Metástasis cutánea metacrónica de carcinoma escamoso de canal anal / Methachronical cutaneous metastasis of squamous carcinoma of the anal canal / Metástase cutânea metacronica de carcinoma escamoso do canal anal

El tratamiento correcto de carcinoma escamoso avanzado requiere de un manejo multidisciplinar entre cirujanos, anatomopatólogos, radioterapeutas y radiólogos. Los protocolos están claros cuando nos hallamos ante una enfermedad localizada, sin embargo, cuando la enfermedad es metastática no existe evidencia científica de los pasos a seguir. Presentamos una paciente con un carcinoma escamoso del ano con una única metástasis cutánea metacrónica que fue tratada con cirugía y radioterapia posterior con buena respuesta.

The right therapy of anal cancer needs a multidisciplinary management of surgeons, pathologists, radiotherapists and radiologist. The treatment of squamous cell carcinoma of the anal canal is well-known when the patient presents a locally disease, nevertheless, there is a lack of information with the advanced anal cancer. We report a case of a 74-year-old woman with a solitary methachronical cutaneous metastasis of anal cancer which responded perfectly to surgery and radiotherapy.

A correta terapêutica do câncer anal necessita de uma gestão multidisciplinar de cirurgiões, patologistas, radio terapeutas e radiologistas.O tratamento do carcinoma espinocelular do canal anal é bem conhecido quando o paciente apresenta uma doença local, porém, há uma falta de informação sobre o câncer anal avançado. Relatamos o caso de uma mulher de 74 anos com metástase cutânea metacrônica solitária de câncer anal que respondeu perfeitamente à cirurgia e à radioterapia.

Metástasis cutánea de adenocarcinoma de próstata: reporte de un caso / Cutaneous metastasis of prostate adenocarcinoma: a case report

RESUMEN Las metástasis cutáneas son eventos muy infrecuentes que corresponden a una invasión tumoral a distancia. Las metástasis de próstata tienen un orden de aparición de 1%; las localizaciones más comunes incluyen la región genital o suprapúbica y muy raramente se ubican a distancia. Reportamos el caso de un paciente varón con metástasis cutánea de adenocarcinoma de próstata de localización cervical y torácica superior, el cual presentaba además antecedente de tuberculosis pulmonar. La tomografía reveló la presencia de metástasis ósea, derrame pleural e infiltración de tejidos blandos del cuello. El estudio histopatológico confirmó la presencia de metástasis cutánea de neoplasia de próstata primaria. Presentamos el caso debido a su presentación inusual y por su importancia en el diagnóstico diferencial de esta patología.

ABSTRACT Cutaneous metastases are very rare events and are related to a distant tumor invasion. Prostate metastases have a 1% appearance rate; the most common locations include the genital or suprapubic region and are very rarely located at a distance. We report the case of a male patient with cutaneous metastasis of prostate adenocarcinoma located in the cervical and upper thoracic area. The patient also had a history of pulmonary tuberculosis. A CT scan revealed the presence of bone metastasis, pleural effusion, and infiltration of the soft tissues of the neck. The histopathological study confirmed the presence of cutaneous metastasis of primary prostate neoplasia. We present this case due to its unusualness and its importance in the differential diagnosis of this pathology.

Follicular thyroid carcinoma metastatic to skin: a small papule and a big diagnostic change

Abstract: Cutaneous metastases are uncommon in daily practice, although very important, since they may be the first manifestation of an undiscovered primary neoplasm or the first indication of recurrence. Cutaneous metastases from the breast are the most frequent in women and cutaneous metastases from the lung are the most frequent in men. Thyroid carcinoma, despite representing the most frequent endocrine neoplasm, is considered a rare neoplasm, corresponding to 1% of malignant neoplasms diagnosed. Cutaneous metastases from follicular carcinoma are rare and occur mainly in the head and neck area. We report a case of cutaneous metastasis in a patient with follicular thyroid carcinoma and breast carcinoma. Because of the association of these two neoplasms, the possibility of Cowden Syndrome - multiple hamartoma syndrome - was raised, but was excluded by genetic analysis of PTEN gene.

