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Metastatic Mimics of Primary Cutaneous Lesions: Averting Diagnostic Pitfalls With Significant Repercussions. Am J Dermatopathol 2021; 42:865-871. [PMID: 32649344 DOI: 10.1097/dad.0000000000001726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cutaneous metastases by solid malignancies often signify advanced disease and portend severely limited survival. Appropriate diagnosis of these lesions is particularly hampered when they closely resemble primary cutaneous tumors. In this article, we present two diagnostically challenging cases of metastatic lesions to the scalp bearing striking histologic resemblance to primary cutaneous neoplasms. One case of a metastatic urothelial carcinoma showed epidermotropism as well as histologic and immunohistochemical features virtually indistinguishable from those of a poorly differentiated squamous cell carcinoma. Next generation sequencing was performed on both the primary urothelial carcinoma and scalp malignancy revealing an identical BRAF p. S467L somatic mutation, confirming the diagnosis. Another case of metastatic renal cell carcinoma showed clinical and histomorphologic features highly reminiscent of a pyogenic granuloma. These cases demonstrate the potential of metastatic lesions to assume a myriad array of innocuous disguises and underscore the vigilance required to avoid misdiagnosis. In addition, we highlight the emerging role of molecular strategies in resolving these problematic cases.
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Lehmann C, Rodriguez Ossa P, Vargas Manrique M, Acosta AE, Quintero Pérez Y. Eccrine Porocarcinoma with Zosteriform Metastasis. Cureus 2020; 12:e6873. [PMID: 32181102 PMCID: PMC7053679 DOI: 10.7759/cureus.6873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Eccrine porocarcinoma is a rare malignant tumor that develops in the eccrine glands, appearing as a primary tumor, or by malignant transformation of an eccrine poroma. It is a carcinoma with high metastatic and recurrent potential; it has the same incidence in both sexes, and mainly affects the elderly. Its diagnosis, rather than clinical, is histological, and due to the rarity of the disease, it is a pathological challenge. There are no standardized treatment guidelines for porocarcinoma, but surgical resection with tumor-free margins is considered the basis of treatment, in addition to sentinel node biopsy under risk factors and individualization of each patient. For the metastatic form, chemotherapy and radiotherapy are the treatment of choice. Herein, we present the case of a man with eccrine porocarcinoma with extensive zosteriform skin metastasis and lymph node involvement, treated with chemotherapy and concomitant radiotherapy.
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Affiliation(s)
- Carlos Lehmann
- Breast and Soft Tissue Surgery, National Cancer Institute, Bogotá D.C., COL
| | | | | | - Alvaro E Acosta
- Dermatology, The National University of Colombia, Bogotá D.C., COL
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3
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Zhang Y, Zhang M, Wu W, Lu J. Zosteriform Lymphangitic Metastases of Eccrine Porocarcinoma. Indian J Dermatol 2019; 64:411-413. [PMID: 31543539 PMCID: PMC6749752 DOI: 10.4103/ijd.ijd_440_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Eccrine porocarcinoma (EPC) is a rare malignant neoplasm which originates from the intraepidermal portion of eccrine sweat glands or acrosyringium. Here, we report a unique case of cutaneous metastases of EPC presenting with an erosive plaque on the left thumb and multiple nodules on left forearm. The histopathological examination of the wrist lesion revealed islands of basaloid tumor cells with eosinophilic cytoplasm, downward infiltrating growths, ductal differentiation, and intracytoplasmic lumen formations and focally connected to the epidermis. Acrosyringeal differentiation was confirmed by positive immunohistochemical staining using antibodies to carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA) in some of porocarcinoma cells. Lymphatic embolization was shown by immunostaining of podoplanin. To the best of our knowledge, this is the first reported EPC case with a primary lesion on the left thumb and zosteriform growth pattern of lymphangitic metastases on left forearm. Our case highlights the diagnostic challenges and reveals lymphangitic metastasis mode of EPC.
