Zosteriform skin metastasis caused by retrograde lymphatic migration of metastatic squamous cell lung carcinoma

Abstract

Background Zosteriform skin metastasis (ZSM) is rare, and its etiology is not well understood. ZSM is possibly derived from the retrograde movement of cancer cells through the lymphatic vessels during disease development. However, it has been difficult to demonstrate it, as no specific findings have been observed. Case presentation A 68-year-old man presented to our department with neck lymphadenopathy. After detailed examinations, squamous cell lung carcinoma (cT2aN3M1c) was diagnosed. Although cisplatin combined with gemcitabine was administered, his cancerous lymphangiopathy was exacerbated, and ZSM was observed on his right chest. Pembrolizumab was initiated as a second-line chemotherapy; however, the patient died 7 months after the initial presentation. In this case, fluorodeoxyglucose-positron emission tomography indicated the presence of skin metastasis and cancerous lymphangiopathy. Similarly, after performing an autopsy, tumor-cell filled lymph ducts were observed in the right subclavian and the cutaneous lymphatic vessel from the right hilar lymph nodes. Conclusions To the best of our knowledge, this is the first study to demonstrate that the localization of ZSM in the cutaneous lymphatics was caused by the retrograde movement of cancer cells through the lymphatic vessels, using radiographical and pathological analysis. In addition, fluorodeoxyglucose-positron emission tomography may help predict skin metastasis induced by cancerous lymphangiopathy.

Zosteriform cutaneous metastases from urothelial carcinoma: Report of a rare case and literature review

“…3 In addition, a study of zosteriform metastases from lung cancer demonstrated the retrograde movement of tumor cells through lymphatic vessels using radiographical and pathological analysis. 19 In our review of zosteriform metastases of urothelial carcinoma, two cases (including ours) demonstrated tumor emboli within lymphatic vessels. Our patient had metastases to regional lymph nodes including ilioinguinal, pelvic, and mesenteric nodes, which may be involved in the drainage of skin in the L1-L3 dermatome.…”

“…In a study of 12 cases of zosteriform metastases from malignant melanoma, all patients with available data had concomitant metastatic involvement of regional lymph nodes 3 . In addition, a study of zosteriform metastases from lung cancer demonstrated the retrograde movement of tumor cells through lymphatic vessels using radiographical and pathological analysis 19 . In our review of zosteriform metastases of urothelial carcinoma, two cases (including ours) demonstrated tumor emboli within lymphatic vessels.…”

Carcinome épidermoïde cutané métastatique zostériforme

“…doi : 10.1503/cmaj.210551-f Voir la version anglaise de l'article ici : www.cmaj.ca/lookup/doi/10.1503/cmaj.210551 étroitement au zona et est également extrêmement douloureux. Il est rare et survient probablement par propagation lymphangitique rétrograde des cellules tumorales; le pronostic est extrêmement sombre [3][4][5][6] . Le diagnostic repose sur un fort degré de suspicion chez les patients qui ont des antécédents de cancer de la peau ou d'autres cancers et qui manifestent un érythème de type zostérien réfractaire aux antiviraux 4,5 .…”

Metastatic zosteriform cutaneous squamous cell carcinoma

“…It is uncommon, and likely occurs through retrograde lymphangitic spread of tumour cells; it carries a dismal prognosis. [3][4][5][6] The diagnosis requires a high index of suspicion in patients with a history of skin cancer, or other cancers, who present with a zoster-like rash refractory to antiviral therapy. 4,5…”

“…[3][4][5][6] The diagnosis requires a high index of suspicion in patients with a history of skin cancer, or other cancers, who present with a zoster-like rash refractory to antiviral therapy. 4,5…”