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KMID : 0363220170550010084
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Korean Journal of Dermatology
2017 Volume.55 No. 1 p.84 ~ p.86
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Non-umbilical Cutaneous Metastasis of Pancreatic Adenocarcinoma
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Kim Hyun-Jee
Choi Jin-Young
Lee Soo-Young
Choo Ji-Yoon
Kim Jin-Wou
Lee Young-Bok
Yu Dong-Soo
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Abstract
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Pancreatic cancer is known to metastasize rapidly. Because clinical symptoms and signs are usually absent until the late stages of the disease, most cases are diagnosed in the advanced stages1,2. Pancreatic cancer most commonly metastasizes to the liver and peritoneum, but metastases to the lungs, bones, brain, lymph nodes, adrenal glands, and kidneys have also been reported3. Cutaneous metastases are uncommon, accounting for only 2.0% of all metastases, but those that do occur are generally located in the periumbilical area and are termed Sister Mary Joseph`s nodules4. Non-umbilical cutaneous metastases are exceedingly rare, with only a small number of cases reported. Herein, we report the rare case of a 71-year-old woman with advanced pancreatic carcinoma who was found to have a metastatic cutaneous lesion on the scalp. A 71-year-old woman with a known history of pancreatic cancer presented with a solitary nodule on the scalp detected 3 weeks previously. The patient had been diagnosed with pancreatic cancer with multiple liver metastases 1.5 years prior to the current presentation, and had undergone subtotal pancreatectomy along with 3 sessions of chemotherapy. On physical examination, an asymptomatic, solitary, domeshaped, erythematous subcutaneous nodule measuring 0.5 cm in size was observed on the scalp (Fig. 1). For diagnostic clarification of the above-mentioned skin lesion, a biopsy was taken for histopathological analysis. The tissue sample showed an infiltrating tumor mass embedded in a desmoplastic stroma in the dermis and subcutis. The tumor mass was composed of moderately differentiated neoplastic glands lined by anaplastic cells, and invasive strands of pleomorphic cells with hyperchromatic, angulated nuclei were seen (Fig. 2A, B). Immunohistochemically, tumor cells stained positive for CK7 and CK19. Staining for CK20 was negative (Fig. 2C∼E). The histopathological diagnosis was consistent with metastatic carcinoma of pancreatic origin, and radiotherapy was initiated. Despite the therapy, the patient`s condition rapidly deteriorated, and she expired after 1 month of treatment. There have been only a few reported cases of cutaneous metastasis of pancreatic cancer. Recognition of this cancer type is important since the prognosis is very poor when untreated, with survival usually less than 4 months4. Chemotherapy or chemoradiotherapy can improve the median overall survival to 6.5 months4. Currently, there are no effective screening modalities for pancreatic cancer, and cutaneous metastases are usually a late finding. If cutaneous lesions are discovered, immunohistochemical staining can be helpful in determining the primary site and predicting the clinical outcome. CK19 shows strong immunoreactivity in pancreatic adenocarcinoma, which makes it a useful diagnostic tool in confirming the pancreatic origin of tumors5. Zapata et al. reported that pancreatic adenocarcinoma showed positive staining for SMAD4 in 80%, CK19 in 100%, and CA19-9 in 100% of selected cases and that the expression of CK19 and CA19-9 was variable in non-pancreatic malignancies. These findings suggest that these markers may assist in confirming the diagnosis of pancreatic adenocarcinoma by differentiating it from other metastatic adenocarcinomas5. Pancreatic cancers have also been reported to express CK7, with variable staining for CK203, and patients who have less intense CK20 staining compared to those with strong CK20 staining have been shown to have better clinical outcomes and increased postoperative survival3. The present case illustrates the importance of considering cutaneous metastasis in any patient with known pancreatic cancer who presents with newly developed skin lesions, even in cases of lesions located in non-umbilical areas. Further investigation including early biopsy is recommended for accurate diagnosis. To the best of our knowledge, this case represents only the second case of cutaneous metastasis of pancreatic cancer in the Korean dermatologic literature.
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KEYWORD
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Cutaneous metastasis, Pancreatic cancer
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