Metástasis cutáneas: como manifestación inicial y de recidiva de cáncer de mama: a propósito de un caso / Cutaneous metastasis as inicial and recurrence manifestation of breast cancer: a case report

INTRODUCCIÓN: Las metástasis cutáneas (MC) son un fenómeno poco frecuente en pacientes que padecen de cáncer de origen visceral, en mujeres se deben principalmente al cáncer de mama (CDM). Las MC se pueden presentar como manifestación de un cáncer avanzado o como signo de recidiva de un cáncer en remisión. La presentación clínica de un CDM en piel es muy variada, al estar presente es un indicador de enfermedad avanzada y , a su vez, de mal pronóstico, donde la variante clínica nodular es la más representativa. PRESENTACIÓN DEL CASO: Paciente femenina, 58 años. Con historia en 2005 de MC como primera manifestación de CDM. Presentó evolución satisfactoria y regresión de MC posterior a tratamiento con quimioterapia y radioterapia. Se resolvió quirúrgicamente, asociado a terapia hormonal, continuando en control ambulatorio. En 2018 consulta por lesión cutánea en pierna derecha, donde se constató además lesión cutánea mamaria izquierda. Se realizó biopsia de ambas lesiones que informó carcinoma epidermoide in situ en pierna derecha y metástasis dérmica de carcinoma ductal mamario con extensión intraepidérmica en zona mamaria izquierda y cervical ipsilateral. DISCUSIÓN: Las MC generalmente son precedidas por el diagnóstico de tumor mamario, rara vez son primera manifestación de él. De las MC cuya aparición es posterior al hallazgo de CDM, pueden observarse lesiones incluso al cabo de 10 años, lo que ha llevado a afirmar que el riesgo de enfermedad a distancia estará presente durante el resto de la vida. La presencia de MC por CDM implica generalmente amplia diseminación de la enfermedad, por lo tanto tener en cuenta este diagnóstico sería de gran ayuda en cuanto a oportunidad de tratamiento.

INTRODUCTION: Cutaneous metastases (MC) are a rare phenomenon in patients suffering from visceral cancer, in women they are mainly due to breast cancer (CDM). MC can occur as a manifestation of advanced cancer or as a sign of recurrence of a cancer in remission. The clinical presentation of a CDM in skin is very varied, being present is an indicator of advanced disease and, in turn, of poor prognosis, where the nodular clinical variant is the most representative. PRESENTATION OF THE CASE: Female patient, 58 years old. With history in 2005 of MC as the first manifestation of BC. After treatment with chemo and radiotherapy she presented satisfactory evolution and regression of CM. It was resolved later with surgery and hormonal therapy, continuing in ambulatory control. In 2018, the patient complained of a cutaneous lesion in the right leg. Physical exam also revealed a left mammary skin lesion. Biopsy was performed on both lesions. It reported carcinoma in situ in the right leg and dermal metastasis of mammary ductal carcinoma with intraepidermal extension in the left mammary and cervical area. DISCUSSION: CM are generally found after discovering the mammary tumor, they are rarely its first manifestation. As late manifestation of the disease, CM have been reported up to ten years later. The presence of MC by CDM generally implies a broad dissemination of the disease, taking into account this diagnosis could be of great help in terms of an opportunity for treatment.

Cutaneous metastasis of colorectal cancer

Abstract: Cutaneous metastases from internal malignant neoplasms are a rare event and a late clinical finding that is associated with disseminated disease and a poor prognosis. Skin metastases from colon tumors occur in only 4% of cases of metastatic colorectal cancer. They are most often located on the abdominal skin. We report a case of 54-year-old male patient with a cutaneous metastatic focus on the lower abdomen as the initial presenting symptom of an underlying colon cancer.

Exuberant case of cutaneous metastasis of breast cancer

Abstract: Cutaneous metastasis is the main cause of morbidity and mortality of cancer patients, denoting a guarded prognosis. The clinical spectrum of the disease is broad and can mimic benign conditions. The diagnosis depends on thorough clinical examination and complementary exams, with emphasis on the histopathological study and immunohistochemistry. Because it indicates a systemic relapse, it is necessary to intervene with intravenous chemotherapy, to which local therapies can be associated. We report the case of a 65-year-old woman with cutaneous metastasis from breast cancer treated 14 years back, manifested by extensive firm and infiltrated red-purple plaques on the sides of the trunk, with a course of six months. After evaluation, she was referred to the regional cancer center. She passed away one month and a half later.

Erysipelatoid Carcinoma

SUMMARY Erysipelatoid Carcinoma (EC), also known as Inflammatory Metastatic Carcinoma, is a rare form of cutaneous metastasis, secondary to an internal malignancy, more often related to breast cancer. Clinically, the lesion has a well-marked, bound erythematous appearance, much like an infectious process, such as erysipelas and cellulitis, these being the most common differential diagnoses. It is characterized by an acute or subacute appearance with an erythematous plaque, sometimes hot and painful, being more often situated in the primary tumor vicinity, especially in the thorax wall in the region of a mastectomy due to breast cancer. Here we present the case of a 75-year-old patient with ductal infiltrated carcinoma for 3 years, who presented an acute erythematous and infiltrated plaque in the region of a previous mastectomy, with a final diagnosis of EC.

