Ann Dermatol.  2014 Oct;26(5):624-627. 10.5021/ad.2014.26.5.624.

Alopecia Neoplastica due to Gastric Adenocarcinoma Metastasis to the Scalp, Presenting as Alopecia: A Case Report and Literature Review

• Kim JH
• Kim MJ
• Sim WY
• Lew BL

• KMID: 2265500
• DOI: http://doi.org/10.5021/ad.2014.26.5.624

Abstract

Alopecia neoplastica is defined as hair loss secondary to a visceral malignancy that has metastasized to the scalp. The scalp is a relatively common site of cutaneous metastasis, usually presenting as a single or multiple firm scalp nodules. Alopecia neoplastica is a well-recognized but rare presentation, and its pathogenesis is incompletely understood. Atrophy of the hair follicles due to tumor invasion of the scalp plays a role in the development of alopecia. Herein, we describe a 33-year-old woman with gastric adenocarcinoma who developed alopecia neoplastica while receiving cancer chemotherapy. Scalp biopsy revealed metastatic adenocarcinoma cells interspersed between collagen bundles and around hair follicles. Immunohistochemical analysis indicated that the tumor cells originated from the primary gastric adenocarcinoma. Therefore, she was diagnosed with alopecia neoplastica due to gastric adenocarcinoma. The findings from this report may be helpful for understanding the mechanism of alopecia neoplastica.

Keyword

Alopecia neoplastica; Gastric adenocarcinoma; Scalp metastasis

MeSH Terms

Adenocarcinoma*
Adult
Alopecia*
Atrophy
Biopsy
Collagen
Drug Therapy
Female
Hair
Hair Follicle
Humans
Neoplasm Metastasis*
Scalp*
Collagen

Figure

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  Fig. 1 Subcutaneous nodule covered with erythematous, hairless patch on the frontal scalp.

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  Fig. 2 (A) Histologic examination revealed decreased pilosebaceous units and scattered, infiltrated tumor cells around hair follicles, upper and mid-dermis (H&E, ×40). (B) Metastatic adenocarcinoma cells were interspersed between collagen bundles and around hair follicles (H&E, ×200). (C) Tumor cells were positively stained against tumor marker MSH-2 (MSH-2, ×200).

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  Fig. 3 (A) Total gastrectomy specimen shows many signet ring cells (H&E, ×200). Signet ring cells are magnified in inset (H&E, ×400). (B) There are poorly differentiated tumor cells either (H&E, ×200). (C) Part of poorly differentiated tumor cells were positively stained against tumor marker MSH-2 (MSH-2, ×200). (D) Whole body fusion positron emission tomography scan performed after diagnosed with stomach cancer shows abnormal FDG uptake on stomach and rectosigmoid. Following colonoscopy and colon biopsy revealed no other malignancy.

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