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Affiliation(s)
- Yunfang Zhang
- Department of Oncology, Hainan Provincial Hospital of TCM, Haikou, China
| | - Ming Zhang
- Department of Dermatology, Hainan Provincial Hospital of Skin Disease, Haikou, China
| | - Weiwei Wu
- Department of Dermatology, Hainan Provincial Hospital of Skin Disease, Haikou, China
| | - Jiejie Lu
- Department of Dermatology, Hainan Provincial Hospital of Skin Disease, Haikou, China
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4
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Cytological diagnosis of a rare case of cutaneous metastasis from transitional cell carcinoma, renal pelvis. J Egypt Natl Canc Inst 2017; 29:197-200. [DOI: 10.1016/j.jnci.2017.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/17/2017] [Indexed: 11/20/2022] Open
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High Aggressive Herpetiform Squamous Cell Carcinoma. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e522. [PMID: 26495235 PMCID: PMC4596447 DOI: 10.1097/gox.0000000000000475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 07/09/2015] [Indexed: 11/25/2022]
Abstract
We describe a highly aggressive squamous cell carcinoma that presents in a dermatome pattern shortly following shingles and review the literature on herpetiform lesions.
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6
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Seradj MH, Naderi N, Peiman S, Saffar H. Metastatic transitional cell carcinoma of the skin presenting as painful zosteriform eruptions. Oxf Med Case Reports 2015; 2015:281-3. [PMID: 26019884 PMCID: PMC4434576 DOI: 10.1093/omcr/omv036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 04/10/2015] [Accepted: 04/12/2015] [Indexed: 11/14/2022] Open
Abstract
Metastatic skin disease is an uncommon manifestation of visceral malignancies and failure to diagnose this early may result in incorrect treatment. Here, we report a 65-year-old man with bilateral painful eruptions on the abdominal skin and a past history of transitional cell carcinoma of urinary bladder.
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Affiliation(s)
- Mehran Heydari Seradj
- Department of Dermatology , Mostafa Khomeini Hospital, Shahed University , Tehran , Iran
| | - Neda Naderi
- Department of Internal Medicine , Imam Khomeini Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | - Soheil Peiman
- Department of Internal Medicine , Imam Khomeini Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | - Hana Saffar
- Department of Pathology , Cancer Institute, Tehran University of Medical Sciences , Tehran , Iran
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7
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Lees AN. Cutaneous metastasis of transitional cell carcinoma of the urinary bladder eight years after the primary: a case report. J Med Case Rep 2015; 9:102. [PMID: 25943325 PMCID: PMC4427993 DOI: 10.1186/s13256-015-0585-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 04/02/2015] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Cutaneous metastasis of bladder carcinoma is extremely rare with a limited number of published cases. An awareness of this rare clinical entity and high index of suspicion is needed for diagnosis, as it can occur months or rarely as in this case, even years, after the primary cancer. CASE PRESENTATION An 81-year-old Caucasian man presented with a one-year history of increasing left leg swelling and a two-month history of a macular-nodular rash on the anterior thigh, on a background of a high-grade (WHO Grade 2 of 3) papillary and invasive transitional cell carcinoma of the bladder in 2006. Following investigations, he was diagnosed as having probable locoregional recurrence of previously resected urothelial cancer of the bladder with extensive retrograde lymphatic permeation into the left thigh with cutaneous eruptions of malignancy. He completed a planned course of palliative radiation therapy to the left thigh lesions (30 Gy divided over 10 fractions) as well as the left pelvic node (a total dose of 18 Gy divided over six fractions). The disease ran an aggressive course and our patient died six months after the diagnosis of cutaneous metastases. CONCLUSIONS Metastatic disease should always be considered in the differential diagnosis in patients with a previous history of bladder cancer who present with cutaneous nodules, even many years after the initial diagnosis at the primary site.
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Affiliation(s)
- Andrea Nicole Lees
- Royal Hobart Hospital, 48 Liverpool Street, Hobart, Tasmania, 7000, Australia.
