Angiosarcoma with pseudoepidermotropism in a patient with breast cancer: a mimic of epidermotropic metastatic adenocarcinoma

We report a case of cutaneous postradiation angiosarcoma of the breast exhibiting pseudoepidermotropism that resembled metastatic adenocarcinoma on hematoxylin and eosin. The patient is a 74-year-old woman with history of breast carcinoma treated with mastectomy, chemotherapy, and radiotherapy who complained of an erythematous "rash" along the central portion of the mastectomy scar. Radiography showed widespread osseous metastasis. Biopsy revealed an infiltrative tumor with single file growth and tumor cells obscuring the dermal--epidermal junction in multiple foci, imparting an appearance of epidermotropism. The tumor cells were positive for CD31, CD34, and D2-40 and negative for Cam 5.2. This novel case of pseudoepidermotropic angiosarcoma highlights a potential pitfall in the histomorphologic assessment of poorly differentiated angiosarcoma.     

A case of ileoileal intussusception caused by metastatic pedunculated tumor of cutaneous angiosarcoma

Cutaneous angiosarcoma is a rare aggressive vascular tumor that occurs in elderly patients and is usually located on the head and face. Metastases often develop in the cervical lymph nodes, lungs, bone, liver and spleen. There have been no reports of ileoileal intussusception due to metastatic tumor from cutaneous angiosarcoma. We reported a case of cutaneous angiosarcoma in a 67-year-old Japanese male accompanied with ileoileal intussusception due to metastatic angiosarcoma. We assume that the metastatic tumor in the small intestine was metastasized hematogeneously from cutaneous angiosarcoma, resulting in the formation of nodules and the rapid growth of a pedunculated tumor as a forerunner of the ileoileal intessusception.     

Extravascular papillary endothelial hyperplasia of the palm masquerading as an angiosarcoma

Cutaneous extravascular papillary endothelial hyperplasia (PEH) is a rare lesion presenting as a cutaneous mass and histologically mimicking angiosarcoma. Herein, we describe a patient who presented with a palm tumor that had developed after trauma. Histologically, the lesion was ulcerated and showed proliferation of atypical epithelioid cells with nuclear enlargement and mitosis. Vascular proliferation was evident, and these were positive for CD31 and CD34, with approximately 20% positivity for MIB-1. We diagnosed this case as an extravascular papillary endothelial hyperplasia because there was no evidence of invasion into the surrounding tissue and elastica staining proved it did not have a vascular structure. To our knowledge, cutaneous extravascular PEH has not yet been reported in the published work.     

Metastasis of Mediastinal Epithelioid Angiosarcoma to the Finger

Epithelioid angiosarcoma (EA) is a rare malignant, vascular tumor that is usually observed in middle-aged and elderly males. Cutaneous metastasis of EA is extremely rare. We report the case of a 41-year-old woman presenting with a painful bluish, bulla-like lesion on the distal extent of the left third finger. The patient had recently been diagnosed with mediastinal EA with disseminated metastases. The skin biopsy specimen revealed metastatic EA. This is thought to be the first reported metastasis of EA to the finger. Whenever a patient has metastatic disease, acrometastases should be considered in the differential diagnosis of inflammatory lesions of the digits and a skin biopsy should be performed.     

Angiosarcoma arising in sclerodermatous skin

We report a case of cutaneous angiosarcoma in a 77-year-old female patient with systemic sclerosis. The tumor developed around a large telangiectasia in the left temporal region. Later on, extensive asymptomatic redness and edema with several nodules over the whole left side of the face developed. Since the conservative therapy failed to produce any improvement, a diagnostic skin biopsy was performed. The pathohistological diagnosis was moderately differentiated angiosarcoma. The patient was treated with a combination of chemotherapy and electron beam irradiation. Despite a notable cutaneous improvement, the control check-up revealed the presence of metastases of the lung and liver. This is the first report of cutaneous angiosarcoma occurring in sclerodermatous skin. The possible pathogenesis of this rare tumorogenic transformation of soft tissues is discussed.     

