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. 2019:56:96-100.
doi: 10.1016/j.ijscr.2019.02.043. Epub 2019 Mar 7.

Large single cutaneous metastasis of colon adenocarcinoma mimicking a squamous cell carcinoma of the skin: A case report

Mario Faenza  1 , Giuseppe Del Torto  2 , Pasquale Di Costanzo  2 , Gorizio Pieretti  2 , Rossella Lamberti  2 , Renato Franco  3 , Giuseppe A Ferraro  2 , Giovanni F Nicoletti  2
Affiliations

Large single cutaneous metastasis of colon adenocarcinoma mimicking a squamous cell carcinoma of the skin: A case report

Mario Faenza et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: Metastases represent one of the most outstanding characteristics of malignant neoplasms and are relatively rare in the skin, in spite of the great extension of the cutaneous organs. Development of cutaneous metastases from colon cancer is a rare event, usually occurring in widely disseminated disease and commonly leading to a poor prognosis. As to location, cutaneous metastases often favor areas close to the primary malignancy, such as lung cancer and skin metastases on the trunk. However, remote sites as the scalp may be also involved.

Case presentation: We present the case of a 92-year-old female patient with a massive single nodular skin lesion on her left supraclavicular area, that came back positive for cutaneous metastasis of colon adenocarcinoma.

Discussion: Cutaneous metastasis of colorectal cancer a rare event (2.3%-6%) that usually occur two years after the detection or resection of the primary tumor. It seldom occurs before the identification of the primary tumor and involvement of secondary organs, such as the liver. There are few cases reported with only cutaneous metastases.

Conclusion: In conclusion, dermatological evaluation of patients who are undergoing screening or who have already been diagnosed with cancer is extremely important.

Keywords: Colon Cancer; Cutaneous Metastasis; Fasciocutaneous Flap; Skin cancer.

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Figures

Fig. 1
Fig. 1
Clinical presentation of the tumor.
Fig. 2
Fig. 2
Intraoperative view of the deep aspect of the tumor invading the clavicle bone.
Fig. 3
Fig. 3
Intraoperative view of the harvesting of two fasciocutaneous flaps.
Fig. 4
Fig. 4
The wound closed by layers at the end of the surgical procedure.
Fig. 5
Fig. 5
Dermal infiltration by neoplastic proliferation with pushing margins (A); this neoplastic proliferation has a solid, trabecular and pseudoglandular growth pattern (B), with focal areas of comedonecrosis and extensive areas of coagulative necrosis and hemorragia (C); the tumor cells are large with abundant eosinophilic cytoplasm and nuclei with finely dispersed chromatin and prominent nucleoli, there are many atypical mitotic figures (D). Hematoxylin-eosin stain.
Fig. 6
Fig. 6
Immunohistochemistry stains; the neoplastic proliferation showed positive stain for CK AE1-AE3 and CDX2, highlighting an epithelial differentiation and likely origin from large intestine. The tumor cells showed negative stain for TTF-1, CK7, Mammoglobin, P63, neuroendocrin markers (CD56, sinaptofisina) and S100.
Fig. 7
Fig. 7
Punch biopsy came back positive for moderately differentiated adenocarcinoma composed by cells with abundant cytoplasm, nuclei with dispersed chromatin and prominent nucleoli. Hematoxylin-eosin stain.
Fig. 8
Fig. 8
Immunohistochemistry stains of the punch biopsy; the neoplastic proliferation showed positive stain for CK AE1-AE3.
See this image and copyright information in PMC

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