Limits...
Cutaneous metastasis from pancreatic cancer: A case report and systematic review of the literature.

Zhou HY, Wang XB, Gao F, Bu B, Zhang S, Wang Z - Oncol Lett (2014)

Bottom Line: Treatment strategies including surgery, radiation, chemotherapy or a combination improved survival time from 3.0 to 8.3 months.Metastasis to the skin indicates a widespread, general dissemination and a poor prognosis.A combination of surgery, radiotherapy and chemotherapy appears to result in improved survival rates.

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China.

ABSTRACT
Cutaneous metastasis from pancreatic cancer is uncommon, therefore, the outcome of this progression has rarely been investigated. The aim of the present report was to evaluate the clinical characteristics of patients exhibiting cutaneous metastasis from pancreatic cancer. Thus, the current report presents a rare case of cutaneous metastatic disease from pancreatic cancer and describes a systematic review of the literature. A total of 54 articles comprising 63 cases were included for analysis. The relevant clinical and pathological characteristics, as well as the treatment strategies and survival outcomes of this rare disease presentation were reviewed. The average patient was was aged 63.9 years and males constituted a marginally greater proportion of the cohort (61.9%). The predominant manifestation of the cutaneous metastasis was a nodule or mass (73%) and the most common site of the skin lesion was non-umbilicus rather than umbilicus. The majority (66.7%) of the skin lesions were singular, particularly in patients exhibiting Sister Mary Joseph's nodule (90%). A wide range of histological subtypes presented, with a predominance of adenocarcinoma (84.1%). Of the cases that specified the tumor differentiation grade, 78.2% were moderately or poorly differentiated. Immunohistochemistry revealed that cytokeratin (CK)20-negative, and CK7-, CK19- and carbohydrate antigen (CA)19-9-positive were specific diagnostic markers for pancreatic cancer. Distal metastases, excluding the skin, were observed in 68.3% of patients and the median survival period was 5 months. Treatment strategies including surgery, radiation, chemotherapy or a combination improved survival time from 3.0 to 8.3 months. Cutaneous metastasis from pancreatic cancer is a rare finding, often providing the only external indication of an internal malignancy and, therefore, should be considered in the differential diagnosis of skin lesions. Metastasis to the skin indicates a widespread, general dissemination and a poor prognosis. A combination of surgery, radiotherapy and chemotherapy appears to result in improved survival rates.

No MeSH data available.


Related in: MedlinePlus

Cutaneous metastatic lesion at the right anterior axillary fold. The nodule is round, indurated and violaceous, measuring 1.5×1.5 cm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4214468&req=5

f1-ol-08-06-2654: Cutaneous metastatic lesion at the right anterior axillary fold. The nodule is round, indurated and violaceous, measuring 1.5×1.5 cm.

