Track: Case Reports

Topic: Neoplasia,Carcinogensis,Tumor Biology

Abstract:

Cutaneous metastases from visceral malignancies are relatively uncommon with an incidence of 5.3%. Cutaneous spread occurs in late-stage disease and may be the initial presenting sign of internal malignancy. Breast carcinoma has the highest incidence of cutaneous metastasis with other primary sites less common. We present a case of a 74-year-old female who initially presented with abdominal pain and painful hemorrhagic papulonodules on the groin and lower abdomen. Imaging showed an enlarging adnexal mass with peritoneal deposits suspicious for an ovarian neoplasm with peritoneal spread. A peritoneal biopsy was performed followed by two cutaneous biopsies, which all revealed nests of malignant cells consistent with a tubo-ovarian carcinoma, specifically high-grade serous carcinoma (HGSC). Immunohistochemical stains supported the diagnosis with positivity for PAX-8, WT1 and aberrant overexpression of p53. The patient was diagnosed with stage IVb disease and neoadjuvant therapy was initiated. Patients with stage IV ovarian carcinoma typically metastasize to the colon, lung/pleura, and distant lymph nodes. Cutaneous metastases are uncommon and estimated at 3.5%. The clinical presentation of metastatic foci are varied with papulonodules classically seen but other appearances such as erythema annulare, herpetiform-pattern nodules and lymphangiosis carcinamatosa have been described. This case highlights an unusual presentation of tubo-ovarian carcinoma with extensive cutaneous involvement at the time of initial presentation. A noninvasive and easily accessible modality, punch biopsies can provide a rapid diagnosis to quickly guide clinical management, especially in the context of an unknown primary.

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Bronwyn Bryant, M.D.