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Subcutaneous Metastatic Adenocarcinoma: An Unusual Presentation of Colon Cancer - Case Report and Literature Review.

Llaguna OH, Desai P, Fender AB, Zedek DC, Meyers MO, O'Neil BH, Diaz LA, Calvo BF - Case Rep Oncol (2010)

Bottom Line: Subcutaneous metastasis from a visceral malignancy is rare with an incidence of 5.3%.Skin involvement as the presenting sign of a silent internal malignancy is an even rarer event occurring in approximately 0.8%.We report a case of a patient who presented to her dermatologist complaining of rapidly developing subcutaneous nodules which subsequently proved to be metastatic colon cancer, and we provide a review of the literature.

View Article: PubMed Central - PubMed

Affiliation: Division of Surgical Oncology and Endocrine Surgery, University of North Carolina School of Medicine, Chapel Hill, N.C., USA.

ABSTRACT
Subcutaneous metastasis from a visceral malignancy is rare with an incidence of 5.3%. Skin involvement as the presenting sign of a silent internal malignancy is an even rarer event occurring in approximately 0.8%. We report a case of a patient who presented to her dermatologist complaining of rapidly developing subcutaneous nodules which subsequently proved to be metastatic colon cancer, and we provide a review of the literature.

No MeSH data available.


Related in: MedlinePlus

a Biopsy showed subcutaneous nodule of metastatic adenocarcinoma (hematoxylin-eosin, original magnification ×20). b The proliferation consisted of glands with atypical epithelial cells, mitoses, and central luminal ‘dirty necrosis’ which is suggestive of a colon primary (hematoxylin-eosin, original magnification ×400). c CK-20 immunostain highlights the cells further supporting a colon primary (hematoxylin-eosin, original magnification ×100).
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Figure 2: a Biopsy showed subcutaneous nodule of metastatic adenocarcinoma (hematoxylin-eosin, original magnification ×20). b The proliferation consisted of glands with atypical epithelial cells, mitoses, and central luminal ‘dirty necrosis’ which is suggestive of a colon primary (hematoxylin-eosin, original magnification ×400). c CK-20 immunostain highlights the cells further supporting a colon primary (hematoxylin-eosin, original magnification ×100).

Mentions: A previously healthy 44-year-old Caucasian female was referred to dermatology with a 5-week history of rapidly growing subcutaneous nodules on her back, chest, breasts, abdomen, axillae and thighs (fig. 1). Except for fatigue, the review of systems was unremarkable. Numerous 0.5-3-cm, well-defined, mobile, firm and slightly tender subcutaneous nodules without overlying epidermal changes were noted on physical examination. Results of a punch biopsy revealed a poorly differentiated adenocarcinoma that was cytokeratin (CK)-7 negative, CK-20 positive, TTF-1 negative, and Cam 5.2 positive, suggestive of metastasis from the lower gastrointestinal tract (fig. 2). A CT scan was obtained which showed circumferential thickening of the cervix, innumerable subcutaneous masses, sigmoid colonic wall thickening, and extensive retroperitoneal and intra-abdominal adenopathy, with suspicion of metastatic disease (fig. 3). Significantly, there was no notable liver involvement. Pelvic examination was unremarkable, but colonoscopy revealed a 4-cm, fungating, non-obstructing sigmoid mass. Given the extent of the disease and the lack of obstructive symptoms a tunneled catheter was placed and the patient began systemic therapy with FOLFOX plus bevacizumab. Approximately 3 weeks after initiation of systemic therapy the patient presented with bowel perforation and underwent abdominal exploration, sigmoid resection and end-colostomy. At laparotomy a perforated colonic mass was noted with peritoneal disease along the root of the small bowel mesentery without evidence of hepatic metastasis. Final pathology returned a poorly differentiated T4, N2, M1 adenocarcinoma with signet ring cell and focal mucinous features, and lymphovascular and perineural invasion. Subsequent testing revealed the tumor to be wild-type for KRAS and microsatellite stable.


Subcutaneous Metastatic Adenocarcinoma: An Unusual Presentation of Colon Cancer - Case Report and Literature Review.

Llaguna OH, Desai P, Fender AB, Zedek DC, Meyers MO, O'Neil BH, Diaz LA, Calvo BF - Case Rep Oncol (2010)

a Biopsy showed subcutaneous nodule of metastatic adenocarcinoma (hematoxylin-eosin, original magnification ×20). b The proliferation consisted of glands with atypical epithelial cells, mitoses, and central luminal ‘dirty necrosis’ which is suggestive of a colon primary (hematoxylin-eosin, original magnification ×400). c CK-20 immunostain highlights the cells further supporting a colon primary (hematoxylin-eosin, original magnification ×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2992426&req=5

Figure 2: a Biopsy showed subcutaneous nodule of metastatic adenocarcinoma (hematoxylin-eosin, original magnification ×20). b The proliferation consisted of glands with atypical epithelial cells, mitoses, and central luminal ‘dirty necrosis’ which is suggestive of a colon primary (hematoxylin-eosin, original magnification ×400). c CK-20 immunostain highlights the cells further supporting a colon primary (hematoxylin-eosin, original magnification ×100).
Mentions: A previously healthy 44-year-old Caucasian female was referred to dermatology with a 5-week history of rapidly growing subcutaneous nodules on her back, chest, breasts, abdomen, axillae and thighs (fig. 1). Except for fatigue, the review of systems was unremarkable. Numerous 0.5-3-cm, well-defined, mobile, firm and slightly tender subcutaneous nodules without overlying epidermal changes were noted on physical examination. Results of a punch biopsy revealed a poorly differentiated adenocarcinoma that was cytokeratin (CK)-7 negative, CK-20 positive, TTF-1 negative, and Cam 5.2 positive, suggestive of metastasis from the lower gastrointestinal tract (fig. 2). A CT scan was obtained which showed circumferential thickening of the cervix, innumerable subcutaneous masses, sigmoid colonic wall thickening, and extensive retroperitoneal and intra-abdominal adenopathy, with suspicion of metastatic disease (fig. 3). Significantly, there was no notable liver involvement. Pelvic examination was unremarkable, but colonoscopy revealed a 4-cm, fungating, non-obstructing sigmoid mass. Given the extent of the disease and the lack of obstructive symptoms a tunneled catheter was placed and the patient began systemic therapy with FOLFOX plus bevacizumab. Approximately 3 weeks after initiation of systemic therapy the patient presented with bowel perforation and underwent abdominal exploration, sigmoid resection and end-colostomy. At laparotomy a perforated colonic mass was noted with peritoneal disease along the root of the small bowel mesentery without evidence of hepatic metastasis. Final pathology returned a poorly differentiated T4, N2, M1 adenocarcinoma with signet ring cell and focal mucinous features, and lymphovascular and perineural invasion. Subsequent testing revealed the tumor to be wild-type for KRAS and microsatellite stable.

Bottom Line: Subcutaneous metastasis from a visceral malignancy is rare with an incidence of 5.3%.Skin involvement as the presenting sign of a silent internal malignancy is an even rarer event occurring in approximately 0.8%.We report a case of a patient who presented to her dermatologist complaining of rapidly developing subcutaneous nodules which subsequently proved to be metastatic colon cancer, and we provide a review of the literature.

View Article: PubMed Central - PubMed

Affiliation: Division of Surgical Oncology and Endocrine Surgery, University of North Carolina School of Medicine, Chapel Hill, N.C., USA.

ABSTRACT
Subcutaneous metastasis from a visceral malignancy is rare with an incidence of 5.3%. Skin involvement as the presenting sign of a silent internal malignancy is an even rarer event occurring in approximately 0.8%. We report a case of a patient who presented to her dermatologist complaining of rapidly developing subcutaneous nodules which subsequently proved to be metastatic colon cancer, and we provide a review of the literature.

No MeSH data available.


Related in: MedlinePlus