ABSTRACT
Taxanes are antineoplastic drugs that can cause dermatotoxicity which can mimic an intraepidermal carcinoma. A 65-year-old woman presented with a cutaneous eruption suggestive of a paraneoplastic syndrome. Imaging studies showed multiple peritoneal nodules and associated ascites. A sample taken from the greater omentum revealed an adenocarcinoma. Clinical data and family history pointed to a gynecological origin of the tumor and the patient was treated with carboplatin and paclitaxel. A new cutaneous biopsy showed that the epidermis was acanthotic with atypical keratinocytes, abundant mitoses, and apoptotic figures, arising concerns of malignancy. According to the Plummer and Shea criteria, the lesion was ultimately interpreted as reactive cutaneous hyperplasia and expression of the taxane effect. We report, for the first time, paclitaxel-induced histologic changes on a previous cutaneous eruption. Pathologists should be aware of the profound cytopathic effects of taxane therapy in order to interpret skin biopsies of patients undergoing this treatment
Los taxanos son fármacos antineoplásicos que pueden causar dermatotoxicidad simulando un carcinoma intraepidérmico. Una mujer de 65 años se presentó con una erupción cutánea sugestiva de síndrome paraneoplásico. Los estudios de imagen mostraron múltiples nódulos peritoneales y ascitis asociada. Una muestra tomada del epiplón mayor reveló un adenocarcinoma. Teniendo en cuenta los datos clínicos y la historia familiar se asumió un origen ginecológico del tumor, y la paciente fue tratada con carboplatino y paclitaxel. Una nueva biopsia cutánea mostró que la epidermis era acantótica con queratinocitos atípicos, abundantes mitosis y figuras apoptóticas. Estos hallazgos levantaron la sospecha de malignidad. De acuerdo con los criterios de Plummer y Shea la lesión fue finalmente interpretada como hiperplasia reactiva epidérmica y expresión del efecto taxano. Presentamos por primera vez los cambios inducidos por paclitaxel sobre una erupción cutánea previa. Los patólogos deberían estar al tanto de los profundos efectos citopáticos de la terapia con taxanos con el fin de interpretar adecuadamente las biopsias cutáneas de los pacientes bajo este tratamiento
Subject(s)
Humans , Female , Middle Aged , Paclitaxel/adverse effects , Exanthema/pathology , Skin Neoplasms/chemically induced , Carcinoma in Situ/pathology , Diagnosis, Differential , Paraneoplastic Syndromes/pathology , Taxoids/adverse effects , Mitosis , Pagetoid Reticulosis/pathologyABSTRACT
Taxanes are antineoplastic drugs that can cause dermatotoxicity which can mimic an intraepidermal carcinoma. A 65-year-old woman presented with a cutaneous eruption suggestive of a paraneoplastic syndrome. Imaging studies showed multiple peritoneal nodules and associated ascites. A sample taken from the greater omentum revealed an adenocarcinoma. Clinical data and family history pointed to a gynecological origin of the tumor and the patient was treated with carboplatin and paclitaxel. A new cutaneous biopsy showed that the epidermis was acanthotic with atypical keratinocytes, abundant mitoses, and apoptotic figures, arising concerns of malignancy. According to the Plummer and Shea criteria, the lesion was ultimately interpreted as reactive cutaneous hyperplasia and expression of the taxane effect. We report, for the first time, paclitaxel-induced histologic changes on a previous cutaneous eruption. Pathologists should be aware of the profound cytopathic effects of taxane therapy in order to interpret skin biopsies of patients undergoing this treatment.