Diphencyprone as a therapeutic option in cutaneous metastasis of melanoma. A single-institution experience

Abstract: Diphencyprone has been reported as a local immunotherapy for cutaneous melanoma metastases. We aim to report cases of melanoma patients treated with diphencyprone in a single Brazilian institution and highlight their outcomes. Since 2012, we have treated 16 melanoma patients with cutaneous metastases with topical diphencyprone. To date, we have had 37.5% of complete response, 25% of partial responses, and 31.25% patients without any response. Treatment was well tolerated and local toxicity was easily controlled. We believe topical diphencyprone is a feasible treatment that can be another option for treating melanoma patients, especially in cases of in-transit or extensive disease.

Metástasis cutáneas de cáncer de mama: revisión de la literatura / Breast cancer cutaneous metastasis: literature review

Introducción: El cáncer de mama es uno de los tumores malignos más frecuentes en mujeres, y representa el principal carcinoma que genera metástasis cutáneas (MC), excluyendo al melanoma. Objetivos: Realizar una revisión de las MC del carcinoma mamario y mostrar las principales formas de presentación clínica. Discusión: Las MC pueden presentarse mediante diferentes manifestaciones dermatológicas, aunque lo más frecuente es un infiltrado eritematoso papulonodular único o múltiple, generalmente localizado en la piel subyacente o próxima al área del tumor primario. Las células tumorales alcanzan la piel por 3 vías de diseminación: hemática, linfática y por contigüidad. Los carcinomas mamarios, normalmente, se diseminan por la vía linfática y llegan a zonas de la piel cercanas; así, las MC de mama adoptan como sitio de implantación principal la piel del tórax. Conclusiones: Las MC pueden ser la manifestación inicial de un cáncer, o bien un signo de recurrencia de este. Es necesario tener un alto nivel de sospecha diagnóstica debido a su gran polimorfismo clínico.

Introduction: Breast cancer is one of the most frequent malignant tumors in women and is the main carcinoma leading cutaneous metastasis (CMs), excluding melanoma. Objectives: To present a literature review about CMs from breast cancer and to show the mainly clinical forms. Discussion: CMs can present different skin manifestations, but single or multiple papulonodular erythematosus infiltrate are the most common, generally located in the underlying skin or close to the primary tumor area. Tumor cells reach the skin through three dissemination forms -hematogeneus, lymphatic, and contiguity-. Breast carcinomas normally disseminate through lymphatic via and reach close skin zones; thus, breast CMs mainly allocate in the thorax skin. Conclusions: CMs can be the initial manifestation of a cancer or a sign of its recurrence. There must be a high level of suspicion because its clinical polymorphism.

Diffuse cutaneous melanosis: rare complication of metastatic melanoma

Abstract Diffuse cutaneous melanosis is a rare complication of metastatic melanoma related to a worse prognosis. There are few cases reported in the literature. Its pathogenesis has not been completely elucidated, although studies have suggested certain mechanisms for its occurrence. It is clinically manifested as a blue-gray discoloration of the skin and mucous membranes in a cephalo caudal progression and usually associated with melanuria. Skin and mucosa histopathology reveals only the presence of melanophages in the dermis, mainly perivascular, and free interstitial melanin. We report the case of a 68-year-old male with metastatic melanoma, diffuse hyperpigmentation of the skin and melanuria.

Cutaneous metastases in a patient with no previous diagnosis of cancer: diagnostic challenge

Abstract: On rare occasions, skin lesions are the first local of metastatic manifestation of internal malignancies. In case of no previous diagnosis of these tumors, the approach of suspicious skin lesions becomes a challenge, especially in differentiating cutaneous metastases and adnexal primary neoplasms. Currently, besides epidemiologic, dermoscopic and histopathologic aspects, the evaluation also integrates immunohistochemical exams and cell markers such as p40 and p63, highly specific for skin metastases. This article describes the case of cutaneous metastases as the sole obvious sign of breast cancer in a previously asymptomatic woman. The diagnosis was made by the finding of neoplastic cells in the dermis and immunohistochemistry compatible with ductal carcinoma.

