Cutaneous metastasis of renal cell carcinoma: a case report

Cutaneous metastasis develops in 5 to 10 percent of high-stage cancer patients. About 6 percent of cutaneous metastases are caused by renal cell carcinomas (RCC). A 64-year-old man presented with a 4-month history of a rapidly enlarging lesion on the mental region. There was a 2 cm x 3 cm multilobular and polypoid angiomatous tumor in the center of the swelling. Histopathologic examination revealed clear cell proliferation with gland formation and red blood cell (RBC) extravasation, compatible with metastatic renal cell carcinoma. The rich vascular structure of RCCs facilitates hematogenous extension and the development of distant metastasis. Arteriovenous and systemic shunts are thought to facilitate the tumor cells' path to the head and neck region. RCC cutaneous metastasis is known to have a vascular appearance. It is important to consider RCC metastasis in the differential diagnosis of new onset tumors with a vascular appearance in the head and neck region.     

Metástasis acral digital ósea por adenocarcinoma renal con afectación cutánea

—Cutaneous metastases are a rare and late manifestation of the internal malignancies. The likelihood of a visceral malignant tumour producing deposits in the skin is increased if the lesion is anaplastic and of long duration. Acral metastasis are specially atypical. Most acral metastases affect bones with late secondary cutaneous involvement.We report the case of a 67-years-old female with metastatic renal cell carcinoma who presented swelling and blue-reddish discoloration in the distal part of the 2^nd finger of her left hand that had appeared four days before. On the hand X-ray there was a lytic lesion on the third phalanx of this finger. The histopathological findings showed a clear cell proliferation replacing deep dermis. A diagnosis of osseous metastases with late secondary skin involvement from renal cell carcinoma was made.     

Imiquimod 5% cream for the treatment of nasal lesion of metastatic renal cell carcinoma

Many reports have shown the efficacy of topical imiquimod in patients with skin carcinoma. This effect is based on the activity of imiquimod as an immune-response modifier. The present authors hypothesized that this agent could also be used to treat skin metastatic lesion from renal cell carcinoma. The present authors report the case of a 54-year-old man who presented with a metastasis renal cell carcinoma lesion on his nose. He had a history of right nephrectomy performed 4 years previously. The present authors started him on topical treatment with imiquimod 5% cream three times a week for his nose lesion. A reduction of the lesion was observed after 2 months, and during the following 12 months no sign of recurrence was observed.     

Cutaneous metastasis of renal cell carcinoma: an electron microscopic study

A case of cutaneous metastasis of renal cell carcinoma in a 67-year-old man is described. Right side nephrectomy had been performed three years earlier, and a renal cell carcinoma was diagnosed. Following a bruise, the patient noticed an erythematous nodule on the scalp. Histological examination of this skin lesion showed atypical tumor cells consisting predominantly of clear cells with a honeycomb-like or adenoid structure. Electron microscopic examination revealed that the tumor cells were divided into three groups: clear cells with abundant glycogen, dark cells with abundant mitochondria, and intermediate cells containing both glycogen and mitochondria in varying proportions. Some of the tumor cells with an adenoid pattern had a brush border-like structure in the lumen. These results support the diagnosis of metastatic renal cell carcinoma. An electron microscopic approach may aid in diagnosis of cutaneous metastasis from renal cell carcinoma.     

An unusual case of sarcomatoid renal cell carcinoma presenting in the skin by direct extension at a laparoscopic port site

Although renal cell carcinoma (RCC) is known for its propensity to metastasize widely throughout the body, cutaneous metastases are uncommon and seen in less than 3% of RCCs. A 56-year-old man presented with a painful red lesion with satellite nodules on his abdomen at a laparoscopic port site from a partial nephrectomy for a pT1a clear-cell RCC that was performed 28 months prior. The lesion was excised; however, after excision the lesion recurred with continued pain and drainage from the surgical site. This was treated with multiple courses of antibiotics. Because of the persistent nature of the lesion, it was re-biopsied, and an atypical, keratin-positive, spindle-cell proliferation was identified within the dermis. The patient's previous skin excision was reexamined, and the same atypical cells were identified within large areas of necrosis, granulation tissue, and fibrosis. Further workup was performed on the initial excision, and the atypical cells showed expression of CD10, CAIX, PAX8, EMA, and vimentin, consistent with cutaneous involvement by RCC. Because of the rarity of skin metastases in RCC and the location at a previous laparoscopic port site, this lesion is presumed to have resulted from direct extension of tumor at the time of surgery.     

