Non-umbilical cutaneous metastasis of a pancreatic adenocarcinoma

Abstract

Pancreatic adenocarcinoma is one of the deadliest human malignancies with the majority of cases diagnosed late in the course of the disease. Cutaneous metastases originating from pancreatic cancer are rare. The most common site reported is the umbilicus. Non-umbilical cutaneous metastases are far less common with only a few cases reported in the literature. Our case involved a 43-year-old man with pancreatic carcinoma who was offered resection and a Whipple procedure was planned. Intraoperatively, the patient was found to have a widely metastatic disease not seen on preoperative imaging. Postoperatively, cutaneous metastasis in the scalp was discovered. Although rare, the recognition of non-umbilical cutaneous metastases of pancreatic adenocarcinoma can be of value because they can not only detect an underlying tumour but also guide management.

Figure 1

Histology sections of the skin lesion stained with H&E. (A) Low power (×40) view demonstrates a dermal-based, poorly differentiated, infiltrative carcinoma embedded in a desmoplastic background. (B) Higher power (×200) view shows invasive strands of pleomorphic cells with hyperchromatic, angulated nuclei.

Figure 2

Lesional cells are shown to be strongly positive for cytokeratin 7.