Biphasic squamoid alveolar renal cell carcinoma: A rare entity with an even rarer presentation as cutaneous metastases – A case report

Biphasic squamoid alveolar renal cell carcinoma (BSARCC) is a newly emerging distinct and rare morphologic variant of renal cell carcinoma (RCC). Morphological, immunohistochemical, and molecular data have shown that BSARCC is closely related to papillary RCC type 1. We report a case of Biphasic squamoid alveolar renal cell carcinoma with a rare presentation as cutaneous metastases. This variant tends to show an aggressive behavior. Hence, accurate histopathological diagnosis can help in effective treatment and for close follow-up of the patients.

Metástasis cutáneas como primera manifestación de neuroblastoma primario de glándula suprarrenal en un paciente pediátrico / Cutaneous metastasis as the first manifestation of primary adrenal gland neuroblastoma in a pediatric patient

Resumen Introducción: El neuroblastoma es el tumor maligno más frecuente en el primer año de vida y el tumor sólido extracraneal más frecuente en la infancia. Solo el 1% de los casos debuta con metástasis cutáneas, caracterizadas por nódulos azulados subcutáneos. Se presenta el caso de un lactante con un neuroblastoma suprarrenal izquierdo en el que las metástasis cutáneas constituían el síntoma principal. Caso clínico: Lactante de sexo femenino, de 2 meses de edad, sin antecedentes de importancia para el padecimiento actual. Acudió por presentar dermatosis diseminada en la región cervical y occipital, el abdomen, el muslo derecho y el pie izquierdo. La dermatosis se caracteriza por nódulos subcutáneos, sólidos, bien delimitados, < 1 cm, de color azulado, que iniciaron su aparición a los 7 días de vida en el hipocondrio derecho, con crecimiento progresivo, asintomáticos. Se realizó biopsia de un nódulo y se reportó la presencia de células pequeñas con núcleo denso hipercromático, escaso citoplasma y dispuestas en nidos. La inmunohistoquímica fue positiva para cromogranina y enolasa neuronal específica. Los hallazgos fueron compatibles con metástasis cutánea de neuroblastoma. Se solicitó valoración y abordaje por oncología pediátrica, que reportó un estadio 4 de la enfermedad y se inició el tratamiento correspondiente. Conclusiones: Los pediatras y los dermatólogos pediatras son los primeros en atender a niños con alguna lesión cutánea. Se deben tener en cuenta las metástasis cutáneas, que pueden aparecer antes o simultáneamente al diagnóstico de un tumor primario. Por lo tanto, se debe realizar un correcto abordaje con el fin de mejorar el pronóstico y la calidad de vida del paciente.

Abstract Background: Neuroblastoma is the most common malignant tumor in the first year of life and the most common extracranial solid tumor in childhood. Only 1% of cases present with cutaneous metastases characterized by subcutaneous bluish nodules. We report the case of an infant with a left adrenal neuroblastoma in whom skin metastases were the main symptom. Case report: Two-month-old female infant with no relevant history for the current condition. The infant presented disseminated dermatosis affecting the head in the cervical and occipital region, abdomen, right thigh and left foot. Dermatosis was characterized by subcutaneous nodules, solid, well limited, < 1 cm, bluish color that appeared at 7 days of life in the right upper quadrant, with progressive growth, asymptomatic. A biopsy of a nodule was performed, which reported the presence of small cells with a dense hyperchromatic nucleus, scarce cytoplasm, arranged in nests. Immunohistochemistry was positive for chromogranin and specific neuronal enolase. Findings were consistent with cutaneous neuroblastoma metastasis. An assessment and approach by pediatric oncology were requested, reporting disease stage 4 and initiating the corresponding treatment. Conclusions: Pediatricians and pediatric dermatologists are the first to attend to children with a skin lesion. We must consider that skin metastases may appear prior to or simultaneously with the diagnosis of a primary tumor. Therefore, we should carry out a correct approach in order to improve the prognosis and the quality of life of the patient.