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Açıkgöz O, Ölçücüoğlu E, Kasap Y, Yığman M, Güneş ZE, Gazel E. Metastatic transitional cell carcinoma presenting with skin metastasis. Int J Crit Illn Inj Sci 2015; 5:53-5. [PMID: 25810966 PMCID: PMC4366830 DOI: 10.4103/2229-5151.152346] [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: 11/04/2022] Open
Abstract
Transitional cell carcinomas (TCC) of upper urinary system account for 5% of all TCCs. The incidence of such metastases ranges from 0.18% to 2%. Experimental studies reported a general unsatisfactory survival time following skin metastasis. We report in this paper a case of metastatic urinary system TCC, which had become evident with a skin lesion in the right hypogastric region. A 60-year-old female patient with a history of being operated upon due to renal pelvic TCC was admitted to our outpatient clinic with complaints of red skin lesion in the near vicinity of the operational incision scar for 3 months. Her medical history revealed nothing but nephroureterectomy operation on the upper urinary system; moreover, it was learned that she had been ignoring what was recommended to her for routine controls. Thoraco-abdominal computed tomographic (CT) examination performed on the basis of aforementioned findings depicted a mass lesion of 24*20 mm dimension with high contrast uptake detected within the subcutaneous fat tissue in the right abdominal wall. The skin lesion depicted in CT was surgically excised. The pathological examination of the excised material was reported to be compatible with TCC. The patient was referred due to abdominal lesion to medical oncology after the operation. Followed up under chemotherapy protocol, the patient died 3 months after the metastasectomy operation. Skin metastasis of upper urinary system TCCs, especially renal pelvic TCCs, are quite rare conditions. Among the likely skin sites of metastasis for genitourinary system TCCs are head, face, extremities, suprapubic region and abdomen. Taking into consideration the low survival rates, the importance of early diagnosis of recurrences and/or distant metastases should be better appreciated. These patients die soon after the skin metastasis even with the administration of aggressive therapy. Similarly, our patient died 90 days after the diagnosis of skin metastasis despite the oncologic therapy.
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Affiliation(s)
- Onur Açıkgöz
- Department of Urology, Turkey Yüksek ?htisas Training and Research Hospital, Ankara, Turkey
| | - Erkan Ölçücüoğlu
- Department of Urology, Turkey Yüksek ?htisas Training and Research Hospital, Ankara, Turkey
| | - Yusuf Kasap
- Department of Urology, Turkey Yüksek ?htisas Training and Research Hospital, Ankara, Turkey
| | - Metin Yığman
- Department of Urology, Turkey Yüksek ?htisas Training and Research Hospital, Ankara, Turkey
| | - Zeki Ender Güneş
- Department of Urology, Turkey Yüksek ?htisas Training and Research Hospital, Ankara, Turkey
| | - Eymen Gazel
- Department of Urology, Turkey Yüksek ?htisas Training and Research Hospital, Ankara, Turkey
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Solitary abdominal wall metastasis from a urothelial carcinoma of the urinary bladder. UROLOGICAL SCIENCE 2013. [DOI: 10.1016/j.urols.2013.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Fesler M, Adeimy C, Gonzalez J, Geary B, Chehval M, Richart J. Zosteriform rash: another manifestation of "the internist's tumor". Clin Genitourin Cancer 2011; 9:59-62. [PMID: 21729682 DOI: 10.1016/j.clgc.2011.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 03/10/2011] [Accepted: 03/29/2011] [Indexed: 10/17/2022]
Affiliation(s)
- Mark Fesler
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, MO, USA.
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12
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Swick BL, Gordon JRS. Superficially invasive transitional cell carcinoma of the bladder associated with distant cutaneous metastases. J Cutan Pathol 2009; 37:1245-50. [PMID: 19919656 DOI: 10.1111/j.1600-0560.2009.01471.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cutaneous metastases from transitional cell carcinoma of the bladder are rare and most often associated with a deeply invasive primary tumor. This case report describes a 69-year-old male with previously resected superficially invasive primary transitional cell carcinoma of the bladder who presented with distant cutaneous and central nervous system metastases associated with recurrent bladder cancer. In addition, this case highlights the differential diagnosis of metastatic carcinomas that display a CK7/CK20 positive immunophenotype including transitional cell carcinoma, pancreatic carcinoma, cholangiocarcinoma and rare gastric carcinomas.
