Cutaneous metastases of pancreatic carcinoma to the labia majora: A case report and review of literature

Abstract

Background: Cutaneous metastases originating from pancreatic cancer are relatively rare. The most common reported site of metastasis is the umbilicus, and this manifestation is known as the Sister Mary Joseph's nodule. Non-umbilical cutaneous metastases are far less common, with only a few cases reported in the literature. Our case is the first case report, to our knowledge, on metastasis involving the labia majora and flat papules.

Case summary: A 49-year-old Chinese female patient presented with a number of red, swollen papules on the vulva for 2 mo. Histological examination of the labia majora lesion revealed metastatic adenocarcinoma. The serum levels of tumor biomarkers CA199, CA242, and CA125 were significantly elevated. B-mode ultrasound-guided needle biopsy of the pancreas demonstrated moderately and poorly differentiated adenocarcinoma. The patient finally declined treatment for financial reasons and died 3 mo later.

Conclusion: Metastatic cutaneous lesions could indicate pancreatic cancer. Serum levels of tumor biomarkers may aid in diagnosing metastatic pancreatic adenocarcinoma.

Keywords: Biomarker; Case report; Cutaneous; Metastasis; Non-umbilical; Pancreatic cancer.

Figure 1

Photographs of our patient. A: Diffuse erythema and swelling on the chest, abdomen, and right leg; B: Edema and a number of flat skin-colored or gray papules on the labia majora.

Figure 2

Positron emission tomography-computed tomography scan showing increased metabolic activity. A: The tail of the pancreas; B: Mediastinum, hilus of the lung, and postperitoneal lymph nodes.

Figure 3

Pathology of cutaneous metastasis. A: Histological examination of the labia majora papule showing nests of moderately differentiated atypical cells partly forming adenomatous structures in the collagen bundle of the dermis and lymphangiectasis in the dermis [hematoxylin-eosin (HE) staining, × 40]; B: Dermis occupied by mass of numerous tumor cells (HE staining, × 200).

Figure 4

Neoplastic glands showing a positive reaction to immunohistochemical staining (100 ×). A: CK7 (+); B: panCK (+); C: CK19 (+); D: CA199 (+); E: CK20 (+); F: CDX-2 (+).

Figure 5

B-mode ultrasound-guided needle biopsy of the pancreas showing the moderately and poorly differentiated adenocarcinoma (hematoxylin-eosin staining, × 200).