A 48-Year-Old Male with Cutaneous Metastases of NUT Midline Carcinoma Misdiagnosed as Herpes Zoster

Abstract

NUT (nuclear protein of the testis) midline carcinoma (NMC) is a rare, poorly differentiated neoplasm with dismal prognosis. Though NMC are often metastatic by the time of presentation, cutaneous metastases have not been well described in the literature. We report a case of NMC in a patient who presented with grouped well-demarcated tender non-ulcerated erythematous nodules on the right mid-back. The lesions were initially diagnosed and treated as herpes zoster. Following failure to improve with antiviral therapy, imaging and skin biopsy revealed that the lesions were in fact cutaneous NUT carcinoma. Although NMC is an uncommon diagnosis, clinicians should be aware that affected patients can develop skin involvement to avoid unnecessary and harmful treatments.

Cutaneous metastasis of nuclear protein of the testis carcinoma: A new presentation of a rare entity

“… 5 Another report described a 48-year-old male smoker with NC of the lung treated with chemotherapy and radiation in whom a persistently painful skin-colored to erythematous dermal plaque developed with grouped, tender nodules on the right side of the back/flank. 6 In contrast, our patient exhibited a solitary nontender, violaceous nodule. He also had a similar tumor origin site and smoking history to the second prior case; however, NC is currently not believed to be associated with any particular risk factors, including smoking, family history, environmental exposures, or infectious agents.…”

“…Among the aforementioned reports with cutaneous involvement, 2 have included clinical descriptions. 4 , 5 , 6 , 7 One report described an 11-year-old girl with NC of the pleura in whom pink-red dermal papules, plaques, and nodules subsequently developed on the right side of her neck, chest, and flank, prior to initiation of treatment. 5 Another report described a 48-year-old male smoker with NC of the lung treated with chemotherapy and radiation in whom a persistently painful skin-colored to erythematous dermal plaque developed with grouped, tender nodules on the right side of the back/flank.…”

“…There has been at least 1 published case of primary cutaneous NC, and 3 cases of NC with cutaneous metastases. 4 , 5 , 6 , 7 We present an additional case of NC metastatic to the skin presenting as a solitary nodule.…”

Genomic profiling of solid tumors harboring BRD4-NUT and response to immune checkpoint inhibitors

“…For example in the first index case, consideration of an NC diagnosis came only on identification of the BRD4-NUT fusion after an initial diagnostic workup that did not include NUT IHC. Similarly, the other cases in this series should be re-evaluated for a diagnosis of NC, including the cases of cutaneous specimens harboring BRD4-NUT as these may be metastatic NC [12] .…”

A 47-year-old woman with nuclear protein in testis midline carcinoma masquerading as a sinus infection: a case report and review of the literature

“…In another case report, a patient presented with a left-sided nasal cavity mass and diplopia [ 18 ], and in another case report there were pleural effusions and subsequently identified bilateral ovarian masses [ 19 ]. These tumors are also commonly confused with infectious processes with reports describing misdiagnoses of tonsillitis in an 8-year-old boy [ 20 ], Epstein–Barr virus (EBV) infection with concomitant Streptococcus superinfection in a 23-year-old man [ 21 ], and herpes zoster (a cutaneous metastasis of NMC) in a 48-year-old man [ 22 ].…”