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Affiliation(s)
- Brian L Swick
- Department of Dermatology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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14
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Ho WT, Lee LM, Chen CL, Tseng JTP, Tsai TH. An interesting and unique pattern of two distinct coexisting cutaneous metastases of a transitional cell carcinoma. Clin Exp Dermatol 2009; 34:e336-8. [PMID: 19486055 DOI: 10.1111/j.1365-2230.2009.03284.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Bassioukas K, Nakuci M, Dimou S, Kanellopoulou M, Alexis I. Zosteriform cutaneous metastases from breast adenocarcinoma. J Eur Acad Dermatol Venereol 2006; 19:593-6. [PMID: 16164715 DOI: 10.1111/j.1468-3083.2005.01205.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cutaneous metastases from breast adenocarcinoma are usually nodular, single or multiple. Their zosteriform distribution is very rare. We present a 54-year-old woman with cutaneous zosteriform nodular metastases on the right side of her thorax, and infiltration of the corresponding arm, 3 months after the excision of adenocarcinoma of her right breast.
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Abstract
Cutaneous metastases may present in a variety of histologic guises simulating more common primary tumors. We present the clinicopathologic features of a case masquerading as basal cell carcinoma. Epidermotropism, vascular invasion, and the absence of stromal retraction around tumor nests prompted further investigation. Clinical history and directed immunohistochemical staining ultimately revealed the diagnosis of cutaneous metastasis of transitional cell bladder carcinoma (TCC).
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Affiliation(s)
- Andrew H Kalajian
- Department of Internal Medicine, University of South Florida, Tampa, FL 33612, USA
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17
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Ku JH, Yeo WG, Park MY, Lee ES, Kim HH. Metastasis of transitional cell carcinoma to the lower abdominal wall 20 years after cystectomy. Yonsei Med J 2005; 46:181-3. [PMID: 15744826 PMCID: PMC2823049 DOI: 10.3349/ymj.2005.46.1.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Iatrogenic implantation has been the main cause in the majority of cases of transitional call carcinoma (TCC) with metastasis to the abdominal wall. A 66-year-old woman had undergone radical cystectomy 20 years prior to presenting. Radiological investigations revealed one mass in the left lower abdominal wall and one mass in the right inguinal area. She underwent wide excision of the lesions that revealed metastasis of TCC. This report describes this case of a woman with bladder carcinoma who developed a metastasis in the anterior abdominal wall following an apparent disease-free interval of 20 years.
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Affiliation(s)
- Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Woon Geol Yeo
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Min Young Park
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Sik Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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18
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Affiliation(s)
- Benjamin W LeSueur
- Mayo Clinic Scottsdale, Department of Dermatology, Scottsdale, AZ 85259, USA.
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19
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Kato N, Aoyagi S, Sugawara H, Mayuzumi M. Zosteriform and epidermotropic metastatic primary cutaneous squamous cell carcinoma. Am J Dermatopathol 2001; 23:216-20. [PMID: 11391102 DOI: 10.1097/00000372-200106000-00009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The first case of primary cutaneous squamous cell carcinoma (SCC) to cause zosteriform and epidermotropic metastasis to skin is reported. The patient is a 72-year-old Japanese woman. A cutaneous SCC appeared on the lateral side of her right knee and was removed. After dissection of the right inguinal lymph nodes, which revealed metastases, and irradiation of the right inguinal region, the patient presented with slightly pruritic and painful erythematous papules on the right hip and small brownish papules and vesicles with crusts on the anterior side of the right thigh. The eruptions were in a zosteriform distribution along the right L1 to L3 dermatomes. Histologically neoplastic squamous cell nests were observed in the epidermis, below the epidermal-dermal junction, and within lymphatic vessels in the deeper reticular dermis. We postulate that neoplastic cells with the ability to fuse with adjacent squamous epithelium may have been carried beneath the basal lamina or to the epidermis via dermal lymphatic backflow, resulting in epidermotropic metastasis.
