Histologic Patterns of Cutaneous Metastases of Breast Carcinoma: A Clinicopathologic Study of 232 Cases

Ronen, Shira; Suster, David; Chen, Wei-Shen; Ronen, Natali; Arudra, Sri Krishna Chaitanya; Trinidad, Celestine; Ivan, Doina; Prieto, Víctor G.; Suster, Saul

doi:10.1097/dad.0000000000001841

Cited by 6 publications

(13 citation statements)

References 31 publications

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“…In two meta‐analyses, up to 49.4% 15,16 of the metastases had a loss of progesterone receptor expression and up to 23% 15,16 loss of oestrogen receptor expression. The gain in HER2 receptor expression was present in our study in two of the tested cases (7.7%; 2/26), comparable to the previously published study 12,16 . This stresses again the importance of redetermination of the hormone receptor status in case of a metastasis 15,16 …”

Section: Discussionsupporting

confidence: 90%

“…According to the literature, most skin metastases are locoregional 9,10,12–14,18 . However, in our study, in the male patients, more than 60% were distant metastases.…”

Section: Discussioncontrasting

confidence: 50%

“…This difference was statistically significant and could be attributed to the frequent locoregional skin metastases of breast carcinomas in women, which is in concordance with other studies. 12 The lymphatic system in the breast, which makes connections to the axillary, parasternal, intercostal, and clavicular lymph nodes and their respective dermal lymphatic vessels can probably be accounted for these locoregional metastases. 12 Thirty-one percent of the cases were metastases to the head and scalp, especially metastatic lung and gastrointestinal tumours, but also some metastatic leiomyosarcomas and head and neck tumours.…”

Section: Discussionmentioning

confidence: 99%

“…12 The lymphatic system in the breast, which makes connections to the axillary, parasternal, intercostal, and clavicular lymph nodes and their respective dermal lymphatic vessels can probably be accounted for these locoregional metastases. 12 Thirty-one percent of the cases were metastases to the head and scalp, especially metastatic lung and gastrointestinal tumours, but also some metastatic leiomyosarcomas and head and neck tumours. It has been suggested that the vertebral venous system, which can supplement blood to the scalp and which parallels and partially bypasses the portal, caval, and pulmonary veins, plays a role in head and scalp metastases from abdominal internal malignancies.…”

Section: Discussionmentioning

confidence: 99%

“…The definitions used of locoregional metastases per organ (system) are described in Table 1. These definitions were based on the anatomical features, regional lymph nodes, and previously published data 9,12–14 …”

Section: Methodsmentioning

confidence: 99%

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Cutaneous metastases of internal malignancies: a single‐institution experience

Vernemmen

Roemen

et al. 2022

Histopathology

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Aims Cutaneous metastases of internal malignancies occur in 1–10% of cancer patients. The diagnosis can sometimes be challenging, especially in cases with an unknown primary cancer. Materials and methods A retrospective case review was performed including all cases of skin metastases from primary internal malignancies diagnosed at the Department of Pathology at the Maastricht University Medical Centre+ from 2007 to 2021. The clinicopathological data were collected and immunohistochemical and molecular diagnostic tests were performed to confirm the primary origin of the metastases. Results We identified 152 cases (71 female; 31 male patients) of cutaneous metastases of internal malignancies. 28 patients (20 women and 8 men) were diagnosed with multiple cutaneous metastases. Among the female patients, the most common primary tumour was breast cancer (50% of the cases), followed by lung (13.6%), gynaecological (7.3%), and gastrointestinal origin (7.3%). Among the male patients, the most common primary sites were gastrointestinal and lung origin (altogether, 50% of the cases). In 19 patients, the cutaneous metastasis was the first presentation of a clinically silent internal malignancy (18.6%), of which most (78.9%) represented metastatic lung carcinomas. Finally, metastasizing patterns were different across tumour types and gender. Conclusion Breast, lung, gastrointestinal, and gynaecologic cancers are the most common primary tumours demonstrating skin metastases. Infrequently, cutaneous metastases can be the first clinically visual manifestation of an underlying not yet diagnosed internal malignancy; therefore, occasional broad immunohistochemical profiling, molecular clonal analysis, and a continuous high level of awareness are necessary for a precise diagnosis of cutaneous metastases of internal malignancies.

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Section: Discussionsupporting

confidence: 90%

“…According to the literature, most skin metastases are locoregional 9,10,12–14,18 . However, in our study, in the male patients, more than 60% were distant metastases.…”

Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Cutaneous metastases of internal malignancies: a single‐institution experience

Vernemmen

Roemen

et al. 2022

Histopathology

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Predictors and outcomes of cutaneous metastatic breast carcinoma: a retrospective, single-institution review

Choo,

2023

Arch Dermatol Res

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Breast carcinoma is among the most common visceral malignancies to metastasize to the skin, but few studies have comprehensively characterized the patient and breast cancer-speci c features of cutaneous metastases of primary breast carcinoma (CMBC). In this case control study, we identi ed key clinical, histopathologic, and molecular features of CMBC within a large, single-institution cohort. We further strati ed between locoregional and distant cutaneous metastases to identify possible predictors of the eventual skin phenotype. Ninety-four (94) histologically con rmed cases of CMBC biopsied between January 2005 and December 2021 were identi ed via review of the University of Chicago Medicine pathology report database. Of these, 37 were locoregional and 57 were distant cutaneous metastases.The mean duration between diagnosis of breast cancer and CMBC was 7.02 years (range, 0-37 years). Histologically, most primary breast tumors were invasive ductal carcinomas (IDC; 82.2%). On subgroup analysis, older age and underlying invasive lobular carcinoma (ILC) were signi cantly associated with distant patterns of CMBC (P = 0.026 and 0.008, respectively). Notably, patients with distant CMBC also demonstrated worse functional status, more recalcitrant disease, and higher mortality than those with locoregional CMBC. Our analysis represents one of the largest cohorts to date of CMBC and highlights the importance of longitudinal skin surveillance in the detection of CMBC. Furthermore, our ndings suggest that the primary breast cancer subtype may in uence the eventual presentation of metastatic disease to the skin, a novel nding that warrants further exploration.

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