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Chen JP, Shen CW, Hsueh FJ, Leung HC. Skin metastasis of a p16-positive squamous cell carcinoma mimicking radiation recall dermatitis. JOURNAL OF CANCER RESEARCH AND PRACTICE 2022. [DOI: 10.4103/jcrp.jcrp_28_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Otsuka I. Cutaneous Metastasis after Surgery, Injury, Lymphadenopathy, and Peritonitis: Possible Mechanisms. Int J Mol Sci 2019; 20:E3286. [PMID: 31277406 PMCID: PMC6651228 DOI: 10.3390/ijms20133286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 12/12/2022] Open
Abstract
Cutaneous metastases from internal malignancies are uncommon. Umbilical metastasis, also known as Sister Joseph nodule (SJN), develops in patients with carcinomatous peritonitis or superficial lymphadenopathy, while non-SJN skin metastases develop after surgery, injury, and lymphadenopathy. In this review, the possible mechanisms of skin metastases are discussed. SJNs develop by the contiguous or lymphatic spread of tumor cells. After surgery and injury, tumor cells spread by direct implantation or hematogenous metastasis, and after lymphadenopathy, they spread by extranodal extension. The inflammatory response occurring during wound healing is exploited by tumor cells and facilitates tumor growth. Macrophages are crucial drivers of tumor-promoting inflammation, which is a source of survival, growth and angiogenic factors. Angiogenesis is promoted by the vascular endothelial growth factor (VEGF), which also mediates tumor-associated immunodeficiency. In the subcutaneous tissues that surround metastatic lymph nodes, adipocytes promote tumor growth. In the elderly, age-associated immunosuppression may facilitate hematogenous metastasis. Anti-VEGF therapy affects recurrence patterns but at the same time, may increase the risk of skin metastases. Immune suppression associated with inflammation may play a key role in skin metastasis development. Thus, immune therapies, including immune checkpoint inhibitors reactivating cytotoxic T-cell function and inhibiting tumor-associated macrophage function, appear promising.
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Affiliation(s)
- Isao Otsuka
- Department of Obstetrics and Gynecology, Kameda Medical Center, Kamogawa 296-8602, Japan.
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Benoulaid M, Elkacemi H, Bourhafour I, Khalil J, Elmajjaoui S, Khannoussi B, Kebdani T, Benjaafar N. Skin metastases of cervical cancer: two case reports and review of the literature. J Med Case Rep 2016; 10:265. [PMID: 27663996 PMCID: PMC5035488 DOI: 10.1186/s13256-016-1042-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/26/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Although cervix carcinoma is one of the most common malignancies in women, hematogenous metastases are relatively not common. Cutaneous metastases, in particular, are unusual even at an advanced stage of disease. Their presence is a predictor of poor prognosis. CASE PRESENTATION Case 1: A 63-year-old postmenopausal Moroccan woman was diagnosed as having cervical squamous cell carcinoma. She was treated with radical concurrent chemotherapy and radiation therapy followed by low-dose brachytherapy. Six months after finishing the therapy, multiple skin nodules appeared on her abdomen and chest wall. An excision biopsy was performed and showed metastatic squamous cell carcinoma. Her disease progressed and she died before completing her fourth course of palliative chemotherapy. Case 2: A 48-year-old Moroccan woman was diagnosed as having cervical squamous cell carcinoma; she was treated with concurrent chemoradiation. Before a planned high-dose brachytherapy, she noticed many nodular lesions on her arms, thighs, and chest wall. An excision biopsy was performed and showed metastatic squamous cell carcinoma. She then underwent a series of imaging examinations, including computed tomography of her chest, abdomen, and pelvis, and a whole body bone scan that showed disseminated disease involving her lungs and bones. She died after two courses of palliative chemotherapy, 2 months after the appearance of the skin lesions. CONCLUSION We report two cases to illustrate a rare localization of metastasis from cervical carcinoma that is highly aggressive requiring early detection and aggressive management.
