Cutaneous metastases from primary internal malignancies represent 0.7-9% of
patients with cancer. We report a 65-year-old female patient referred for
evaluation of normochromic papules on the trunk and upper limbs that had been
present for three months. A skin biopsy revealed diffuse cutaneous infiltration
by small round cell tumors. Immunohistochemistry was positive for AE1/AE3, CK7,
estrogen receptor and mammaglobin. The final diagnosis was cutaneous metastasis
of occult breast cancer, since the solid primary tumor was not identified. The
location of the primary tumor can not be determined in 5-10% of cases. In these
cases, 27% are identified before the patient’s death, 57% at autopsy, and the
remaining 16% can not be located.
Blue nevus is a benign melanocytic lesion, typically asymptomatic and of unknown
etiology. Many histological subtypes are recognized, the most commons being:
common blue nevus, cellular blue nevus, and combined blue nevus. New rare
variants have been described in the literature, with emphasis on eruptive blue
nevus, plaque, agminate, linear, with satellitosis, disseminated, familial and
targetoid. The diagnosis of blue nevus usually presents no difficulties,
however, the presence of structures such as irregular edges or satellitosis, are
highly suggestive of malignancy, and the differential diagnosis with malignant
blue nevus and melanoma with peripheral spread should be considered. We report a
case of blue nevus with satellitosis in a 15-year-old female patient.
CONTEXT: Carney complex (CNC), a familial multiple neoplasm syndrome with dominant autosomal transmission, is characterized by tumors of the heart, skin, endocrine and peripheral nervous system, and also cutaneous lentiginosis. This is a rare syndrome and its main endocrine manifestation, primary pigmented nodular adrenal disease (PPNAD), is an uncommon cause of adrenocorticotropic hormone-independent Cushing's syndrome. CASE REPORT: We report the case of a 20-year-old patient with a history of weight gain, hirsutism, acne, secondary amenorrhea and facial lentiginosis. Following the diagnosing of CNC and PPNAD, the patient underwent laparoscopic bilateral adrenalectomy, and she evolved with decreasing hypercortisolism. Screening was also performed for other tumors related to this syndrome. The diagnostic criteria, screening and follow-up for patients and affected family members are discussed.
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