Renal cell carcinoma marker (RCC-Ma) is specific for cutaneous metastasis of renal cell carcinoma

BACKGROUND: Renal cell carcinoma marker (RCC-Ma) is a monoclonal antibody against a normal renal proximal tubule antigen. RCC-Ma expression is relatively specific for primary clear cell renal cell carcinoma. Its expression in cutaneous metastasis of renal cell carcinoma (MRCC) and other cutaneous clear cell lesions has not been studied. METHODS: One hundred and thirty-seven cutaneous clear cell lesions including eight xanthomas, 32 xanthelasmas, 25 xanthogranulomas, seven balloon cell nevi, six clear cell hidradenomas, 29 sebaceous adenomas, six sebaceous epitheliomas, eight sebaceous carcinomas, and 16 MRCC were examined using immunohistochemistry for the expression of RCC-Ma. RESULTS: RCC-Ma was expressed in 10 of 16 (62.5%) MRCC, all with greater than 20% of cell labeling. Of these, 4 of 10 (40%) labeled with a membranous pattern and 6 of 10 (60%) labeled with both a membranous and a cytoplasmic pattern. RCC expression was not seen in any of the other clear cell lesions (p < 0.001). Furthermore, lack of expression in each of the other diagnostic groups was significant when each group was compared with the MRCCs (p < 0.01 at least for each group). CONCLUSIONS: Our study demonstrates that RCC may be a valuable component of a panel of immunohistochemical markers when evaluating cutaneous clear cell lesions.     

Three cases of verrucous carcinoma

Verrucous carcinoma of the skin and mucosa is an uncommon clinicopathological variant of low grade squamous cell carcinoma. Here, we present three different clinical types of verrucous carcinoma. The first patient presented with an anogenitial verrucous carcinoma, also known as Buschke-Loewenstein tumour. The second patient had verrucous carcinoma of the heel with endophytic growth (i.e. epithelioma cuniculatum) and the third patient had gluteal verrucous carcinoma with a cauliflower-like appearance. Clinically, the lesion of the first patient best resembled giant condyloma accuminatum without any prominent verrucous component, whereas the second patient showed a big deep ulcer on the heel. None of the patients had metastasis. The diagnosis was confirmed with biopsy and total excision was performed in all cases. Although the cases have different clinical presentations in different locations, we think that they should be considered as a single entity: that is, verrucous carcinoma.     

Skin metastasis of breast cancer clinically undistinguished from amyopathic dermatomyositis

We report a 65-year-old woman who consulted us on May 25, 1998, showing pruritic, partially flagellate erythema on the back and upper extremities, livedo lesions with erythema on the loins, and erythematous papules on the dorsal finger joints for 2 months. Histopathological findings of erythema on the back showed mononuclear cell infiltration around capillaries and marked edema in the dermis. Laboratory data were within normal range except for positive anti-nuclear antibody. She had undergone total left mastectomy on June 2, 1997 for breast cancer. Supraclavicular lymph node metastasis was found at the beginning of May, 1998. A diagnosis of amyopathic dermatomyositis associated with breast cancer was made. Erythema with itching gradually subsided from the end of August, 1998. Treatment with radiation and chemotherapy reduced lymph node swelling, but complete remission was not obtained. Erythema similar to the previous lesion but without itching re-appeared on the back from January, 2000. Histological findings of erythema showed many carcinoma cells similar to the primary lesion of left breast cancer in the whole dermis. A diagnosis of skin metastasis of breast cancer was made. These findings suggest that skin metastasis should be taken into account for patients with erythema on the trunk similar to dermatomyositis.     

