Metastatic transitional cell carcinoma mimicking zoster sine herpete

Zosteriform Metastasis: Case Presentation and Review of the Literature

“…While the precise route of metastasis in this patient remains speculative, the unusual distribution and location over the initial lung mass would suggest either a neural route or direct infiltration of cancer cells. As hypothesized by Jaworsky and Bergfeld, 7 we feel that our patient had tumoral invasion of a dorsal root ganglion. Hematogenous metastases of carcinoma to the dorsal root ganglia without invasion of the central nervous system have been reported, and presumably occur because the vascular endothelium of the dorsal root ganglia is fenestrated and consequently provides no blood/ganglion barrier 14 .…”

“…In 1966, Brownstein and Helwig made reference to a patient “with unilateral sclerodermoid lesions in zosteriform distribution to the lower abdomen from carcinoma of the ipsilateral ovary.” 5 However, it was not until more than 20 years after Bluefarb et al's original article that Hodge et al presented a case of thoracic zosteriform metastasis from bronchogenic adenocarcinoma 6 . A lag ensued until Jaworsky and Bergfeld reported an additional case in 1986, the latter an instance of thoracic zosteriform metastases due to transitional cell carcinoma of the bladder 7 . We believe our patient to be the fifth case of zosteriform metastasis to be reported in the dermatologic literature.…”

Zosteriform and Epidermotropic Metastasis

“…Many skin diseases have been described as occurring in a dermatomal pattern (reviewed in detail in Cohen 5 ), but only a few cases of zosteriform metastases have been previously reported (Table l) 6–18 . In our two cases, as in some of the cases from the literature, the dermatomal distribution of vesicular lesions resembled herpes zoster.…”

“…Bluefarb et al 18 described metastases in a zosteriform distribution over the flank caused by perineural lymphatic spread. Other authors believe the tumoral invasion of the dorsal root might explain the zosteriform distribution 14,17 . In our first case, the proximity of the metastases to the primary carcinoma all suggest a direct lymphatic infiltration of cancer cells.…”

Zosteriform metastatic melanoma

“…The patho-physiological background for zosteriform metastases may be a "Köebner-like" phenomenon in areas of recent herpes zoster infection, 8,9 trauma, 10 via the fenestrated vessels of the dorsal root ganglion, 11 or metastatic spread by perineural lymphatic invasion. 2,3 Our case evidently represents the infiltration of cancer cells into the lymphatic vessels, which might explain the mechanism of zosteriform distribution.…”