Metastatic porocarcinoma achieving complete radiological and clinical response with pembrolizumab - PubMed (original) (raw)

Case Reports

Metastatic porocarcinoma achieving complete radiological and clinical response with pembrolizumab

Karla A Lee et al. BMJ Case Rep. 2019.

Abstract

A 67-year-old woman presented in 2012 with a crusty nodule on the left lower limb. Histopathological examination at this time reported a poorly differentiated squamous cell carcinoma (SCC). Two years later, she underwent lymphadenectomy and radiotherapy due to unilateral inguinal and pelvic sidewall nodal metastases. The following year she required excision of two subcutaneous lesions, reported pathologically to be SCC metastases. Further imaging following cyberknife radiotherapy to new brain metastases demonstrated widespread metastatic visceral disease. Twelve cycles of carboplatin and capecitabine failed to halt disease progression. In February 2017, she commenced pembrolizumab, achieving an excellent response and currently has no clinical or radiological evidence of disease. Given the unusual behaviour of her cancer, a histopathological review was requested. The diagnosis was revised to that of porocarcinoma (PC). This represents the first documented case of PC treated with immunotherapy. As of March 2019, the patient remains free of disease.

Keywords: dermatology; skin cancer; therapeutic indications.

© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1

Figure 1

Histopathology of the primary cutaneous tumour, which is composed of infiltrating cords and trabeculae of basaloid cells, some with retraction artefact. Comedo necrosis and multiple foci of epidermal involvement, including pagetoid spread. These features are characteristic of porocarcinoma.

Figure 2

Figure 2

CT imaging demonstrates bulky lymph nodes metastases in the left groin, pelvic sidewall and lower left retroperitoneum preimmunotherapy and postimmunotherapy.

Figure 3

Figure 3

(A–D) Histopathology of resected lymph node displays multiple strips of cohesive atypical basaloid epithelial cells. Immunohistochemistry confirms the epithelial lineage (D).

Figure 4

Figure 4

Histopathological comparison between primary tumour and lymph node metastasis indicates much morphological similarity between the epithelial strips within the lymph node and portions of the primary carcinoma.

Figure 5

Figure 5

Immunohistochemistry for PD-L1 demonstrates numerous foci of positivity in the inflammatory cell infiltrate, and several weak foci of tumour expression. PD-L1, programmed cell death ligand-1.

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