Atypical Carcinoid Metastasis to the Skin

Abstract

Carcinoid tumors are derived from neuroendocrine cells, and are most frequently found in the gastrointestinal tract and bronchopulmonary system. Cutaneous involvement of carcinoid tumors is relatively rare, with isolated case reports in the literature. We detail a patient with stage IV pulmonary atypical carcinoid tumor with skin metastasis. This case is unusual because the patient did not have any erythema or induration of the scalp, only a complaint of pain. On biopsy, the tumor cells had cytologic features of a carcinoid tumor, but were arranged as infiltrating cords, small aggregates and single units, rather than the organoid or trabecular pattern seen in the primary tumor. Further, along with neuroendocrine markers, the tumor cells had the staining pattern of cytokeratin 7+/cytokeratin 20-/thyroid transcription factor-1+, supporting a carcinoid tumor of lung origin. Thus, this case of skin metastasis from an atypical pulmonary carcinoid tumor illustrates a unique clinical and histologic presentation.

Well‐differentiated neuroendocrine tumors in skin: Terminology and diagnostic utility of cytokeratin 5/6 and p63

“…One of the cases in our series (case 4) showed clear cell change. These architectural features are similar to what has been described in the literature …”

Alopecia neoplastica as a sign of visceral malignancies: a systematic review

“…Regarding the primary site of malignancy, gastrointestinal (GI) tract accounted for 24.4% (30/123), 2,14,16,23,30,32,33,36,46,48,49,56,61,63,64,71,78,79,83,84,88,93,96,98,101,102,105,106,115,118 breast for 17.9% (22/123) of cases, 4,6,7,10,11,13,15,[17][18][19]26,27,29,34,35,37,44,66,67 kidney for 8.1% (10/123), lung for 7.3% (9/ 123), 25,38,43,<...>…”

“…Regarding clinical appearance, AN was identified as a nodule, plaque and patch in 58% (69/119), 8,9,21,22,24,27,33,34,37-41,43,44,46,47,49- 2,6,7,11,[14][15][16][17][18][19][20]23,25,29,67,96 respectively; under the general term of a 'mass' in 16.8% (20/119) 28,32,35,42,45,48,58,59,71,73,80,81,83,87,95,106,110,111,114,117 and as an 'excoriated lesion' in 2.5% (3/119) of cases. 69,78,109 Specifically, breast cancer was mainly associated with patch lesions (9/20), followed by plaques and nodules (five and five out of 20, respectively).…”

“…Ulceration (histologically diagnosed) was present in 31 out of 94 cases (33%), 13,15,26,[28][29][30][31]34,38,42,46,52,56,60,68,69,72,[76][77][78]80,84,92,95,97,102,106,109,114,116,117 with a higher incidence in AN related to lung cancer (4/5 cases). 68,69,72,77 The main colour of AN lesions was red-violaceous (66.7% -66/99), 2,4,6,8,9,12,13,15,17,20,21,27-29,34,40,42,43,46,47,50,53,55,57,59,61,63,65,67,68,70,71,73,75,76,78,80,83,85-89,91-93, 95-100,102,104,105,108-110,113,115-118,120,121 followed by flesh-coloured in 25.3% (25/99) 10,11,14,16,19,[23][24][25]32,33,36,45,…”

“…4,12,29,60,63,64,71,76,89,91,120 In 16 out of 94 cases, two sites were involved, 10,21,26,28,32,39,47,54,57,61,73,74,79,84,113 being the frontal and parietal areas the most frequently involved with six cases; finally, in six cases, the involvement of three scalp sites was reported, 14,20,34,58,59,109 and in two cases, it was defined as diffuse. [18][19][20][21][22][23][24][25] Concerning the association between site of the scalp and primary tumour, no metastasis from lung and uterus cancers involved the frontal area alone, whereas one case of uterus cancer had a temporal-parietal-frontal distribution and one case of lung cancer was defined as diffuse. Moreover, AN cases involving only the parietal area mainly derived from GI tumours (6/19).…”