Ovarian carcinoma presenting as cutaneous nasal metastasis

Abstract Metastatic ovarian cancer uncommonly presents with skin metastasis. When present, skin metastases of ovarian cancer are usually localized in the vicinity of the primary tumor. We report a case of a 58-year-old woman with a rapid growing erythematous, well-defined nodule localized on the left nasal ala. A skin biopsy was performed and histopathological and immunohistochemical findings were compatible with a cutaneous metastasis of adenocarcinoma. A systematic investigation revealed a bilateral ovarian cystadenocarcinoma associated with visceral dissemination, likely associated with nose cutaneous metastasis. We report a very uncommon case because of the presentation of ovarian carcinoma as cutaneous metastasis. To our knowledge, this atypical localization on the nose has not been described yet in the literature.

Melanoma as a surprising solution to the puzzle of intestinal obstruction

Abstract We present a case of a 71-year-old man with an advanced melanoma of the right colon. The final diagnosis was determined based on histopathological examination of the material collected during urgent laparotomy performed due to ileus. Although we considered the tumor to be a disseminated primary melanoma of the colon, the possibility of unknown primary origin could not be excluded. Palliative chemotherapy and radiotherapy reduced symptoms associated with the disease and prolonged patient's survival.

Cutaneous metastasis as the first manifestation of occult malignant breast neoplasia

Abstract Cutaneous metastases from primary internal malignancies represent 0.7-9% of patients with cancer. We report a 65-year-old female patient referred for evaluation of normochromic papules on the trunk and upper limbs that had been present for three months. A skin biopsy revealed diffuse cutaneous infiltration by small round cell tumors. Immunohistochemistry was positive for AE1/AE3, CK7, estrogen receptor and mammaglobin. The final diagnosis was cutaneous metastasis of occult breast cancer, since the solid primary tumor was not identified. The location of the primary tumor can not be determined in 5-10% of cases. In these cases, 27% are identified before the patient’s death, 57% at autopsy, and the remaining 16% can not be located.

Single cutaneous metastasis of colon adenocarcinoma - Case report

Abstract: Skin metastases are relatively rare and occur most often when the cancer is already advanced, invading other organs. As to location, they often seem to elect areas located close to the primary tumor, although distant sites, such as the scalp, may be affected with some frequency. We present a case of a 76-year-old woman with colon adenocarcinoma that had a single metastatic lesion on the scalp.

Cutaneous metastasis of unknown primary presenting as massive and invasive abdominal lesion: an elective approach

Abstract: We describe herein what is to our knowledge the first reported case of an invasive cutaneous metastasis with unknown primary, electively treated solely with electrochemotherapy. We describe a female patient with a large, invasive and painful lesion in her hypogastric region, extending up to the pubic area. The cutaneous biopsy and instrumental and laboratory analyses, all failed to reveal the primary site. A final diagnosis of cutaneous metastasis with unknown primary was made and treatment was performed with electrochemotherapy. Our case highlights the importance of interdisciplinary choices in clinical practice to cope with the lack of a primary site and to improve quality of life, since no standardized therapy exists for these classes of patients.

Cutaneous metastasis from gastrointestinal adenocarcinoma of unknown primary origin

AbstractCutaneous metastasis is a rare manifestation of visceral malignancies that indicates primarily advanced disease. Due to its low incidence and similarity to other cutaneous lesions, it is not uncommon to have a delayed diagnosis and a shortened prognosis. We describe the case of a patient who presented with a cutaneous nodule in the sternal region as a first sign of malignancy.

Melanoma inhibitory activity in Brazilian patients with cutaneous melanoma

Abstract BACKGROUND: Melanoma inhibitory activity is a protein secreted by melanoma cells and has been used as a tumor marker. Increased Melanoma inhibitory activity serum levels are related to metastatic disease or tumor recurrence. Currently there are no studies on Melanoma inhibitory activity and cutaneous melanoma involving Brazilian patients. OBJECTIVE: To evaluate the performance and feasibility of measuring Melanoma inhibitory activity levels in Brazilian patients with cutaneous melanoma. METHODS: Blood was obtained from ten patients with proved metastatic cutaneous melanoma (Group 1), 15 patients resected for cutaneous melanoma without metastasis (Group 2) and 5 healthy donors (Group 3). Melanoma inhibitory activity was measured using a commercially available ELISA kit. RESULTS: There was a statistically significant difference of Melanoma inhibitory activity levels between patients with and without metastasis (p=0.002), and between patients with metastasis and healthy donors (p=0.002). There was no difference between patients without metastasis and healthy donors (p=0.443). CONCLUSION: Melanoma inhibitory activity is a tumor marker for cutaneous melanoma and the Melanoma inhibitory activity-ELISA test can be easily performed. Patients with metastasis have increased Melanoma inhibitory activity serum levels when compared to patients without metastasis and healthy donors. .