Metástasis cutánea de carcinoma de mama primario / Cutaneous metastasis of primary breast carcinoma

RESUMEN: Se consideran metástasis cutáneas aquellas neoplasias que se extienden a la piel por diseminación linfática, hemática o por contigüidad, originadas generalmente de un tumor extracutáneo, casi siempre diseminado y agresivo. Las metástasis en la piel suelen constituir un evento tardío en el curso de la enfermedad neoplásica, pero también pueden presentarse como el primer signo de un tumor desconocido.1 El carcinoma de mama es la neoplasia maligna interna más frecuente en las mujeres y se manifiesta con mayor frecuencia entre la quinta y sexta década de la vida. El 45% de las metástasis en la piel de cáncer de mama se presentan entre 6 meses y 4 años después del diagnóstico del tumor primario, aunque pueden observarse lesiones metastásicas al cabo de 10 años, por lo que el riesgo de metástasis quedaría latente durante el resto de la vida.2 Constituye un factor pronóstico desfavorable de la enfermedad asociándose a la morbi-mortalidad de la paciente, ya que generalmente se encuentran metástasis concomitantes en órganos internos.

SUMMARY: Cutaneous metastases are considered to be those neoplasms that extend to the skin due to lymphatic and hematic dissemination, generally originating from an extra cutaneous tumor, almost always disseminated and aggressive. Metastases in the skin are usually a late event in the course of neoplastic disease, but they can also present as the first sign of an unknown tumor.1 Breast carcinoma is the most frequent internal malignant neoplasm in women, manifesting most frequently between the fifth and sixth decade of life. 45% of skin metastases of breast cancer occur between 6 months and 4 years after diagnosis of the primary tumor, although metastatic lesions can be observed after 10 years, so the risk of metastasis would remain latent during the rest of life.2 It is a prognostic factor of the disease associated with the morbidity and mortality of the patient, since concomitant metastases are usually found in distant organs.

Metástasis cutáneas de cáncer de mama: presentación de 3 casos / Cutaneous metastases of breast cancer: three case report

Las metástasis cutáneas de neoplasias internas constituyen un hecho infrecuente. Su incidencia se incrementó en los últimos años debido a nuevas terapias oncológicas que llevan al aumento en la sobrevida de los pacientes y a su mayor conocimiento y diagnóstico por parte de los profesionales. Suelen desarrollarse en el curso evolutivo de una neoplasia ya diagnosticada, pero en algunos casos pueden ser la forma de presentación de un tumor primario desconocido y se asocian a mal pronóstico. Presentamos tres pacientes con cáncer de mama que desarrollaron metástasis en piel.

Cutaneous metastases from internal malignancies are a rare occurrence. Its incidence has increased in recent years due to new cancer therapies that lead to increased patient survival and greater awareness and diagnosis by the professional. Cutaneous metastases usually develop in the clinical course of a previously diagnosed malignancy, but in some cases they may be the presentation of an unknown primary tumor and are associated with poor prognosis. Three patients with breast cancer developing skin metastases are presented.

Metástasis cutánea de adenocarcinoma secundaria a paracentesis / Skin metastasis from adenocarcinoma secondary to parecentesis

Las metástasis cutáneas constituyen una entidad infrecuente que permite diagnosticar la existencia de una neoplasia maligna de órganos internos o cutánea, su diseminación o su recurrencia, siendo en todos los casos un signo de mal pronóstico. Presentamos el caso de un paciente con metástasis de adeno carcinoma en piel de abdomen tras implantación de células tumorales luego de una paracentesis diagnóstica

Cutaneous metastases are a rare entity that allow diagnose malignant neoplasm of skin or internal organs, dissemination or recurrence. It ́s a sign of poor prognosis in all cases. A patient with metastatic adenocarcinoma in abdominal skin after tumor cell implantation post diagnostic paracentesis is reported.

Cutaneous Lesions As A Presenting Sign Of Metastases In Male Breast Cancer: A Rare Clinical Entity

Male breast cancer accounts for only 1% of cancers in men and 1% of breast cancers. Cutaneous metastases occur less than 10% of all patients with visceral malignancies and are considered a rare and late event in progression of metastatic disease. A 45-year-old man presented with a lump in the left breast which was confirmed to be infiltrating ductal carcinoma. He underwent a left mastectomy and axillary clearance followed by chemotherapy and radiotherapy to the left chest wall. However, he was non-compliant to adjuvant tamoxifen due to hot flushes. One year later, he presented with biopsy proven cutaneous metastases. Initially he had complete excision of the lesions, however, two months later more skin lesions appeared predominantly over the chest wall and back. Hormonal therapy failed to control the metastases as such he was treated with systemic chemotherapy. He is currently on third line chemotherapy.

