Cutaneous Pancreatic Metastasis: A Case Report and Review of Literature

Abstract

Hisham Zayan Abdel-Hafez, MD, has indicated no significant interest with commercial supporters. C utaneous metastases of pancreatic carcinoma is a rare phenomenon. The most common site of cutaneous metastasis is the umbilicus, which is known as Sister Joseph's nodule. There are scant reports of pancreatic cutaneous metastasis at nonumbilical areas. After reviewing the published literature on this phenomenon by conducting a detailed PubMed search, 16 cases of pancreatic carcinoma with cutaneous metastasis at sites other than the umbilical area were identified. This is a report on a new case of advanced pancreatic carcinoma with cutaneous metastases on the neck. This case represents a scenario that validates that nonumbilical cutaneous pancreatic metastases arise secondary to primary pancreatic cancer located at the head of pancreas. Case ReportA 55-year-old woman was referred to our department with skin lesions that had appeared 3 weeks before on her left neck. On physical examination, there were asymptomatic violaceous nodules and indurated plaques; the remainder of the examination was normal.The patient was admitted to the Oncology Department because of jaundice and general fatigue accompanied by multiple enlarged, firm, nontender left cervical lymph nodes. Routine laboratory testing showed high total and direct bilirubin and high liver enzymes, whereas renal and hepatitis marker tests were within normal ranges. Chest and bone roentgenograms showed no pathological findings. Abdominal ultrasound visualized a mass located at the head of the pancreas measuring 4.6 Â 4.8 cm with multiple enlarged porta hepatis lymph nodes and evidence of dilated intrahepatic biliary radicals and common bile duct. Consequently she was referred for a computed tomography (CT) scan of the abdomen, which revealed enlarged head of the pancreas with a heterogeneous soft tissue mass measuring 5 Â 5 cm with multiple porta hepatis and para-aortic lymph node enlargement with no evidence of hepatic focal lesions. Examination and thorough investigation did not detect metastases elsewhere.Abdominal ultrasound and CT findings were compatible with cancer of the head of pancreas with multiple metastatic abdominal lymph nodes causing common bile duct obstruction. Surgical abdominal exploration revealed a large mass at the head of the pancreas, cholecystojejunostomy and enteroenterostomy were done, but the surgeons did not take a biopsy from the unresectable mass for fear that it would be complicated by a pancreatic fistula.The patient was referred for an evaluation by a dermatologist for skin lesions at the left side of the neck that appeared 3 weeks after starting palliative chemotherapy. Skin and lymph node biopsy were done. Histopathological examination of the lymph nodes revealed metastatic carcinoma, and that of the skin revealed nests of poorly differentiated atypical cells throughout the dermis (Figure 1). Silver stain and chromogranin were negative, whereas epithelial

Cutaneous metastasis from pancreatic cancer: A case report and systematic review of the literature

“…Pancreatic cancer has the ability to metastasize to all cutaneous tissue, most frequently to the umbilicus. Non-umbilical cutaneous nodules have also been observed on the scalp ( 4 ), neck ( 14 ), temple ( 5 ), thorax, epigastric region and axilla ( 15 , 16 ). Local surgery is closely associated with the site of the cutaneous metastases of pancreatic cancer.…”

Metastatic Pancreatic Adenocarcinoma to Umbilical Skin

“…Metastasis of internal tumors to umbilical skin, known as Sister Mary Joseph nodule (SMJN), is uncommon [ 1 , 2 ]. The metastasis to the umbilical skin is more common than other parts of the skin [ 3 , 4 ].…”