Korean J Gastroenterol.  2016 Oct;68(4):221-224. 10.4166/kjg.2016.68.4.221.

Non-umbilical Cutaneous Metastasis of Pancreatic Adenocarcinoma as the First Clinical Manifestation: A Case Report

• Moon JI
• Park JY
• Jeon TJ
• Choi JM
• Shin WC
• Sung JM
• Kim YM
• Kim HJ

• KMID: 2383520
• DOI: http://doi.org/10.4166/kjg.2016.68.4.221

Abstract

Non-umbilical cutaneous metastases from pancreatic adenocarcinomas are extremely rare. Only a few cases have been reported in the literature. An 83-year-old Korean woman, with no previous medical history, presented with a painful nodule on her scalp. Histologic examination of the nodule revealed a metastatic adenocarcinoma, and immunohistochemical staining was positive for cytokeratin (CK) 7 and CK 19. These findings were consistent with a metastatic carcinoma of pancreatic origin. An abdominal computed tomography scan identified a mass on the pancreatic head and multiple enlarged lymph nodes. Pathological examination of an endoscopic ultrasound-guided fine needle biopsy of the pancreatic mass determined that it was a poorly differentiated carcinoma. The patient refused any treatment owing to her old age and short life expectancy. Four months later, the disease progressed rapidly, and the patient died.

Keyword

Pancreatic neoplasms; Cutaneous; Neoplasm metastasis; Immunohistochemistry

MeSH Terms

Adenocarcinoma*
Aged, 80 and over
Biopsy, Fine-Needle
Female
Head
Humans
Immunohistochemistry
Keratins
Life Expectancy
Lymph Nodes
Neoplasm Metastasis*
Pancreatic Neoplasms
Scalp
Keratins

Figure

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  Fig. 1. Erythematous plaque with a central plug is seen on the scalp.

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  Fig. 2. (A) Histology section of the scalp lesion. The nodule is highly cellular and infiltrating towards the fat lobule. (B) Ductal proliferation with severe nuclear atypia, frequent mitoses, intraluminal necrotic debris (asterisk), and intracytoplasmic mucin vacuoles (arrow), suggestive of high-grade adenocarcinoma. (C) Diffuse and strong staining for cytokeratin 7 in the tumor cells, supportive of a ductal type carcinoma (such as pancreas, breast, or biliary).

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  Fig. 3. Abdominal CT scan shows a 1.4-cm, ill-defined, ovoid, low-density lesion (arrow) in the pancreatic head with upstream pancreatic duct dilatation.

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  Fig. 4. (A) The needle biopsy from the pancreatic head mass shows loosely cohesive atypical epithelial cells, embedded in a blood-tinged fibrin clot (H&E, ×40). (B) Pleomorphic tumor cells with vesicular nuclei and several prominent nucleoli. Occasional atypical mitoses are indicated (arrow) (H&E, ×400).

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  Fig. 5. (A) Abdominal CT scan taken three months after the diagnosis shows the increased size (4.1 cm) of the pancreatic head mass with upstream pancreatic duct dilatation (white arrow). (B) Multiple newly detected metastases to the liver (black arrows).

Reference

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