Pseudolymphomatous cutaneous angiosarcoma: a report of 2 new cases arising in an unusual setting

Pseudolymphomatous cutaneous angiosarcoma represents a rare, relatively new variant of cutaneous angiosarcoma exhibiting a prominent inflammatory lymphoid infiltrate that can mask the underlying vascular malignant proliferation and mimic a lymphomatous or pseudolymphomatous process. We describe the clinicopathologic characteristics of two new cases of pseudolymphomatous cutaneous angiosarcoma whose originality lies in the unusual setting from which they have arisen. In fact, the first case was an exceedingly lymphocyte‐rich recurrence of a typical epithelioid cutaneous angiosarcoma whose primary lesion that was almost devoid of inflammatory infiltrate underwent surgical excision and radiotherapy while the second one was an unexpected histopathological finding associated with a basal cell carcinoma. Immunohistochemically, most of the lymphocytes expressed immunoreactivity for T‐cell markers, while the neoplastic endothelial lymphatic cells expressed CD31 and CD34. D2‐40 immunoreactivity was observed lining some channels and some neoplastic cells. In the first case a possible relationship between radiotherapy and the pseudolymphomatous reactive pattern is discussed while the second case has been considered as a rare example of collision tumor.     

Cutaneous angiosarcoma with skin metastases and persistent bloody pleural effusions

Cutaneous angiosarcoma is a rare aggressive malignancy of vascular origin that usually arises in the scalp or face of elderly men. We describe a case of primary cutaneous angiosarcoma with skin metastases and presumed metastases to the lung in a 58-year-old man who presented with persistent bloody pleural effusions, an asymptomatic nontraumatic red patch on the forehead of 2 to 3 months' duration, and a pair of purpuric papules on his left mid back of unknown duration. Cutaneous metastases of angiosarcoma are uncommon. Spontaneous persistent bloody effusions without hemoptysis are distinctly uncommon, and pleural fluid cytology is repeatedly negative in lung or pleural angiosarcoma, making it difficult to diagnose without tissue biopsy.     

Superficially invasive transitional cell carcinoma of the bladder associated with distant cutaneous metastases

Cutaneous metastases from transitional cell carcinoma of the bladder are rare and most often associated with a deeply invasive primary tumor. This case report describes a 69‐year‐old male with previously resected superficially invasive primary transitional cell carcinoma of the bladder who presented with distant cutaneous and central nervous system metastases associated with recurrent bladder cancer. In addition, this case highlights the differential diagnosis of metastatic carcinomas that display a CK7/CK20 positive immunophenotype including transitional cell carcinoma, pancreatic carcinoma, cholangiocarcinoma and rare gastric carcinomas. Swick BL, Gordon JRS. Superficially invasive transitional cell carcinoma of the bladder associated with distant cutaneous metastases.     

Association between prognosis and complete resection in primary cutaneous myoepithelial carcinoma: two case presentations and literature review

Myoepithelial carcinoma is a rare tumor that occurs in the salivary glands. Therefore, primary cutaneous myoepithelial carcinoma is extremely rare. The malignancy of this tumor is due to its aggressive nature and high metastatic potential. Despite the general consideration that primary cutaneous myoepithelial carcinoma has a poor prognosis, there are few available prognostic data. Herein, we report two cases of primary cutaneous myoepithelial carcinoma to expand the literature on the clinical and pathological characteristics of this disease. In case 1, the tumor was completely resected and sentinel lymph node biopsy was performed, resulting in long‐term survival. In contrast, case 2 progressed aggressively with multiple bone metastases despite treatment with docetaxel chemotherapy, and the patient ultimately died of the disease. Only 14 cases, including the present two cases, of primary cutaneous myoepithelial carcinoma have been reported to date. Overall, patients with clinical regional or distant metastases show a severe clinical course. Nevertheless, even in cases of inappropriate resection or local recurrence, if complete resection is ultimately achieved prior to clinical metastasis, the prognosis is good and survival is prolonged. Therefore, obtaining complete resection appears to be the most important treatment strategy for primary cutaneous myoepithelial carcinoma.     

Cutaneous metastasis of breast adenoid cystic carcinoma to the scalp

Adenoid cystic carcinoma (ACC) is a tumor that can be of primary cutaneous origin or secondary to metastatic disease, most commonly salivary origin. Aside from primary cutaneous and salivary types, ACC of the breast is a rare, more indolent variant. Cutaneous metastases secondary to breast ACC is exceedingly uncommon and not previously reported to our knowledge. We present the case of a 67‐year‐old woman who developed cutaneous metastasis from primary breast ACC.     