Cisplatin combination chemotherapy in squamous cell carcinoma and adenoid cystic carcinoma of the skin

Seven patients with skin cancers, six with squamous cell carcinoma (SCC) and one with adenoid cystic carcinoma, were treated with cisplatin in combination with vindesine or adriamycin. Partial response was observed in three patients with squamous cell carcinomas: two cases with metastatic lung lesions and one with a primary skin lesion and lymph node metastasis. Two of the responding SCC had been resistant to previous chemotherapy, including peplomycin and mitomycin C. Multiple metastatic lesions of adenoid cystic carcinoma of the skin completely regressed after two courses of the combination chemotherapy with cisplatin and adriamycin. This report showed that cisplatin combination chemotherapy may be useful for the treatment of cutaneous squamous cell carcinoma, which is resistant to peplomycin, and adenoid cystic carcinoma of the skin.     

Parotideal lymph node metastasis in squamous cell carcinoma of the skin

BACKGROUND: Metastatic involvement of the parotideal lymph nodes from cutaneous squamous cell carcinoma is rare in occurrence, but has a high prognostic value. The aim of the present study was to define a patient group with a high risk for development of regional metastasis and to determine the follow-up course and therapy of metastasis in these patients. MATERIAL AND METHODS: Nineteen patients treated with malignancies of the parotid gland over a time period of four years were analyzed prospectively. RESULTS: In 6 out of 19 patients the parotideal tumor proved to be a lymph node metastasis of previously treated poorly differentiated squamous cell carcinoma of the skin. The diameter of the primary tumor was at least 1.5 cm in 5 out of 6 cases. The time interval between detection of metastatic involvement of the parotid gland and diagnosis of a preexisting skin cancer was approximately 7 months. Metastastic infiltration of cervical lymph nodes could be shown in 4 patients. In one patient pulmonary metastases were detected. CONCLUSION: On the basis of data from the literature and the results presented here, patients who are at high risk for regional metastasis were defined. Clinical examination of the parotid gland and cervical lymph nodes should be performed frequently in these patients at least for 18 months after primary tumor diagnosis. Parotideal lymph node metastases of a squamous cell carcinoma of the head skin should have similar treatment to primary squamous cell carcinoma of the parotid gland provided that a curative option exists.     

Metastatic laryngeal large cell neuroendocrine carcinoma: A rare case of presentation and extreme tumor burden

Large cell neuroendocrine carcinoma (LCNEC) of the larynx is an aggressive form of neuroendocrine carcinoma that affects smokers at an average age of 60 years. LCNEC is characterized by large cells with round to ovoid nuclei distributed in a trabecular or nested growth pattern. Previously, laryngeal LCNEC and atypical carcinoid tumors were considered identical; however, laryngeal LCNEC has been shown to have higher mitotic rates and worse prognosis, which has led to laryngeal LCNEC's being separated from atypical carcinoid and classified as a poorly differentiated neuroendocrine carcinoma in the most recent World Health Organization classification. We present a case of a 56‐year‐old female who presented with painful subcutaneous skin lesions that were diagnosed as metastatic carcinoma at an outside facility. Subsequent workup revealed a primary epiglottic lesion. Over the next 4 years, she continued to develop over 100 similar subcutaneous nodules. Additional workup confirmed neuroendocrine differentiation, thus clarifying the diagnosis of metastatic LCNEC. Review of literature has revealed only 1 reported case of LCNEC with skin metastasis. This is the first reported case in which skin metastasis was the initial presenting symptom; moreover, our case is unique with regard to the heavy metastatic burden to the skin.     

以皮角为表现的肾透明细胞癌皮肤转移1例

患者男,55岁。右枕部红褐色皮角样增生物3个月,进行性增大1个月。2010年确诊为"肾癌"并行右肾摘除术。皮肤科情况:右枕部可见一长约2.0cm圆锥形红褐色增生物,顶部球状角化,外观似"跳棋状",基底部直径约0.8cm,质硬,皮损周围红肿。皮损组织病理示:顶端表面破溃结痂,肉芽组织增生,真皮浅层见结节状肿瘤组织,肿瘤由巢状、腺泡状透明细胞构成,细胞核轻度异型,细胞巢周围可见丰富的血窦及毛细血管。免疫病理示:EMA(+),CD10(+),vimentin(+),CK7(-),CK20(-)。诊断:肾透明细胞癌皮肤转移。术后患者拒绝化疗,现仍在随访观察中。     

Squamous cell carcinoma in a renal transplant recipient with linear porokeratosis.

