Metastatic transitional cell carcinoma mimicking zoster sine herpete

Jaworsky, C.

doi:10.1001/archderm.122.12.1357

Cited by 23 publications

(27 citation statements)

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“…Zosteriform metastases are cutaneous metastases, which occur in a dermatomal distribution, suggesting herpes zoster. A total of 26 cases of zosteriform metastases (18 due to internal malignancies, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] four due to squamous cell carcinoma of the skin, 17-20 three due to melanoma [21][22][23] and one due to an adnexal neoplasm 11 ) have been reported. A review of these cases reveals an average patient age of 61.6 years.…”

Section: Discussionmentioning

confidence: 99%

“…25 This is thought to occur because the vascular endothelium of the dorsal root ganglia is fenestrated and does not provide a blood-ganglion barrier. 7 In summary, we present a case of zosteriform skin metastases occurring on the leg of a patient with adenocarcinoma of the lung. This case highlights the importance of including cutaneous metastasis in the differential diagnosis of patients with nonhealing herpes zoster-like lesions, especially in those with a known underlying neoplasm.…”

Section: Discussionmentioning

confidence: 99%

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Zosteriform skin metastases

et al. 2004

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A 66‐year‐old woman was referred for evaluation of a rash on the leg. She had a 1‐year history of stage IV bronchogenic adenocarcinoma with previous metastases to the right first metatarsal‐phalangeal (MTP) joint and a left supraclavicular lymph node. She underwent six cycles of chemotherapy with paclitaxel (Taxol; Bristol‐Myers Squibb Company, Princeton, NJ, USA) and carboplatin (Paraplatin; Bristol‐Myers Squibb Company, Princeton, NJ, USA) as well as palliative radiation therapy to the metastasis sites. One month after completing radiation therapy, the patient developed a nonpainful rash on the right thigh. This eruption was treated as a herpes zoster infection by her internist with 3 weeks of valcyclovir (Valtrex; Catalytica Pharmaceuticals, Greenville, NC, USA), but without improvement. One month later the leg became painful and swollen and the rash spread up the thigh to involve the groin and vulva. The patient was referred to the dermatology department. Physical examination revealed multiple red, indurated, crusted papules and nodules involving the medial, anterior, and lateral right thigh, labia majora, and suprapubic area. The lesions were grouped and arranged in a dermatomal zosteriform distribution (Fig. 1). There was a visible peau d’orange appearance of the right leg with pitting edema. A punch biopsy showed irregular islands of atypical glandular epithelial cells infiltrating the superficial and deep dermis, consistent with metastatic adenocarcinoma (Fig. 2a). Immunohistochemistry showed positive staining to thyroid transcription factor (TTF) and cytokeratin 7 (Fig. 2b and c). The tissue did not stain with progesterone receptor, estrogen receptor, or gross cystic disease fluid protein (BRST‐2). This immunostaining pattern was identical to previous biopsies of the right first MTP joint and left supraclavicular lymph node metastases and is consistent with adenocarcinoma of the lung. 1 Eruption on the right thigh with grouped papules and nodules arranged in a zosteriform pattern 2 (a) Punch biopsy showing irregular islands of atypical glandular epithelial cells within the dermis (hematoxylin and eosin; original magnification × 100). (b) Positive staining with thyroid transcription factor (original magnification × 40). (c) Positive staining with cytokeratin 7 (original magnification × 40)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Zosteriform skin metastases

et al. 2004

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“…The mechanism of zosteriform distribution in metastatic skin cancer is still speculative. It has been suggested that it might be due to: (1) a ‘Köbner-like’ reaction at the site of prior herpes zoster infection; (2) perineural lymphatic spread [3]; (3) via the fenestrated vessels of the dorsal root ganglion [5], or (4) accidental surgical implantation [1, 7]. Prior herpes zoster infection might cause ‘locus minoris resistentiae’ (site of lessened resistance), as has been reported in cases of leukemia cutis [7].…”

Section: Discussionmentioning

confidence: 99%

Zosteriform Metastatic Skin Cancer: Report of Three Cases and Review of the Literature

2001

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Background: Metastatic skin cancer is a rare complication of internal malignancies. Patients who do develop skin metastases seldom present with a zosteriform distribution. Objective: To elucidate the characteristics of zosteriform metastatic skin cancer, 15 cases from the medical literature and 3 cases seen in our clinic were reviewed clinically and histopathologically. Methods: The age and sex of each patient, site of the primary tumor, pathology of primary and metastatic lesions, location of the skin cancer and presence of pain were determined for the 18 cases of zosteriform skin cancer. Results: The most frequent site of the primary tumor was the breast (4 cases), ovary or lung (3 cases each), prostate, bladder or stomach (2 cases each) and uterus or colon (1 case each). The most common site of the skin metastases was the chest wall (8 cases) and abdominal wall (7 cases). The histology of the primary lesion was compatible with adenocarcinoma (10 cases), transitional cell carcinoma or serous papillary cystadenocarcinoma (2 cases each) and ductal carcinoma (1 case). Eleven cases developed on the nearest covering skin and/or on the same side as the primary tumor. Eleven patients complained of pain. Seven cases were treated as herpes zoster with antiviral agents. Conclusion: Approximately 50% of cases of metastatic skin cancer developed on the nearest skin covering and on the same side as the primary tumor. This evidence may be useful when trying to pinpoint the location of the primary tumor. One third of patients with skin metastases were misdiagnosed and their lesions were treated initially as herpes zoster. When a band-like eruption is seen in patients with internal malignancies, the possibility of metastatic skin lesions should be considered. A skin biopsy is necessary to confirm the diagnosis.

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“…12 Perineural lymphatic invasion may also explain the zosteriform distribution as described with prostate carcinoma by Bluefarb et al 8 Alternatively Jaworsky hypothesized spread via the fenestrated vasculature of the dorsal root ganglion. 13 In addition, the nonrandom localization of metastatic lesions could be explained by spread via lymphatic and haematogenous routes.…”

Section: Reportmentioning

confidence: 99%