Cutaneous Metastases from Head and Neck Squamous Cell Carcinoma

The presence of cutaneous metastases in squamous cell carcinomas of the head and neck (SCCHN) is rare and associated with a dismal prognosis. It is vital to distinguish these lesions from direct invasion of the skin by SCCHN or primary cutaneous malignancies as the prognosis is vastly different and so is the management. In this case report, we present four cases of cutaneous metastases and also briefly review the literature pertaining to this phenomenon.

Zosteriform cutaneous metastases: A case report and brief review of literature.

A 56-year-old woman presented with painful erythematous, papulo-nodular lesions on the left side of the trunk in a dermatomal distribution of two-weeks duration. She had earlier undergone surgery for breast carcinoma and was receiving palliative chemo-radiotherapy, when seen by us. A diagnosis of zosteriform cutaneous metastases was made and biopsy was done from the representative lesion which showed chords and sheets of malignant cells. Majority of these cases in the past have been misdiagnosed as herpes zoster and were treated with antiviral drugs. Metastatic diseases should be considered in the differential diagnosis of zosteriform rash in elderly.

Algunos aspectos del compromiso cutáneo por el cáncer de mama: revisión de la literatura a propósito de tres casos / Cutaneous metastasis of breast cancer: three clinical cases and a review of the literature

Las metástasis cutáneas son infrecuentes, reportándose en la literatura rangos entre 0,6 por ciento y 10 por ciento. El cáncer de mama es la neoplasia más común en las mujeres con metástasis cutáneas. La presencia de éstas constituye un signo de enfermedad avanzada y es indicadora de mal pronóstico. Las lesiones pueden tener distintos patrones clínicos: tipo nodular, erisipeloide, alopecia y carcinoma telangiectásico. En el presente artículo se realiza un análisis retrospectivo de tres casos clínicos atendidos en nuestro centro y una revisión de la literatura.

Cutaneous metastases are unusual; their frequency in the literature ranges from 0.6 percent to 10 percent. Breast cancer is the most common cancer in women with cutaneous metastases. They are perceived as a sign of advanced disease and are regarded as a serious prognostic indicator. The lesions may present in distinct clinical forms: nodular pattern, erysipelas like presentations, alopecia and carcinoma telangiectaticum. In this article we analyzed three clinical cases that were seen in our center and a review of the literature.

A Case of Medullary Thyroid Carcinoma in which the Skin Metastasis was Concurrently Present and Response Occurred to Chemotherapy / Journal of the Korean Cancer Association, 대한암학회지

Medullary thyroid carcinoma accounts for 3% of all thyroid gland malignancies. It commonly metastasizes to liver, lung, and bone. It rarely metastasizes to skin, and only a few such cases have been documented. Cutaneous metastasis suggests a poor prognosis, with a mean survival of 7.5-19 months. The most effective treatment for skin metastasis is complete surgical removal of all local and regional lesions. The response to systemic chemotherapy is typically poor. We report a case of medullary thyroid carcinoma with cutaneous metastases, which responded to chemotherapy.

A Case of Multiple Cutaneous Metastases from Metastasizing PleomorphicAdenoma of the Submandibular Gland / 대한피부과학회지

Pleomorphic adenomas are the most common neoplasms of the salivary glands. A long-lasting pleomorphic adenoma can develop into a malignant tumor. Malignant mixed tumor of the salivary gland includes carcinoma ex pleomorphic adenoma, carcinosarcoma, and metastasizing pleomorphic adenoma. The metastasizing pleomorphic adenoma is to be distinct from the true malignant mixed tumor, because it remains histologically benign and can metastasize. We report the case of a 64-year-old female with a long-standing goose egg-sized neck mass and multiple small firm nodules on the trunk and extremities, which showed histological features metastasizing pleomorphic adenoma of the salivary gland.

