男性乳腺癌皮肤转移1例

报告1例男性乳腺癌皮肤转移.患者男,66岁.右下肢红斑、水肿1年余，曾被诊断为“血管炎”。组织病理检查结果示转移性皮肤癌，乳腺肿块组织病理检查结果显示浸润性导管癌，皮肤转移组织免疫组化染色示细胞角蛋白（CK）阳性。     

A Case of Metastatic Renal Cell Carcinoma Mimicking Granuloma Pyogenicum

Renal cell carcinoma (RCC) is well known for its frequent metastasis and particularly to the lungs, liver, bones and brain, but metastasis to the skin is rare. We report here on a case of metastatic RCC in a 73-year-old man who presented with a 1.5 cm sized, moist, beefy-red and exophytic nodule on the scalp. The lesion had grown rapidly for 2 months and it clinically mimicked granuloma pyogenicum. A skin biopsy revealed a solid mass composed of clear cells with clear cytoplasm and oval hyperchromatic nuclei, and they were arranged in an alveolar pattern. As skin metastasis from renal cell carcinoma signals widespread systemic metastasis and a poor prognosis, clinicians should conduct a careful inspection of the skin of a patient with RCC and they should also have a high index of suspicion for finding a primary internal organ malignancy in the RCC patients who present with a skin lesion.     

埃兹蛋白在皮肤鳞癌、基底细胞癌中的表达及相关研究

目的 探讨埃兹（Ezrin）蛋白在皮肤基底细胞癌（BCC）和鳞状细胞癌（SCC）中的表达及在肿瘤侵袭转移过程中的作用.方法 采用免疫组化SP法检测Ezrin蛋白在皮肤BCC（30例）、SCC（32例）及正常皮肤对照组（10例）中的表达情况.结果 Ezrin蛋白在BCC、SCC及正常皮肤对照组中阳性表达率分别为60.0％、84.4％和10％.Ezrin蛋白在各组之间表达差异有统计学意义（P＜0.05）.Ezrin蛋白阳性表达与SCC的分化程度和淋巴结转移密切相关,各组间表达差异有统计学意义（P＜0.05）.结论 Ezrin蛋白的检测可能成为预测皮肤恶性肿瘤转移和预后的一项指标.     

Salivary duct carcinoma of the parotid gland metastasizing to the skin: a case report and review of the literature

Salivary duct carcinomas of parotid gland are rare, as are the skin metastases from them. Four cases are reported with metastases to the skin. We present an additional case, with subcutaneous metastases of the back and leg. To our knowledge, this is the first case reported in the literature in which the nodule on an extremity was the metastasis of a salivary duct carcinoma of parotid gland.     

原发性皮肤鳞状细胞癌淋巴结转移的评估与治疗

原发性皮肤鳞状细胞癌是一种常见的皮肤恶性肿瘤，一般不发生转移。一旦发生转移，通常首先扩散至区域淋巴结群，进而扩散至全身,严重致死。本文对原发性皮肤鳞癌淋巴结转移的评估以及治疗进行了综述。     

Delayed cutaneous metastasis of gastric carcinoma

This paper describes a case of skin cancer resembling carcinoma en cuirasse associated with multiple bone lesions, which were both judged to be due to metastasis of poorly differentiated carcinoma of the stomach, the primary lesion excised ten years previously. Overt bone involvement had been observed for more than two years and a half. Histologic examination of a skin biopsy specimen showed that carcinoma cells had infiltrated into the middle and lower dermis, forming clusters and strands in an abundance of fibrous stromata. No primary lesion was detected in the remnant stomach at autopsy.     

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.     

鳞状细胞癌和麻风慢性下肢溃疡

目的：进一步了解麻风下肢溃疡癌变的流行病学情况、临床特征及其治疗预后，为溃疡恶变的预防，早期发现和合理治疗提供参考。方法：对1980年6月－2001年9月期间由全省各地转到我院作住院治疗且有完整病历的麻风下肢溃疡癌变病例作回顾性分析，并对治疗结果作进一步追踪观察。结果：共收治21例，男15例，女6例；年龄48－71岁（平均59．1岁）溃疡病程8－30年（平均16．2年）；16例溃疡位于足底，4例位于小腿下部，1例位于踝部。病理分级：1级16例，2级5例；1993年10月以前的病例全部作了大腿截肢，此后的病例全部作了小腿截肢。3例失访；得到随访的18例中，截止2001年9月术后已平均存活37．7个月；已有9例死亡，大部分死亡术后1年左右。有10例确定有肿瘤转移，2例在局部，4例腹股沟淋巴结转移，4例发生远处转移。结论：溃疡病期在10年以上者是溃疡癌变的高发人群。早期诊断和治疗是提高存活期的关键     

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.     

Carcinoma erysipelatoides originating from stomach adenocarcinoma

Carcinoma erysipelatoides is an uncommon form of cutaneous metastasis, which is most commonly caused by breast carcinoma, it has rarely been linked to the primary cancers of other organs. We report a 36-year-old woman with carcinoma erysipelatoides originating from a gastric carcinoma. Immunohistochemical and morphologic studies of skin biopsies revealed that the signet ring cells in the dilated lymphatics originated from adenocarcinoma of the stomach.     

