Inflammatory Cutaneous Metastasis from Rectal Adenocarcinoma

Abstract

Key words: Rectal adenocarcinoma; Inflammatory cutaneous metastasis] Melis M, Scintu F, Marongiu L, Mascia R, Frau G, Casula G. Inflammatory cutaneous metastasis from rectal adenocarcinoma: report of a case. Dis Colon Rectum 2002;45:562-563.C utaneous metastases occur in fewer than 4 percent of patients with colorectal adenocarcinoma. 1 Inflammatory cutaneous metastasis (ICM) is a rare subset of neoplastic disease, most often seen in patients with breast cancer, that usually presents clinically as a zone of pink, deep-red, or purplish-red indurated erythema with a well-demarcated border. 2 We recently observed a case of ICM that originated from a rectal cancer. REPORT OF A CASEA previously healthy 41-year-old male was referred to our department for a rectal adenocarcinoma that invaded the anal sphincter. Computed tomographic scan and endorectal ultrasound showed infiltration of the prostate and multiple metastases in both hepatic lobes; the patient underwent neoadjuvant chemoradiotherapy. A few weeks after completion of treatment, he developed an erythematous, well-demarcated eruption over the anterior pelvic region and the perineum. The eruption rapidly formed confluent erythematous plaques that were associated with pain and severe edema of scrotum, penis, and perineum (Fig. 1). Lymphedema of the lower extremities was not present; enlarged lymph nodes were palpable in both groins. Imaging did not reveal further dissemination of the disease, compared with the previous staging; specifically, no direct extension of the primary tumor to the abdominal or pelvic wall was noted. Biopsies of the skin showed metastasis of adenocarcinoma, with widespread dermal invasion and tumor cells plugging both lymphatic and vascular vessels. In the absence of tumor-related complications, we thought that surgery would be of no benefit to the patient in terms of survival and quality of life, and for this reason, he did not undergo surgery. DISCUSSIONCutaneous metastases very seldom present as erythematous, warm, well-demarcated and indurated

Skin metastasis: a pathologist's perspective

“…This type of metastasis is frequently observed in patients with breast carcinomas 59 . Also, it can be encountered during the course of carcinomas of the esophagus, larynx, stomach, pancreas, lung, parotid, tonsils, ovary, uterus, prostate, rectum and salivary glands 16,40,112,137–139 . En cuirasse metastatic carcinoma is characterized by a diffuse morphea‐like induration of the skin 126 .…”

Colorectal Carcinoma metastasizing to Scrotum: A series of five cases with unusual presentation and late recurrences from a single tertiary oncology centre of India

“…Very rarely they can present as warm erythematous indurated plaques simulating erysipelas, lymphangitis, or cellulitis. It is only after the failure to respond to antibiotics and local therapy in the absence of leukocytosis and fever; that a biopsy or excision is performed unravelling the diagnosis of metastatic disease [12]. Two of our cases presented as ulcers over the scrotum, one presented as a skin papilloma and another case had a nodule over the scrotal skin.…”

Cutaneous and Subcutaneous Metastases of Adenocarcinoma of the Colon and Rectum

“…WT's and TW's metastases were inflammatory in nature. To our knowledge, this inflammatory type of cutaneous metastases arising from rectal cancer has been only described 3 times previously 4,8 and is a zone of deep red or purplish red indurated erythema with a well demarcated border. The oedema and erythema were suggested to arise from retrograde tumour spread leading to capillary congestion combined with partial vascular and lymphatic obstruction.…”