以皮肤表现首诊的胃癌一例并发皮肤转移癌临床分析

目的统计我院皮肤科病理室皮肤转移癌患者资料,分析其临床特点,加深对皮肤转移癌的认识。方法报告1例以皮肤表现首诊的胃印戒细胞癌,并综合2011年1月—2016年1月的皮肤转移癌资料,分析患者年龄、性别、皮损形态特征和发生部位等特点,以及原发肿瘤的类型及皮肤转移癌与原发肿瘤发生时间的关系。结果共统计皮肤转移癌14例,占我科皮肤病理室组织病理切片总数0.24%(14/5 955例),其中男5例(36%),女9例(64%),平均年龄(57.46±12.02)岁;9例女患者中,原发于乳腺癌7例(77.8%),胃癌1例,未明确原发灶1例;5例男患者中,原发于肺癌3例(60.0%),食管癌1例,未明确原发灶1例。所有患者中以皮肤表现为首发症状3例,皮肤转移癌首发率21.4%(3/14);11例患者表现为浸润性红斑及红斑基础上的丘疹、结节,2例表现为头皮孤立结节,1例表现为胸腹部多发结节。14例皮损均分布于头颈部及胸腹部。3例患者的免疫组化显示为低分化腺癌,其中1例经及时化疗后皮损基本消失,随访1年已临床痊愈。结论皮肤转移癌发生率低,以皮肤表现首诊的转移癌少见。对于皮肤转移癌早发现、早诊断、早治疗可一定程度改善预后。     

Cutaneous scrotal metastasis: origins and clinical characteristics of visceral malignancies that metastasize to the scrotum

Cutaneous metastases occur in about 10% of patients with cancer, occasionally presenting as the initial sign of internal malignancy. Most often cutaneous metastases are an indicator of advanced cancer and are associated with a poor prognosis. The scrotum is a rare site of cutaneous metastasis, and metastatic tumor to the scrotum can be mistaken for other skin lesions. We reviewed the published literature regarding patients who developed cutaneous metastasis to the scrotum. We summarized the clinical characteristics of these men, including primary tumor sites, age at diagnosis, treatment regimens, interval between diagnosis of primary tumor and subsequent metastasis, and outcomes. We extensively searched the PubMed medical database for papers on visceral malignancies with metastasis to the scrotum. We limited our definition to solid organ tumors; thus lymphomas, sarcomas, and melanomas of the scrotum were excluded. We identified 29 patients who developed scrotal metastases from visceral cancers. The colon/rectum (34%), prostate (28%), and lung (14%) were the most frequent sites of tumor origin. The prognosis for these patients is poor: mean patient survival was only four months after diagnosis of metastatic skin lesions. Cutaneous metastasis to the scrotum is a rare manifestation of internal malignancies that most often represents an advanced and/or progressive cancer associated with a poor prognosis. Treatment is often unsuccessful, and the mean patient survival following scrotal metastasis is <4 months.     

Rhabdomyosarcoma of the skin resembling carcinosarcoma: report of a case and literature review

Rhabdomyosarcomas (RMSs) are soft tissue sarcomas with skeletal muscle differentiation. Cutaneous RMSs are exceedingly rare, and in most cases, they represent metastatic disease or the dermal involvement by a tumor arising in the underlying soft tissues. We herein report the case of a 41-year-old man who developed a cutaneous swelling of the right nasal orbital angle. An initial incisional biopsy showed cytokeratin-positive atypical spindle cells forming long and intersecting fascicles, thus the case was diagnosed as carcinosarcoma. In the subsequent excisional biopsy, the skeletal myogenic differentiation of the tumor cells infiltrating the dermis and subcutis was demonstrated by morphology (presence of rhabdomyoblasts), immunohistochemistry (positivity for desmin, myogenin, myoglobin, and actins), and electron microscopy (evidence of rudimentary sarcomeric structures). A final diagnosis of primary cutaneous RMS was made. The patient was subjected to postoperative radiation and chemotherapy, but after 4 months, the patient developed a tumor recurrence followed by distant metastases and death. Review of the literature reveals that RMSs of the skin are often underrecognized and display peculiar clinical features in comparison with their more common soft tissue counterpart.     

Cutaneous metastasis on the nasal tip: first clinical sign of pulmonary carcinoid tumor

Skin metastases are rare and may occur in the context of a known metastatic disease or be the first clinical sign of an underlying primary tumor. In the case of carcinoid neoplasms, determining whether the cutaneous tumor is primary or secondary and identifying the tumor origin in metastatic cases is not always an easy task. This is the report of a case of cutaneous metastasis presenting as the first clinical manifestation of a previously unknown pulmonary carcinoid tumor, including the discussion of histopathological and immunohistochemical findings that allowed an adequate diagnosis of the tumor etiology and reinforces the importance for dermatologists and dermatopathologists to be familiar with these findings.     