播散性低分化腺癌并发印戒细胞癌皮肤转移

报告1例播散性低分化腺癌并发印戒细胞癌皮肤转移.患者男,23岁.躯干、头面部、四肢出现黄豆至鸽卵大结节2个半月,无自觉症状.皮损组织病理检查:真皮胶原纤维间及皮下组织内肿瘤细胞弥漫性浸润,真皮胶原纤维被破坏,肿瘤细胞体积较大,胞质略空,并见瘤巨细胞.免疫组化染色示LCA、CK7、CD138均(-),CK20( ).诊断:低分化腺癌并发印戒细胞癌皮肤转移.患者于皮肤转移癌出现后8个月死亡.     

Basal Cell Carcinoma of the Vulva with Lymph Node and Skin Metastasis

A 79-year-old Japanese woman who had basal cell carcinoma presenting as a large ulcer on her vulva with lymph node and skin metastasis is described. Histological examination revealed that tumor nests with peripheral palisading invaded deeply into the subcutaneous tissue and were accompanied by marked mucinous changes and fibrous reaction. Vascular invasion was also observed. There were inguinal lymph node metastases and two papular skin metastases on her right thigh. The primary tumor and the metastases were excised. The defect was repaired by bilateral gracilis musculo cutaneous flaps and a skin graft. We surveyed the literature and found 20 cases of metastasizing basal cell carcinoma in Japan.     

Cutaneous metastasis from hepatocellular carcinoma resembling granuloma teleangiectaticum

We reported a case of cutaneous metastasis originated from hepatocellular carcinoma, which appeared as a nodule resembling granuloma teleangiectaticum. The nodule, which was composed of tumor cells and intervening capillaries, showed characteristics similar to those of primary hepatocellular carcinoma. On immunohistochemical staining, the tumor cells were positive not only for AFP (alpha-fetoprotein), but also for CEA (carcinoembryonic antigen), which is negative in most cases of primary hepatocellular carcinoma. We discussed this case with a review of previous reports of skin metastasis from liver carcinoma.     

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.     

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.     

An unusual case of diffuse Merkel cell carcinoma successfully treated with low dose radiotherapy

Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine carcinoma of the skin. MCC should be included in the diagnosis of a rapidly growing infiltrating mass and histology as well as laboratory investigations such as Merkel cell polyoma virus (MCPyV) detection are valuable in its diagnosis. We present an unusual case of giant MCC‐positive MCPyV in a Greek woman located on the lower leg. Our patient is very unusual in terms of her extensive MCC and her rapid and complete response to radiotherapy.     

Trichilemmal Carcinoma Developing in a Burn Scar: A Report of Two Cases

Two cases of trichilemmal carcinoma (TLC) developing in burn scars are reported. In Case 1, a 73-year-old man developed a TLC on his left lower leg five years after a burn. In Case 2, a 43-year-old man developed a cauliflower-like mass on his head 42 years after a burn. Histologically, tumor cells showed a lobular proliferation in continuity with the epidermis. Tumor nests were mostly composed of large atypical cells with clear cytoplasms containing PAS-positive, diastase sensitive materials. Some of the nests showed trichilemmal-type keratinization. These cases were treated only with surgical excision, and there has been no evidence since of local recurrence or metastasis.     

A case of giant porokeratosis with vestiges of a cornoid lamella

We report a case of giant porokeratosis combined with ulcerative squamous cell carcinoma. In our patient, we biopsied the skin, including the edge of the skin lesion, four times until we obtained histologic proof of a cornoid lamella. After we had established the diagnosis, we totally excised the affected skin including a 10-mm safety margin, because such lesions tend to develop into skin cancer. We reconstructed the excised area using a skin graft. After the operation, we took 13 samples of skin (seven from the lower leg and six from the sole of the foot) from the edge of the main lesion, including a putative cornoid lamella. Five of the six samples from the sole and one of the seven from the lower leg were demonstrated histologically to include a cornoid lamella. Our results suggest that skin biopsies should be taken from various sites at the edge of a giant porokeratotic lesion and in particular from the prominent ridge to prove the presence of a cornoid lamella. Shallow keratin-filled invaginations and underlying squamous cells with eosinophilic cytoplasm were observed at the edge of the lesion on the lower thigh, which might suggest a diagnosis of porokeratosis with an incomplete cornoid lamella if porokeratosis was strongly suspected from the patient's clinical features. Better recognition of giant porokeratosis is required, so that an earlier diagnosis can be made and appropriate therapy initiated in a timely manner.     

Renal cell carcinoma with cutaneous metastases

An 86-year-old man presented with multiple papules on his face, neck, lips and ears 4 years after a left nephrectomy for renal cell carcinoma. Shave biopsies and excisions of the cutaneous lesions revealed findings consistent with metastatic renal cell carcinoma of clear cell type. The patient continued to present to the clinic over the next 3 years with similar eruptions, and biopsies continued to confirm renal cell carcinoma. During this time, metastases to the bone, lung, soft palate and posterior leg were also diagnosed. This case represents an unusual clinical presentation of metastatic renal cell carcinoma. It shows that a high index of suspicion should be maintained as cutaneous metastases can mimic other skin conditions.     

银屑病并发砷角化症、Bowen病及多发性鳞状细胞癌一例

[摘 要] 报道1例银屑病并发砷角化症、鲍温病及多发性鳞癌。患者男,55岁,患寻常型银屑病25年,口服砷制剂治疗8年,出现右大腿肿物3年,周身多处角化性丘疹2年,加重5个月,手术切除10处皮损组织后病理检查显示,1处皮损证实为鲍温病,4处皮损为鳞癌,其余符合砷角化症。值得临床医生警惕含砷制剂的远期效应及避免不规范治疗。