Epithelioid malignant mesothelioma metastatic to the skin: A case report and review of the literature

Abstract

Malignant mesothelioma (MM) is an aggressive and invasive neoplasm primarily affecting the pleura, peritoneum and pericardium. While mesothelioma commonly metastasizes to visceral organs, it has rarely been documented to involve the skin and subcutaneous tissue. There is a paucity of reports of cutaneous metastatic mesothelioma, and histologic examination is often challenging because the tumor closely mimics other primary and metastatic neoplasms. We report a case of a 75-year-old man presenting with a firm, hard nodule on his upper back, which on initial histologic evaluation resembled metastatic adenocarcinoma. However, upon review of his medical history and immunohistochemical evaluation of the lesion, the diagnosis of epithelioid MM metastatic to the skin was rendered. The purpose of this case report and review of the literature is to summarize the most effective available immunostains to aid in the diagnosis of this challenging entity, highlight the histologic similarities between metastatic epithelioid MM and other primary and metastatic neoplasms of the skin, and provide prognostic information for these rare tumors.

Metastasis of Sarcomatoid Malignant Mesothelioma With p16/CDKN2A Deletion Presented as a Subcutaneous Mass in the Back: a Case Report and Review of Literature

“…As we noticed, there were lymph nodes, subcutaneous and brain metastases in this case. The disseminating routes of MM are direct invasion, lymphatic and hematogenous spread [23]. The solitary mass in the back was probably via hematogenous in this case.…”

“…The solitary mass in the back was probably via hematogenous in this case. To our knowledge, there are 18 case reports of cutaneous or subcutaneous metastases from MM [4][5][6][23][24][25][26][27][28][29][30][31][32][33][34][35][36] (Fig. 6), but only 3 sarcomatoid type of MM among them [4][5][6].…”

Distant cutaneous metastasis of malignant epithelioid mesothelioma

“…Cutaneous metastasis to distant sites, on the other hand, is rare. To our knowledge, there are only 17 reported cases of pleural mesothelioma with distant cutaneous metastases including 14 cases to head and neck 4‐16 and 3 cases to trunk, 21‐23 as in our cases (Table 1). Among 14 cases metastasizing to head and neck area, epithelioid morphology was seen in 6 cases, sarcomatoid (spindle) and mixed/biphasic morphology in 3 cases each, and unreported or unknown morphology in 2 cases.…”

When the Diagnosis of Mesothelioma Challenges Textbooks and Guidelines

“…Even more rarely, the clinical onset of MPM may be represented by symptoms related to the presence of distant metastases; though rare, several organs have been reported as metastatic sites, such as bone marrow [ 54 ], bone [ 55 ], breast [ 56 ], head and neck [ 57 ], intestine [ 58 ], kidney [ 59 ], liver [ 60 ], muscle [ 61 ], orbit [ 62 ] pancreas [ 63 ], oral cavity [ 64 ], skin [ 65 , 66 , 67 ], and brain [ 68 ]. Unexpectedly, different case series demonstrate that brain metastasis occurs in about 4–5% of MPM [ 69 ].…”