Mentions: In May 2012, a 76-year-old female was referred to the Department of Oncology (Shandong Cancer Hospital and Institute, Jinan, China) with the complaint of nausea and a lack of appetite for 10 days prior to referral. The patient had experienced gallstones for several years. Upon physical examination, asymptomatic violaceous nodules were observed on the right anterior axillary fold, occipital scalp, chest and abdomen (Fig. 1). Completion of the physical examination identified no further abnormalities. Routine laboratory testing revealed that renal and hepatic markers were within the normal ranges, including white blood cell (9.2×109/l; normal range, 3.5–9.5×109/l), platelet (301×109/l; normal range, 125–350×109/l) count, serum alanine aminotransferase (10 U/l; normal range, 7–40 U/l), blood urea nitrogen (3.98 mmol/l; normal range, 2.9–8.2 nmol/l), creatinine (45 μmol/l; normal range, 45–84 μmol/l) and glucose levels (5.85 mmol/l; normal range, 5.85 mmol/l). The hemoglobin (111 g/l; normal range, 115–150 g/l) levels were slightly below the normal range, potentially due to the increased age of the patient and low food uptake, the albumin (35.1 g/l; normal range, 40–55 g/l) level may be lower than the normal range due to a decrease in food uptake and decreased synthesized liver function due to metastasis, potassium levels (3.4 mmol/l; normal range, 3.5–5.3 mmol/l) were lower than the normal range potentially due to decreased food uptake and increased fibrinogen levels (4.48 g/l; normal range, 2–4 g/l) may correlate with the end-stage of the disease (6). Serum carbohydrate antigen (CA)19-9 (2.1 U/l; normal range, 0–39 U/l), cancer antigen 72-4 (5.06 U/l; normal range, 0–6.9 U/l) and α-fetoprotein (2.52 ng/ml; normal range, 0–7 ng/ml) were also within normal limits, however, carcinoembryonic antigen (CEA) was elevated to 27.54 ng/ml (reference range, 0–3.4 ng/ml). A computed tomography (CT) scan of the abdomen, chest, pelvis and brain was performed, which revealed an enlarged pancreatic tail containing a low-density soft tissue mass measuring ~7 cm in diameter. Post-peritoneum lymph node enlargement, lesions on the lungs, hepatic focal lesions (maximum size, ~8×10 cm) and multiple subcutaneous nodules were also identified on the right upper chest, occipital scalp, upper arm and abdomen (Fig. 2). Examination and thorough investigation did not detect metastases elsewhere (for example in the ovaries or brain). Abdominal ultrasound and CT findings were consistent with signs for cancer of the tail of the pancreas with multiple metastatic lesions. The nodule of skin at the right anterior axillary fold was removed for biopsy and pathological examination of the excised lesion identified a poorly differentiated metastatic adenocarcinoma involving the dermis and subcutaneous tissue. Immunohistochemical staining (Fig. 3) revealed that the tumor was weakly and focally positive for CEA (Fig. 3B) and strongly positive for cytokeratin (CK) 7 (Fig. 3C) and CK19 (Fig. 3D). Staining was negative for estrogen and progesterone receptors, thyroid transcription factor-1, and CK20 (not shown). Thus, the patient was diagnosed with stage IV disease, according to the American Joint Committee on Cancer TNM staging system for pancreatic cancer (7) and was subsequently treated with one cycle of gemcitabine. Prior to administration of the second cycle of gemcitabine (1.2 g, days 1 and 8, every three weeks), the lesion at the occipital scalp enlarged due to a superficial ulceration. As a result of disease progression, the patient was administered with oxaliplatin (100 mg, day 1, every two weeks) combined with S-1 capsules; however, the patient rapidly deteriorated and succumbed following two months of treatment. An autopsy was not permitted for this patient.


Cutaneous metastasis from pancreatic cancer: A case report and systematic review of the literature.

Zhou HY, Wang XB, Gao F, Bu B, Zhang S, Wang Z - Oncol Lett (2014)

Cutaneous metastatic lesion at the right anterior axillary fold. The nodule is round, indurated and violaceous, measuring 1.5×1.5 cm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214468&req=5

