested as a Presenting Sign of Pancreatic Tail Cancer

A 68-year-old male patient visited our clinic complaining of a single skin lesion on the left shoulder for 5 months. The lesion was a bluish to pigmented, bean-sized nodule. No subjective symptoms and signs accompanied it. Histologically, the tumor mass was composed tumor emboli in the vessels and moderately differentiated neoplastic glands lined by anaplastic cells. These findings were consistent with the metastatic adenocarcinoma. Abdominal sonography and CT scanning showed a mass at the tail of the pancreas. Therefore, we diagnosed this skin lesion as a metastatic adenocarcinoma originating from the pancreatic tail. We report herein a rare case of skin metastasis from pancreatic tail cancer, in which the cutaneous involvement was the first sign of the internal malignancy.

A case of neuroblastoma with multiple skin metastases / 대한피부과학회지

We report a case of neuroblastoma with multiple skin metastases as a chief complaint in a 2-month-old girl. the skin lesions were rnultiple, pea-sized, bluish, nontender, moable subcutaneous nodules on abdomen, back and scalp. Histopathology showed small round or poly gonal tumor cells which have deeply stained, basophilic, hyperchromatic nuclei with some mitoses. Th.se tumor cells showed clumping tendency which is one of early menifestations of rosette formation. Immunohistochemically positive reaction was demonstrated by anti-NSE(neuron specific enolase) antilody but negative reaction by anti-NFP (neurofilament proteiin ) antibody. She has been succesfully treated with combined chemotherapy for 10 months without relapse.

A Case of Midline Malignant Reticulosis Associated with Distant Skin Metastases / 대한피부과학회지

Midline malignant reticulosis is a relentlessly progressive, localized, destructive inflammatory process of upper respiratory tract including the nose, nasopharynx, palate, paranasal sinuses, and midface. Histologically, it is characterized by a dense aceumulation of pleomorphic mononuclear cells with an admixture of inflammatory cells. We report a case of midline malignant reticulosis developed in a 64-year-old man, who showed a serosanguineous nasal discharge, perforation of nasal septum, persistent ulceration of hard palate, and disseminated lesions on the abdominal skin, which was confirmed by histopathalogical examination. In addition we studied infiltrated cells with atypical nuclei by immunohistochemical staining with a pannel of monoclonal antibodies. The results revealed that the atypical cells expressed the T-cell marker, but not the macrophage and B-cell marker.