Cutaneous Metastasis from Prostatic Cancer

Cutaneous or subcutaneous metastases occur in 2% to 9% of visceral malignancies. Skin metastases are seen most commonly from carcinomas of the breast, lung, large intestine. Skin metastases of prostatic origin are quite uncommon and preferentially localized to the lower abdomen and genital area. Two cases of cutaneous metastases of prostatic origin have been reported in the Korean dermatological literature in our review. We report a case of cutaneous metastases from prostatic cancer

Cutaneous metastases from visceral carcinoma in Siriraj Hospital: A retrospective review.

Cutaneous metastases occurred in 0.1% of all patients with cancer. The most common primary tumor was carcinoma of the breast (47.8%). They were recognized after the primary tumor in 56.5%. They were the first sign of cancer in 30.5%, especially in carcinoma of the lung. However, they were not uncommon as an early indicator of metastatic disease. They tended to appear in areas overlying the primary carcinoma. Only carcinoma of lung and cervix may disseminate to distant cutaneous sites. The prognosis depended on the type of primary carcinoma. Carcinoma of the breast with cutaneous metastases had a prolonged survival. Survival of patients with carcinoma of the lung averaged 2 months after the appearance of cutaneous metastases.

Two Cases of Cutaneous Metastasis from Carcinoma of Cervix / 대한피부과학회지

Metastasis to the skin from internal malignant neoplasms are an uncommon and often preterminal event. Although carcinoma of the cervix is the fourth most common malignancy in women, cutaneous involvement originating from cervical cancer is particularly unusual, even in the terminal stages of disease. We report two cases of cutaneous metastasis from cervical cancer. Case one was a 57-year-old woman, who has been treated with radiotherapy and chemotherapy for an cervical cancer(Stage IIa) since 11 years ago. She showed multiple grouped shallow ulcerative nodules and papules on the external genitalia 1 month ago. Another case was a 46-year-old woman noted irregular vaginal bleeding, and pelvic examination revealed an cervical cancer(Stage IIb) for 2 years ago. She visited our clinic because of swelling of the right leg and multiple erythematous nodules and ulcerative lesion on the right thigh for 2months. Histopathologic findings showed skin tumors, which were considered to originate from the cervix.

A Case of Metastatic Carcinoma en Cuirasse and Nodular Carcinoma from Gastric Carcinoma / 대한내과학회지

Cutaneous metastases from gastric carcinoma are uncommon. The frequency of metastses to the skin from gastric carcinoma have ranged from 0.3% to 0.4%. Carcinoma en cuirasse, first described by Velpeau in 1838, is marked sclerodermatous change and characterized by a difffuse morphea-like induration of the skin and represents a rare manifestations of breast carcinoma metastatic to the chest wall. It is vary rarely seen in lung, stomach, kidney and other metastasizing malignancies. We report a case of carcinoma en cuirase and nodular carcinoma from gastric carcinoma in a 36-year-old male who complained chiefly of multiple cutaneous nodules. He had mixed lesions of an erythematous morphea-like induration on the neck and multiple erythematous nodules on the chest and abdomen. Gastroscopy finding showed a Borrmann type IV advanced gastric carcinoma. Histopathologic examination of skin and stomach showed atypical cells with pleomorpic, hyperchromatic nuclei and scanty, eosinophilic cytoplasm, which are consistent with poorly differentiated adenocarcinoma. Immunohistochemical stainings showed positive reaction for cytokeratin. He died three months after the appearance of cutaneous lesions.

Two Cases of Hepatoma with Cutaneous Metastases / 대한피부과학회지

Skin metastases from internal cancers are unusual; from a hepatoma they are extremely rare. The most common clinical presentation are solitary or multiple nodules that have appeared in one area of the body. Other forms include inflammatory and sclerodermoid metastatic growths. Case one was a 54-year-old male who had had partial hepatectomy of the right lobe of his liver following diagnosis of hepatocellular carcinoma five years ago. He presented with a 10 month history of a solitary nodule on the chin. Another case was a 46-year-old male, who had developed hepatocellular carcinoma forming a large subcutaneous mass by hemat,ogenous metastasis of the left zygomatic bone, masseter muscle and subcutaneous fat. Additional metastases were observed in the portal vein and multiple bones including the right shoulder, the 1st, 2nd, 3rd sacral spine and the right 3rd, 7th rib. In view of the clinical and histopathologic findings both skin tumors were considered to originate from the liver. The skin metastases may be indicative of progression by the primary tumor and also the first indication that a malignant tumor has not been eradicated.