2020.3.16.nodules

Subcutaneous nodules as an initial presentation of metastatic gastric carcinoma

James Ralph1, Louise Lane2, Gregg Murray1, Siona Ní Raghallaigh1

1Departments of Dermatology, Beaumont Hospital, Dublin, Ireland; 2Departments of Histopathology, Beaumont Hospital, Dublin, Ireland

Corresponding author: Dr. James Ralph


Submission: 30.03.2020; Acceptance: 05.05.2020

DOI: 10.7241/ourd.20203.16

Cite this article: Ralph J, