Recurrent Metastatic Eccrine Porocarcinoma: A Case Report and Review of the Literature - PubMed (original) (raw)

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Recurrent Metastatic Eccrine Porocarcinoma: A Case Report and Review of the Literature

Misbahuddin Khaja et al. Am J Case Rep. 2019.

Abstract

BACKGROUND Eccrine porocarcinoma, or malignant eccrine poroma, is a rare primary skin tumor that develops in the sixth and seventh decades of life, and can present as a painless and solitary nodule. Histopathology is required to confirm the diagnosis. A rare case is presented of metastatic eccrine porocarcinoma, occurring four years after surgical excision of the primary scalp tumor, and includes a review of the literature. CASE REPORT A 67-year-old man initially presented with a scalp lesion that was non-painful, exophytic, and pigmented. Following complete excision, histopathology confirmed the diagnosis of eccrine porocarcinoma with clear resection margins. Four years later, he presented with discrete erythematous patches and plaques, in a zosteriform distribution, in the skin of the right neck, shoulder, and chest. A biopsy and histopathology of the skin rash confirmed metastatic eccrine porocarcinoma. A positron-emission tomography-computed tomography (PET-CT) scan identified areas of hypermetabolic activity, with a standardized uptake value (SUV) of 12, and an infiltrating soft tissue tumor in the right suboccipital region. Surgical resection of the suboccipital mass, followed by histopathology, confirmed metastatic eccrine porocarcinoma. During a postoperative ear, nose, and throat (ENT) examination, he was found to have metastases in the right ear canal. The patient received five cycles of chemotherapy, but later developed renal failure and eventually chose palliative care. CONCLUSIONS A rash-like presentation of skin metastasis to the trunk and metastasis to the ear from a primary eccrine porocarcinoma is rare. Early diagnosis and adequate surgical resection are recommended to reduce patient mortality.

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Figures

Figure 1.

Figure 1.

The macroscopic appearance of an exophytic, pigmented, immobile, irregular lesion on the scalp in a case of eccrine porocarcinoma.

Figure 2.

Figure 2.

Representative photomicrographs of the histopathology and immunohistochemistry of the scalp tumor showing features consistent with a diagnosis of eccrine porocarcinoma. (A) Photomicrograph of the histopathology shows large, pleomorphic, round and oval cells, arranged in groups and lobules, infiltrating the dermal tissue. Hematoxylin and eosin (H&E). (B) Photomicrograph of the immunohistochemistry (brown) shows malignant cells that are strongly positive for cytokeratin (AE1/AE3). (C) Photomicrograph of the histopathology shows tumor nests in the dermis. Malignant cells are also seen within dilated lymphatics. Hematoxylin and eosin (H&E).

Figure 3.

Figure 3.

Positron emission tomography (PET) images of the patient on initial presentation and following recurrence of an eccrine porocarcinoma four years later. (A) Positron emission tomography (PET) scan, performed at initial presentation, shows no uptake in the brain or skull. (B) PET scan performed four years later shows hypermetabolic activity in an infiltrative soft tissue mass in the right posterior sub-occipital region.

Figure 4.

Figure 4.

The macroscopic appearance of the right side of the neck, right shoulder, and right chest shows multiple confluent and discrete erythematous patches and plaques.

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