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Affiliation(s)
- N Kato
- Department of Dermatology and Clinical Research Institute, National Sapporo Hospital, Kikusui 4-2, Shiroishi-ku, 003-0804 Sapporo, Japan.
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20
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Affiliation(s)
- T. IIYAMA
- From the Department of Urology, Kochi Prefectual Aki Hospital, Aki-shi, Kochi-ken, Japan
| | - H. WATANABE
- From the Department of Urology, Kochi Prefectual Aki Hospital, Aki-shi, Kochi-ken, Japan
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SCROTAL METASTASIS FROM URETERAL CANCER. J Urol 2001. [DOI: 10.1097/00005392-200105000-00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Zirwas MJ, Hunt S, Logan TF, Abernethy JL, Seraly MP. A painful cutaneous nodule as the presentation of metastatic transitional cell carcinoma of the renal pelvis. J Am Acad Dermatol 2000; 42:867-8. [PMID: 10767689 DOI: 10.1016/s0190-9622(00)90256-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a 43-year-old man with HIV who presented with a painful, vascular-appearing nodule as the initial manifestation of metastasis of a prior transitional cell carcinoma of the renal pelvis. The transitional cell carcinoma had been treated by nephroureterectomy 4 years before the appearance of the nodule. Histopathologic comparison of the nodule with the prior transitional cell carcinoma and immunoperoxidase staining with monoclonal antibodies confirmed that the nodule was a metastasis of the original transitional cell carcinoma. In general, metastasis of transitional cell carcinoma to the skin is quite uncommon. This case is the first reported episode of transitional cell carcinoma of the renal pelvis metastasizing to the skin in the form of a vascular-appearing nodule. The significance of this unusual metastasis occurring in a person with HIV is unknown.
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Affiliation(s)
- M J Zirwas
- University of Pittsburgh School of Medicine, the Departments of Internal Medicine and Dermatology, Pittsburgh, PA, USA
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23
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Abstract
An 87-year-old woman developed erythema, induration and tenderness of the skin overlying each breast. One year before, she had undergone an axillary lymph node dissection because of metastases from melanoma. The primary site was unknown. A skin biopsy showed pigmented tumor nests within the dermal lymphatic vessels, and immunohistochemistry confirmed the melanocytic origin. The diagnosis of inflammatory metastatic melanoma was made.
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Affiliation(s)
- A Flórez
- Department of Dermatology, Complejo Hospitalario Universitario, Faculty of Medicine, Santiago de Compostela, Spain.
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Abstract
Malignant melanoma presenting as an inflammatory skin metastasis has been described but is an exceedingly rare phenomenon. We report an unusual case of a patient who developed right leg lesions that were initially thought to be infectious in origin. There was no resolution of these lesions with antibiotic therapy, and the patient subsequently underwent an incisional biopsy that showed atypical S-100 positive cells within dermal vessels. On further questioning, the patient revealed that 20 years earlier she had a pigmented lesion removed from her right posterior calf. Review of that material revealed malignant melanoma, approximately 3.2 mm in depth. Although the patient was subsequently treated with a right groin lymph node dissection and isolated limb perfusion chemotherapy, she has continued to develop locally recurrent disease. This case is unusual both in terms of clinical presentation and interval of disease progression.
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Affiliation(s)
- J Cotton
- Department of Pathology, Indiana University School of Medicine, Indianapolis, USA
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25
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Abstract
The relative frequencies of cutaneous metastases are similar to those of the primary cancers; breast, colon, and melanoma are the most frequent in women and lung, colon, and melanoma are the most common in men. Cutaneous metastases represent an opportunity to detect a potentially treatable cancer before other evidence of it is present, to modify therapy as appropriate to the tumor stage, or possibly to use the cutaneous lesion as a source of easily accessible tumor cells for specific therapy. Cutaneous metastatic disease as the first sign of internal cancer is most commonly seen with cancer of the lung, kidney, and ovary.
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Affiliation(s)
- R A Schwartz
- New Jersey Medical School, Newark 07103-2714, USA
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