Cutaneous metastasis of hepatocellular carcinoma following liver transplantation

Cutaneous metastases from hepatocellular carcinoma (HCC) are extremely rare and can represent a sign of an underlying malignancy or relapse/progression from an existing tumor. We report a case of a cutaneous metastasis arising in a patient with metastatic HCC following orthotopic liver transplantation. Diagnosis is a multistep process as cutaneous HCC metastases must be differentiated from primary cutaneous malignancies as well as other cutaneous metastases. Making this even more challenging, HCC metastases have heterogeneous clinical and histologic appearances. Therefore, the use of immunohistochemical stains, including hepatocyte paraffin-1, arginase-1, and glypican-3, and correlation with the clinical context are essential for a correct diagnosis.     

CD4+ CD56+ hematodermic/plasmacytoid dendritic cell tumor with response to pralatrexate

The CD4(+) CD56(+) hematodermic/plasmacytoid dendritic cell tumor is a rare, highly aggressive, systemic neoplasm for which effective therapies have not yet been established. These tumors express CD4, CD56, CD123, and T-cell leukemia/lymphoma (TCL)-1 and are clinically characterized by cutaneous involvement with spread to bone marrow and blood, and poor prognosis with current chemotherapy regimens. We describe a Caucasian woman who presented with plasmacytoid dendritic cell tumor, but an absence of systemic symptoms. Clinically, multiple cutaneous lesions were brown to violaceous firm nodules on the face, arms, and trunk. The patient underwent two courses of cyclophosphamide, Adriamycin, vincristine, and prednisone chemotherapy but relapsed quickly. The investigational agent, pralatrexate (30 mg/m(2)) was given weekly with vitamin B12 and folic acid and resulted in remarkable clinical response with regression of skin tumors. Our observation highlights pralatrexate as a promising therapeutic option for hematodermic/plasmacytoid dendritic cell lymphoma/leukemias.     

Cutaneous metastasis of colorectal cancer

Cutaneous metastases from internal malignant neoplasms are a rare event and a late clinical finding that is associated with disseminated disease and a poor prognosis. Skin metastases from colon tumors occur in only 4% of cases of metastatic colorectal cancer. They are most often located on the abdominal skin. We report a case of 54-year-old male patient with a cutaneous metastatic focus on the lower abdomen as the initial presenting symptom of an underlying colon cancer.     

Cardiac Myxoma Diagnosed by Signs of Purpuric Macules on Both Palms and Soles

Cardiac myxoma, the most prevalent primary cardiac tumor, is rare. The clinical features of this tumor are principally intracardiac obstruction, extracardiac embolism, and general symptoms including fever, myalgia, arthralgia. Although cutaneous manifestations in patients with cardiac myxoma are frequent, in rare cases, cutaneous signs have been clues to the correct diagnosis. We report a 42-year-old male who presented with recurrent multiple purpuric patches on both palms and soles for 4 months. Histopathological finding showed a myxomatous embolus in the arteriole in the lower dermis. Echocardiogram demonstrated the presence of a left atrial myxoma with a provisional diagnosis of left atrial myxoma. In our patient, skin examinations and histopathological finding led us to the diagnosis of cardiac myxoma.     

Angiosarcoma in an irradiated breast: a case description

Post-radiotherapy cutaneous angiosarcomas have been described in different locations, including the breast. We present a case of cutaneous angiosarcoma of the breast, diagnosed 6 years after a carcinoma of the breast had been treated with radiation. The patient was a 44-year-old female with a history of ductal carcinoma (CA) of the right breast treated with tumorectomy, axillary lymphadenectomy, chemotherapy (FEC) and radiotherapy, who 6 years later presented with a violaceous, indurated plaque with a satellite nodule on the same breast. The histology of the skin biopsies showed angiomatous proliferation throughout the entire dermis, with no cellular atypia. Considering the patient's symptoms, history and the changes observed via mammography, it was decided to completely excise the lesion followed by a simple mastectomy, with the diagnosis of angiosarcoma being confirmed. The patient was later treated with paclitaxel, and the disease was apparently controlled. Despite this fact, two years and one month later, the angiosarcoma recurred on the internal area of the mastectomy scar. The patient was treated with paclitaxel, and surgical excision of the lesion area was once again performed. This complication usually appears 5-10 years after treatment with radiotherapy, so angiosarcoma should be ruled out if any angiomatous lesions later appear on skin that had been irradiated.