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Painful erythematous swelling on the left thumb and distal phalanx of the right middle finger.
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Figure 2: Painful erythematous swelling on the left thumb and distal phalanx of the right middle finger.

Mentions: Twenty-seven months after surgery, he revisited our hospital because of painful erythematous swelling of the left thumb and the distal phalanx of the right middle finger (Figure 2). Physical examination showed that the patient had a firm, hard, painful swelling that measured 3 cm in diameter on the affected fingers. Skin biopsy from the right middle finger revealed a well-differentiated adenocarcinoma (Figure 3B). In order to confirm that this lesion originated from the primary ampullary carcinoma. and to exclude that this lesion was from other primary sites, immunohistochemical staining was performed with cytokeratin 7 (CK 7), cytokeratin 20 (CK 20), mucin 1 (MUC 1), mucin 2 (MUC 2), thyroid transcription factor-1 (TTF-1), prostate specific antigen (PSA) against the ampullary tumor and skin biopsy specimen. Both tissues were not stained with the TTF-1, PSA, MUC 2, CK 20; however, they stained positive with MUC 1 and CK 7 (Figure 3C-F). The negative result for TTF-1 and PSA supported exclusion of other primary sites (eg lung, prostate). Therefore, our findings confirmed acral metastases from the ampullary carcinoma primary.

Acral Metastasis in a Patient with Ampullary Carcinoma

Cho EY, Kim TH, Park SD, Yun KJ, Choi SC, Kim HC, Nah YH - Korean J. Intern. Med. (2007)

Bottom Line: Physical examination revealed ill-defined, painful and hard erythematous nodules at the left thumb and distal phalanx of the right middle finger.The computed tomography scan showed low density masses in the retroperitoneum; the histological examination of a nodule from the right middle finger showed a metastatic adenocarcinoma.This case illustrates that cutaneous metastasis from ampullary carcinoma has a poor prognosis.

Affiliation: Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.

ABSTRACT
Although skin metastasis from a malignant tumor of an internal organ usually occurs at an advanced disease stage, there has been no prior report of a cutaneous acral metastasis from ampullary carcinoma to date. We report a 71-year old male patient with cutaneous metastasis from an ampullary adenocarcinoma. The patient had a history of pylorus preserving pancreaticoduodenectomy for carcinoma of the ampulla of Vater two years prior to presentation. Physical examination revealed ill-defined, painful and hard erythematous nodules at the left thumb and distal phalanx of the right middle finger. The computed tomography scan showed low density masses in the retroperitoneum; the histological examination of a nodule from the right middle finger showed a metastatic adenocarcinoma. This case illustrates that cutaneous metastasis from ampullary carcinoma has a poor prognosis.

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