Cutaneous metastasis of carcinomatous component of ovarian carcinosarcoma: A case report and review of the literature

Abstract

Skin metastasis of ovarian cancer is extremely rare. We report an unusual case of ovarian carcinosarcoma with cutaneous metastasis of carcinomatous component that displayed distinct clinical manifestation. A 48-year-old woman presented to the dermatologist complaining of a new onset of erythematous, plaque-like skin rash with multiple small nodules on the left inner thigh, the area measuring 8 × 5cm. While the patient had no history of dermatologic conditions, she underwent a total hysterectomy and bilateral salpingo-oophorectomy, omentectomy, and lymph node dissection 16 months ago with a pathology confirmed stage IIIC ovarian carcinosarcoma. Of note, the carcinomatous component, mainly adenocarcinoma with hybrid features of seromucinous, endometrioid and minor high-grade serous carcinoma, involved bilateral fallopian tubes, omentum, and parametrium with extensive lymph node metastases. A skin biopsy specimen revealed an adenocarcinoma involving epidermis, dermis, and subcutaneous tissue with nodular contours, consistent with metastatic carcinomatous component of carcinosarcoma. Both carcinomatous component of primary ovarian carcinosarcoma and metastatic adenocarcinoma in the skin demonstrated Pax8, WT-1, and ER positivity and a mutation pattern of p53. The patient passed away 15 months after identification of skin metastasis. This case represents a unique example of cutaneous metastasis of ovarian carcinosarcoma with distinct clinical manifestation and detailed histopathological description. Alertness to the possibility of cutaneous metastasis, in combination with clinical history, morphological and immunohistochemical findings, is critical for a definitive classification.

Keywords: Cutaneous metastasis; Malignant mixed müllerian tumor; Ovarian carcinosarcoma.

Fig. 1

(A) Computed Tomography (CT) scan showed that the right ovarian mass extending to the left. The tumor displayed a biphasic morphology composed of intimately admixed carcinoma and sarcoma. (B) Predominant component was of homologous sarcoma. (C) Focal seromucinous/endometrioid carcinomatous component was present. (D) Focal area showed features of high-grade serous carcinoma. (E) The uterine cervix with extensive lymphovascular space invasion. (F) Pelvic lymph node with metastatic carcinoma. (G) 16 months after the initial diagnosis of ovarian carcinosarcoma, the patient presented with a skin lesion in the left inner thigh. (H) High grade adenocarcinoma involving epidermis, dermis, and subcutaneous tissue with nodular contour. (I) The morphology of skin tumor was similar to that of carcinomatous component of ovarian carcinosarcoma

Fig. 2

Immunohistochemical findings in ovarian carcinosarcoma and metastatic carcinoma in the skin. The carcinomatous component of carcinosarcoma, corresponding to Fig.1C and 1D, was diffusely positive for CK-7 (A and B), whereas the sarcomatous component was positive for CD10 (C). The metastatic carcinoma was positive for WT-1 (D)

Fig. 3

The carcinomatous component of ovarian carcinosarcoma (A and B, corresponding to Fig.1C and 1D) and skin metastatic adenocarcinoma (C, corresponding to Fig.1I) were positive for Pax8 (D-F). ER was diffusely positive in the seromucinous/endometrioid carcinoma (G) and metastatic carcinoma (I) but showed only weak and focal positivity in the high-grade serous carcinoma (H). PR was also diffusely positive in the seromucinous/endometrioid carcinoma (J) but negative in other component (K, L)