A 40-year-old man developed squamous cell carcinoma on a perianal lesion of linear porokeratosis after renal transplantation. The tumor metastasized to the left inguinal lymph node 25 months after the primary tumor was excised. p53 overexpression was observed in the tumor cells, but not in the porokeratotic lesion. Interestingly, continuous subcutaneous infusion of peplomycin for the lymph node metastasis significantly improved the warty lesions of porokeratosis. In this patient, immunosuppressive agents might have accelerated the development of carcinoma on a skin area with malignant potential.     

A case of skin metastasis of lung carcinoma associated with superior vena cava syndrome

An unusual case of lung carcinoma with both skin metastasis and superior vena cava syndrome (SVCS) is reported. The histological type of the primary lesion as taken by punch biopsy was small cell carcinoma consisting of relatively small cells with hyperchromatic nuclei and scanty cytoplasm. The cutaneous metastatic lesion consisted of large cells with light-staining nuclei and small cells with deep-staining nuclei; it had foci of glandular elements by light microscopy. Neurosecretory granules characteristic of small cell carcinoma were found in the tumor cell cytoplasm by electron microscopy. Cutaneous metastatic rates, complication rates of SVCS, and histological varieties of small cell lung carcinomas are discussed.     

Cutaneous metastasis as the presenting sign of papillary thyroid carcinoma

Cutaneous metastasis of visceral tumors accounts for 2% of skin tumors. We report the case of a 71‐year‐old male with a smoking history who presented to dermatology department with a violaceous nodule of the right sideburn skin. The lesion was interpreted as an adenocarcinoma that was completely excised and was suspicious for a metastasis. There was a recommendation for additional work‐up. At a different institution, a positron emission tomography scan showed a left hilar mass and uptake in the right thyroid. He was then referred to our hospital for tissue diagnosis. Mediastinoscopy with biopsy of the left hilar mass showed metastatic follicular thyroid carcinoma. Subsequently, a thyroid fine needle aspirate showed suspicion for malignancy with similar morphology. Thyroidectomy and central neck dissection showed right thyroid papillary carcinoma extending to one margin and involving the lymph nodes. The left hilar metastasis mass resection showed similar lymph node findings. A re‐review of the sideburn excision revealed similar histopathology to the thyroid and mediastinal resection. This case illustrates the opportunity of considering metastatic thyroid carcinoma to skin even in cases which lack the classic cytologic and architectural features of papillary thyroid carcinoma follicular variant.     

Adenoid basalioma of the axilla

Basal cell carcinoma is the most common malignant skin tumor in the elderly. It occurs predominantly in the head and neck region. As is well known, skin exposed to sunlight is the most frequent location, but basal cell carcinoma can arise elsewhere. This report describes a 81-year old woman who developed a basal cell carcinoma of the adenoid subtype in the axilla. Before surgical excision, the lesion was diagnosed cytologically. This diagnosis was confirmed by histology. Cytologic examination of skin lesions whose size and location allow this procedure appears to be the sole conservative means of achieving a presurgical diagnosis. The technique is simple. The morphologic differential diagnosis of basal cell carcinoma is discussed.     

Medullary thyroid carcinoma metastatic to skin

Cutaneous metastases are a rarity, even more so when they arise from a medullary thyroid carcinoma (MTC) which accounts for only 8% of all thyroid cancers. MTC arises from C‐cells that produce calcitonin, and it most commonly metastasizes to lymph nodes in the neck. Distant metastases of MTC may involve bone, lung and liver. We report a case of a 56‐year‐old man, who presented with an ulcerated, nodular lesion on his scalp that proved to be a metastasis from his MTC diagnosed 2 years earlier. Cutaneous metastases from MTC generally signify widespread disease and carry a poor prognosis. A case discussion and relevant review of the literature is provided. Nashed C, Sakpal SV, Cherneykin S, Chamberlain RS. Medullary thyroid carcinoma metastatic to skin.     

Renal cell carcinoma metastatic to the thumb: a case report and review of subungual metastases from all primary sites

Subungual metastatic cancer from any primary site is rare. Only seven cases from primary renal cell carcinoma have previously been reported. We now describe a further example of this condition and review its clinical features, radiographic findings and pathological changes. The diagnosis of subungual metastasis should be considered in any patient with metastatic cancer who develops a new lesion of the distal phalanx.