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Affiliation(s)
- Meryem Benoulaid
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
| | - Hanan Elkacemi
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Imane Bourhafour
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Jihane Khalil
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Sanaa Elmajjaoui
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Basma Khannoussi
- Department of Pathology, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Tayeb Kebdani
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Noureddine Benjaafar
- Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco
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Hoyt BS, Cohen PR. Radiation port cutaneous metastases: reports of two patients whose recurrent visceral cancers presented as skin lesions at the site of previous radiation and literature review. Indian J Dermatol 2014; 59:176-81. [PMID: 24700938 PMCID: PMC3969679 DOI: 10.4103/0019-5154.127680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Radiation therapy is associated with a variety of complications, including the development of primary skin cancers in the radiated region. However, it is rare for patients with visceral cancers who are treated with radiation therapy to subsequently develop cutaneous metastasis within the radiation port. We describe two patients with internal malignancies who developed cutaneous metastases within their radiation ports following radiotherapy. In addition, we used PubMed to perform an extensive literature review and identify additional reports of cutaneous metastasis within a radiation port. We excluded patients who developed melanoma or primary skin cancers in the radiation port. We also excluded patients with non-solid organ malignancies. Herein, we summarize the characteristics of 23 additional patients who experienced radiation port cutaneous metastases and explore possible mechanisms for the occurrence of radiation port cutaneous metastases.
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Affiliation(s)
- Brian Spencer Hoyt
- Department of Dermatology, Medical School, the University of Texas Medical School at Houston, Houston, TX, USA
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5
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Jacob J, Pierga JY, Fourchotte V, Kirova YM, Bollet MA. [A case of cutaneous mammary re-irradiation]. Cancer Radiother 2012; 16:638-40. [PMID: 23092807 DOI: 10.1016/j.canrad.2012.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 07/07/2012] [Accepted: 08/09/2012] [Indexed: 11/19/2022]
Abstract
In early-stage breast cancer, radiotherapy delivered after conservative surgery leads to a reduction in the risk of local recurrences by approximately two thirds. However, some local recurrences can occur in a previously irradiated region and be relevant for a second radiotherapy, exposing to an increased risk of adverse effects. We describe here the observation of a 66-year-old woman treated for a triple negative ductal infiltrative carcinoma of the left breast, who presented an early locoregional recurrence, notably as skin nodules, developed within the irradiated volume and progressing on chemotherapy. The patient was treated by re-irradiation performed concomitantly to oral chemotherapy by capecitabine.
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Affiliation(s)
- J Jacob
- Département de radiothérapie, institut Curie, Paris, France.
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6
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Agrawal A, Yau A, Magliocco A, Chu P. Cutaneous metastatic disease in cervical cancer: a case report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:467-472. [PMID: 20500956 DOI: 10.1016/s1701-2163(16)34501-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cervical cancer metastasizes to skin in < 2% of patients. Cutaneous metastases can be confused with dermatitis. Their presence signals a poor prognosis. CASE A 66-year-old postmenopausal woman with a diagnosis of stage IVa cervical carcinoma was treated with radical concurrent chemotherapy and radiation. Two months after completing treatment, the patient noted maculopapular skin lesions in the lower abdomen. These were confirmed on biopsy as metastases from the cervical cancer. The cutaneous metastases progressed rapidly to involve the inguinal regions, vulva, and perineum. Further assessment ruled out metastases to other organs. Despite six courses of palliative combination chemotherapy, the patient's disease progressed, and she died six months after the appearance of the cutaneous metastases. CONCLUSION We reviewed the details of 47 reported cases of cutaneous metastases of cervical carcinoma. In the majority of these cases, patients presented within 10 years of initial diagnosis and died within a mean of 8.5 months from cutaneous metastasis.
