Multiple distant painful subcutaneous nodules in a healthy young non-smoker (original) (raw)
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A Rare Presentation of Cutaneous Metastases in Advanced Lung Adenocarcinoma
Journal of Clinical and Health Sciences
Patients with lung cancer may present with respiratory and systemic symptoms. However, cutaneous metastases from primary lung cancer is a rare phenomenon, especially in women, that signifies a poor prognosis. This paper reported a case regarding a 71-year-old woman who was first presented with a cutaneous nodule over the year. Her condition was further progressed to multiple lesions on the back and abdomen, dyspnoea, haemoptysis and weight loss. The results of the skin lesion biopsy exhibited metastatic lung adenocarcinoma with positive immunohistochemistry for thyroid transcription factor 1 (TTF1) and cytokeratin 7 (CK7). Computed tomography (CT) scan was conducted, and it revealed a left upper lobe lung mass. The patient was subsequently scheduled for additional management, but she had succumbed to complications of pulmonary embolism before the necessary interventions could be provided. In this particular case presentation, the biopsy of cutaneous lesions obtained had revealed an ...
Cutaneous metastasis from carcinoma of lung
Indian dermatology online journal, 2013
A 65-year-old male with a history of smoking since 30 years presented with breathlessness, hemoptysis, multiple swellings all over the body, and weakness in September 2010 at our hospital. Clinically, a diagnosis of chronic obstructive pulmonary disease (COPD) with cutaneous lymphoma or soft tissue tumor was made. Chest X-ray (CXR) and computed tomography (CT) scan revealed a neoplastic lesion in the right lung with secondary cavitation. Biopsy of the cutaneous nodules showed metastatic deposits from squamous cell carcinoma. Metastatic skin cancer is a relatively rare complication of internal malignancy. The clinical features of metastatic skin disease vary enormously. They may present as erysipeloid, sclerodermoid, alopecia neoplastica or in an inflammatory or bullous form or as multiple nodules as in our case. A high index of suspicion for metastatic deposits is required in an elderly male patient who is a known case of lung cancer or even one who is a chronic smoker and presents ...
Cutaneous Metastasis in a Case of Adenocarcinoma of the Lung: A Cytological Diagnosis
Middle East Journal of Cancer, 2015
Subcutaneous metastatic nodules are an uncommon first sign of underlying cancer. Cutaneous metastasis occurs in 0.8% to 4% of all cancer patients and less than 5% in those with lung cancer. These metastases are usually single or multiple painless nodules that may be mobile or fixed. Cutaneous metastases from the lung are not very common and indicate a worse prognosis. The limited literature on skin metastases from a primary lung suggests that if other extracutaneous metastases exist, median survival does not exceed three months; however, if the skin is the only site of metastatic disease, survival can reach ten months. Fine needle aspiration cytology is an excellent noninvasive method for early diagnosis of subcutaneous nodules, which in the presence of characteristic cytomorphology obviates the need for more invasive methods and surgery. Once diagnosed, the aim is to start treatment as soon as possible before widespread visceral metastases occur. Although the response to chemothera...
Cutaneous metastasis of carcinoma lung: a rare cytological association
Skin metastasis is an uncommon presentation of cancer. Cutaneous metastases as initial manifestation of internal neoplasms, represent only 0.8% of total cases and implies, in general, a very advanced grade of the disease and short survival. Metastasis to the skin from lung cancer is less common than metastasis to other organs. The incidence of skin metastasis was 2.8% among all 579 cases of lung cancer. Large cell carcinoma showed the greatest tendency to spread to the skin and epidermoid carcinoma showed the least tendency. Back of the trunk was the most common site for metastatic cutaneous lesions. Almost all lesions ranged from 1 to 5 cm in diameter. Clinical manifestation of skin metastasis was nodular type in all the cases and was accompanied by metastasis to other organs at the time of clinical presentation. A slight response to combination chemotherapy was noted in only 5 cases of lung cancers, with most lesions being progressive. Median survival after skin involvement was ap...
Ulcerative Cutaneous Lesions Synchronously Present with the Diagnosis of Primary Lung Cancer
Case Reports in Medicine, 2013
The percentage of patients with lung cancer that develop skin metastases is low. The diagnosis is usually made using clinical information and skin biopsy in patients with suspicious skin lesions and history of smoking or lung cancer. The prognosis for patients having lung cancer with skin metastasis is very poor. We describe findings in a 70-year-old man with lung cancer with skin metastases. Interestingly, multiple skin lesions were the first manifestation of the underlying lung cancer. The prognosis for patients having lung cancer with skin metastasis is thus very poor.
