Cutaneous scalp metastases from retroperitoneal leiomyosarcoma: a case report

Abstract

A 71-year-old woman presented with five scalp nodules that were clinically suspicious for pilar cysts. Histopathologic examination showed a proliferation of mitotically active pleomorphic spindle cells arranged into intersecting fascicles in the dermis and subcutis. Tumor cells displayed deeply eosinophilic cytoplasm and expressed desmin but were negative for S100 protein by immunohistochemistry. Before 10 years, the patient was diagnosed with high-grade retroperitoneal leiomyosarcoma and underwent resection with intraoperative radiation. Metastatic disease involving the lungs, liver and soft tissue developed, requiring treatment with resections, radiation and chemotherapy. Owing to the presentation of multiple scalp nodules with microscopic features of leiomyosarcoma in conjunction with the clinical history of retroperitoneal leiomyosarcoma, a diagnosis of metastatic leiomyosarcoma was made. Scalp metastasis from retroperitoneal leiomyosarcoma is extremely rare and portends a poor prognosis. To our knowledge, only two other cases have been reported in the English literature, and a further search discovered only nine additional cases of scalp metastasis from soft tissue leiomyosarcoma of any non-gynecologic anatomic site. This case highlights the striking microscopic similarity between primary cutaneous and metastatic leiomyosarcoma and illustrates the necessity of adequate clinical information and an appropriate index of suspicion in excluding the possibility of cutaneous metastases of leiomyosarcoma from somatic soft tissue.

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

“…Median time between primary tumour and AN diagnosis was 10 months (ranging from 0 to 240 months; IQR: 0-36). Finally, AN was the first metastatic event in 65 cases, 6,9,11,12,16,17,[19][20][21][22]24,28,34,36,37,39,41,51,54,56,60,62,67,70,72,[74][75][76][77]79,80,84,86,92,93,109,115,[117][118][119]121 with a median number of 1 lesion (ranging from 1 to 8) and a median diameter of 3 cm (ranging from 1 to 20 cm; IQR:1.5-4.7).…”

“…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).…”

“…Treatment of the primary tumour was reported in 84 performed treatment (alone in 23 cases; combined with surgery or radiotherapy, respectively, in 11 and 10 cases), followed by surgery (alone in 24 cases; combined with chemotherapy or radiotherapy, respectively, in 11 and three cases). 2,4,8,13,20,[22][23][24][29][30][31]33,[35][36][37][38][39]51,53,54,66,67,76,77,80,84,93,95,99,104,109,110,112,115…”

Retromammary fat, axillary and arm metastases from a retroperitoneal leiomyosarcoma: report of a case with an indolent behaviour

“…Cutaneous metastasis, although very rare, may also occur. It is usually a late event and heralds a poor prognosis [ 3 ]. We present a case of a 46-year-old woman who developed subcutaneous metastases to the axilla, arm, and breast after surgical resection of the primary tumour.…”