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Affiliation(s)
- Anita Agrawal
- Department of Obstetrics and Gynecology and Reproductive Sciences, Royal University Hospital, Saskatoon SK
| | - Annie Yau
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB
| | - Anthony Magliocco
- Tom Baker Cancer Centre, Calgary AB; Department of Oncology, University of Calgary, Calgary AB
| | - Pamela Chu
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Calgary, Calgary AB
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7
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Cohen PR, Prieto VG. Radiation port xanthogranuloma: solitary xanthogranuloma occurring within the irradiated skin of a breast cancer patient-report and review of cutaneous neoplasms developing at the site of radiotherapy. J Cutan Pathol 2010; 37:891-4. [DOI: 10.1111/j.1600-0560.2010.01524.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pierga JY, Benyahia B, Cammilleri S, Palangié T, Beuzeboc P, Pouillart P, Magdelénat H. Overexpression of PDGF receptor β in dermal fibroblasts of lymphangitic post radiotherapy relapses of breast carcinoma. Breast 1997. [DOI: 10.1016/s0960-9776(97)90575-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yamamoto T, Ohkubo H, Nishioka K. Cutaneous metastases from carcinoma of the cervix resemble acquired lymphangioma. J Am Acad Dermatol 1994; 30:1031-2. [PMID: 8188871 DOI: 10.1016/s0190-9622(09)80151-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- T Yamamoto
- Department of Dermatology, Tokyo Metropolitan Bokuto Hospital, Japan
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Roos DE, Wigg DR. Skin infiltration within a radiotherapy portal for metastatic bladder cancer--case report and review of the clinical literature. Acta Oncol 1993; 32:689-91. [PMID: 8260189 DOI: 10.3109/02841869309092453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- D E Roos
- Department of Radiation Oncology, Royal Adelaide Hospital, South Australia
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Dhall R, Grant KA. Cervical adenocarcinoma metastasizing to the skin incision: a case report. ASIA-OCEANIA JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1991; 17:261-3. [PMID: 1953438 DOI: 10.1111/j.1447-0756.1991.tb00271.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In a patient previously operated upon for cervical adenocarcinoma, an abdominal wall swelling of identical histology developed in the surgical incision line. The skin involved was the site of external irradiation. The case is discussed and the literature reviewed.
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Affiliation(s)
- R Dhall
- Department of Obstetrics and Gynaecology, Falkirk and District Royal Infirmary, U.K
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12
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Brouty-Boyé D, Raux H, Azzarone B, Tamboise A, Tamboise E, Béranger S, Magnien V, Pihan I, Zardi L, Israël L. Fetal myofibroblast-like cells isolated from post-radiation fibrosis in human breast cancer. Int J Cancer 1991; 47:697-702. [PMID: 2004850 DOI: 10.1002/ijc.2910470512] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cells were isolated from post-radiation fibrosis biopsies of patients with recurrent breast carcinoma. These cells were identified as fibroblasts and compared with fibroblasts from normal breast tissues for their proliferative activities, chromosome number and for the presence of various components of the extracellular matrix and cytoskeleton. The proliferative activity of the fibrosis-derived fibroblasts did not significantly differ from that of normal breast fibroblasts. Both cell types required serum to grow and did not form colonies in soft agar. Cells from 2 of the 3 fibroses analyzed displayed aneuploid karyotypes with multiple structural abnormalities. All of the fibroblastic cells produced types I, III and V collagen, fibronectin and vimentin. However, in contrast to normal breast fibroblasts, fibrosis-derived cells produced high amounts of oncofetal fibronectin. In addition, fibrosis of fibroblasts also expressed the alpha-actin isoform which is specific for smooth-muscle cells. These results suggest that post-radiation fibrosis in malignant breast contains atypical fibroblasts with fetal and myofibroblastic characteristics.
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Affiliation(s)
- D Brouty-Boyé
- Institut d'Oncologie Cellulaire et Moléculaire Humaine, Bobigny, France
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Abstract
Virtually every modality employed in the treatment of cancer has demonstrated an adverse effect upon metastasis under some conditions. This review surveys the experimental and clinical literature pertaining to the untoward effects of ionizing radiation upon metastatic processes. Two processes are described: (1) enhancement of metastases following local tumor irradiation; (2) localization of metastasis in previously irradiated normal tissues. In the first process the experimental evidence indicates a local effect of irradiation upon the tumor-stroma interface. It predominates under conditions of non-curative radiation doses. There is no proof that this process occurs in clinical practice, but a review of data provides suggestive evidence for its existence following non-curative therapy. The second process is documented both experimentally and clinically. It requires the presence of viable, circulating tumor cells and appears mediated through vascular damage. The few clinical reports suggest that this effect is rare in practice. The clinical significance of both processes appears small under conditions of effective tumor therapy, but it is speculated that inadequate tumor irradiation, or irradiation of normal tissues with uncontrolled tumor elsewhere, may be deleterious.
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Affiliation(s)
- C F von Essen
- Department of Radiation Oncology, Southwood Community Hospital, Norfolk, Massachusetts
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