Cutaneous metastases as initial presentation of malignancy
BJR|case reports
We describe a case of 73-year-old female who presented with dry cough, chest pain and light-headedness. On examination, multiple subcutaneous masses were noticed on the chest wall, bilateral breast, anterior abdomen and both arms. Subsequent CT-TAP and CT-brain showed multiple subcutaneous nodules in scalp, neck, anterior chest wall, breast and abdomen. A biopsy taken from breast revealed metastatic malignant melanoma; however there was no evidence of primary cutaneous malignant melanoma. We also describe a case of 72-year-old male who presented with tender mass on his lower back and posterior neck. He was known to have COPD and was a heavy smoker. A CT-TAP showed right lower lung mass with soft tissue masses near lumbar spine and lower cervical spine. While awaiting bronchoscopy, biopsy taken from the mass on lower back showed features of metastatic lung adenocarcinoma. In fact, presence of cutaneous metastasis is herald sign and indicates advanced malignancy with poor prognosis regardless of type of primary malignancy.
Skin metastases from lung cancer: a case report
BMC Research Notes, 2015
Background: Lung cancer is one of the most frequent malignancies, with high mortality rates. It can metastasize in almost all organs, but more often invades hilar nodes, liver, adrenal glands, bones and brain. There are various data on the incidence of lung cancer metastases in the skin. In 1-12% of patients with lung cancer are developed skin metastases. Metastases in the skin may be the first sign of lung cancer. Case presentation: Forty-five years old Albanian male, smoker, was admitted to our department with multiple nodules localized in the skin of the head, neck, back and chest. The nodules measuring 5-15 millimeters in greatest dimension were round and skin-colored, with telangiectasias, firm and tender. They appeared in an eruptive form about two weeks before being admitted at our hospital. In addition, the patient exhibited signs of weight loss, anorexia and fatigue. Excisional biopsy was performed to one of the lesions. Histopathology confirmed metastatic nature of the lesion namely, malignant tumor of neuroendocrine phenotype consistent with small-cell carcinoma. Chest X-ray and computed tomography revealed an expansive process in the 7 th segment of the left lung, left hilar and mediastinal lymphadenopathy and a suspicious initial secondary deposit in the left adrenal gland. The patient was referred to the department of oncology for further treatment. After the third cycle of chemotherapy, the magnetic resonance imaging revealed brain metastases. The patient passed away four months after the diagnosis of lung cancer first presented with skin metastases. Conclusions: Metastases in skin may be the first sign of lung cancer. Although rare appearing, we should raise suspicion in cases of atypical lesions in the skin not only of the smokers, but also of the non-smokers. Skin metastases from small-cell lung carcinoma are a poor prognostic indicator. The appearance of multiple skin metastases with other internal metastases shorten the survival time.
Case Reports in Oncology
Lung cancer has the highest cancer incidence, and it is the most common cause of cancer death worldwide. Cutaneous metastases are infrequent compared to hilar nodes, adrenal glands, liver, brain, and bones. However, unusual skin lesions in patients at high risk of lung cancer should be regarded carefully to rule out a metastatic manifestation of an occult primary site tumor. Surgical excision, or incisional biopsy when the former is deemed unfeasible, should be performed to allow histopathological examination in case of occult primary site. In patients affected by advanced lung tumors, surgical excision could be beneficial in terms of pain control and improvement of the quality of life. We report a case of a solitary large skin lesion as an early manifestation of a lung adenocarcinoma.
Cutaneous metastasis as a primary presentation of a pulmonary enteric adenocarcinoma
International Journal of Biological Markers, 2019
Background: Primary pulmonary enteric adenocarcinoma (PEAC) is a rare non-small cell lung cancer subtype sharing morphologic and immunohistochemical features with colorectal adenocarcinoma. Given the frequency of lung metastases in colorectal cancer, the differential diagnosis of PEAC according to routine morphological and immunohistochemical findings may be difficult. Genome sequence by next-generation sequencing has recently introduced new perspectives to better define the diagnosis and tumor sensitivity to treatments, while the rarity of this subtype of cancer still limits the current knowledge of its molecular features and provides no information to address patients to tailored therapies. Methods: We diagnosed a rare case of subcutaneous metastasis as a first symptom of a PEAC. Formalin-fixed paraffinembedded samples of the primary tumor and subcutaneous metastases were examined by immunohistochemistry, and subsequently by targeted next-generation sequencing analysis. Results: Morphological and immunohistochemical findings suggested a rare case of metastatic pulmonary adenocarcinoma with enteric aspects. Next-generation sequencing analysis performed on both the primary tumor sample and the cutaneous lesion identified two pathogenic variants on CDKN2A and KRAS in both of them. However, the metastasis showed two additional pathogenic mutations located in SMAD4 and FLT3 genes. Conclusions: We describe for the first time an extensive molecular analysis on a rare case of PEAC with an unusual cutaneous metastasis. Our observation suggests that a specific pattern of mutations is harbored in this neoplasm, and that additional molecular studies may provide further information to identify prognostic and hopefully predictive genes of response to treatment.