Track: Clinical Studies

Abstract:

Ovarian adenocarcinoma is an aggressive malignancy that rarely metastasizes to the skin, occurring in only about 2.5% of patients¹. Cutaneous metastases of ovarian adenocarcinoma traditionally present on the abdominal wall. Some of the clinical patterns that have been described are dermal or subcutaneous nodules, Sister Mary Joseph Nodules, and carcinoma erysipeloides. Diagnosis relies heavily on histopathological evaluation, which typically reveals dermal infiltration by glandular neoplastic cells forming cribriform structures containing mucin. Ovarian carcinoma may also demonstrate psammoma bodies within papillary structures. Immunohistochemical markers play a crucial role in confirming ovarian origin, with positive staining for CA125, CK7, ER/PR, mesothelin, WT-1, and PAX8, while CK20 and TTF-1 often remain negative. We report a case of a woman in her late 70s who presented to the outpatient dermatology office in August 2024 with 2 months of progressive painful, pruritic lesions on her superior left chest wall as well as edema of the left upper extremity. Physical examination revealed scattered purpuric macules and patches ranging between 0.4cm-2.5cm overlying her left chest. The differential diagnosis encompassed a broad range of vasculopathies versus vasculitidies. Punch biopsy was performed, revealing changes consistent with metastatic adenocarcinoma including intravascular tumor cells immunopositive for CK7 and immunonegative for CK20. PD-L1 mutation was also present. She reported she had ovarian adenocarcinoma twelve years prior but had achieved remission with total abdominal hysterectomy with bilateral salpingoophorectomy, and carboplatin-paclitaxel. This case highlights a novel purpuric presentation of cutaneous ovarian adenocarcinoma metastasis and the aid of dermatopathology in achieving accurate diagnosis.

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Janine Malone