f1-ol-08-06-2654: Cutaneous metastatic lesion at the right anterior axillary fold. The nodule is round, indurated and violaceous, measuring 1.5×1.5 cm.
Mentions: In May 2012, a 76-year-old female was referred to the Department of Oncology (Shandong Cancer Hospital and Institute, Jinan, China) with the complaint of nausea and a lack of appetite for 10 days prior to referral. The patient had experienced gallstones for several years. Upon physical examination, asymptomatic violaceous nodules were observed on the right anterior axillary fold, occipital scalp, chest and abdomen (Fig. 1). Completion of the physical examination identified no further abnormalities. Routine laboratory testing revealed that renal and hepatic markers were within the normal ranges, including white blood cell (9.2×109/l; normal range, 3.5–9.5×109/l), platelet (301×109/l; normal range, 125–350×109/l) count, serum alanine aminotransferase (10 U/l; normal range, 7–40 U/l), blood urea nitrogen (3.98 mmol/l; normal range, 2.9–8.2 nmol/l), creatinine (45 μmol/l; normal range, 45–84 μmol/l) and glucose levels (5.85 mmol/l; normal range, 5.85 mmol/l). The hemoglobin (111 g/l; normal range, 115–150 g/l) levels were slightly below the normal range, potentially due to the increased age of the patient and low food uptake, the albumin (35.1 g/l; normal range, 40–55 g/l) level may be lower than the normal range due to a decrease in food uptake and decreased synthesized liver function due to metastasis, potassium levels (3.4 mmol/l; normal range, 3.5–5.3 mmol/l) were lower than the normal range potentially due to decreased food uptake and increased fibrinogen levels (4.48 g/l; normal range, 2–4 g/l) may correlate with the end-stage of the disease (6). Serum carbohydrate antigen (CA)19-9 (2.1 U/l; normal range, 0–39 U/l), cancer antigen 72-4 (5.06 U/l; normal range, 0–6.9 U/l) and α-fetoprotein (2.52 ng/ml; normal range, 0–7 ng/ml) were also within normal limits, however, carcinoembryonic antigen (CEA) was elevated to 27.54 ng/ml (reference range, 0–3.4 ng/ml). A computed tomography (CT) scan of the abdomen, chest, pelvis and brain was performed, which revealed an enlarged pancreatic tail containing a low-density soft tissue mass measuring ~7 cm in diameter. Post-peritoneum lymph node enlargement, lesions on the lungs, hepatic focal lesions (maximum size, ~8×10 cm) and multiple subcutaneous nodules were also identified on the right upper chest, occipital scalp, upper arm and abdomen (Fig. 2). Examination and thorough investigation did not detect metastases elsewhere (for example in the ovaries or brain). Abdominal ultrasound and CT findings were consistent with signs for cancer of the tail of the pancreas with multiple metastatic lesions. The nodule of skin at the right anterior axillary fold was removed for biopsy and pathological examination of the excised lesion identified a poorly differentiated metastatic adenocarcinoma involving the dermis and subcutaneous tissue. Immunohistochemical staining (Fig. 3) revealed that the tumor was weakly and focally positive for CEA (Fig. 3B) and strongly positive for cytokeratin (CK) 7 (Fig. 3C) and CK19 (Fig. 3D). Staining was negative for estrogen and progesterone receptors, thyroid transcription factor-1, and CK20 (not shown). Thus, the patient was diagnosed with stage IV disease, according to the American Joint Committee on Cancer TNM staging system for pancreatic cancer (7) and was subsequently treated with one cycle of gemcitabine. Prior to administration of the second cycle of gemcitabine (1.2 g, days 1 and 8, every three weeks), the lesion at the occipital scalp enlarged due to a superficial ulceration. As a result of disease progression, the patient was administered with oxaliplatin (100 mg, day 1, every two weeks) combined with S-1 capsules; however, the patient rapidly deteriorated and succumbed following two months of treatment. An autopsy was not permitted for this patient.

Bottom Line: Treatment strategies including surgery, radiation, chemotherapy or a combination improved survival time from 3.0 to 8.3 months.Metastasis to the skin indicates a widespread, general dissemination and a poor prognosis.A combination of surgery, radiotherapy and chemotherapy appears to result in improved survival rates.

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China.

ABSTRACT
Cutaneous metastasis from pancreatic cancer is uncommon, therefore, the outcome of this progression has rarely been investigated. The aim of the present report was to evaluate the clinical characteristics of patients exhibiting cutaneous metastasis from pancreatic cancer. Thus, the current report presents a rare case of cutaneous metastatic disease from pancreatic cancer and describes a systematic review of the literature. A total of 54 articles comprising 63 cases were included for analysis. The relevant clinical and pathological characteristics, as well as the treatment strategies and survival outcomes of this rare disease presentation were reviewed. The average patient was was aged 63.9 years and males constituted a marginally greater proportion of the cohort (61.9%). The predominant manifestation of the cutaneous metastasis was a nodule or mass (73%) and the most common site of the skin lesion was non-umbilicus rather than umbilicus. The majority (66.7%) of the skin lesions were singular, particularly in patients exhibiting Sister Mary Joseph's nodule (90%). A wide range of histological subtypes presented, with a predominance of adenocarcinoma (84.1%). Of the cases that specified the tumor differentiation grade, 78.2% were moderately or poorly differentiated. Immunohistochemistry revealed that cytokeratin (CK)20-negative, and CK7-, CK19- and carbohydrate antigen (CA)19-9-positive were specific diagnostic markers for pancreatic cancer. Distal metastases, excluding the skin, were observed in 68.3% of patients and the median survival period was 5 months. Treatment strategies including surgery, radiation, chemotherapy or a combination improved survival time from 3.0 to 8.3 months. Cutaneous metastasis from pancreatic cancer is a rare finding, often providing the only external indication of an internal malignancy and, therefore, should be considered in the differential diagnosis of skin lesions. Metastasis to the skin indicates a widespread, general dissemination and a poor prognosis. A combination of surgery, radiotherapy and chemotherapy appears to result in improved survival rates.

No MeSH data available.


Related in: MedlinePlus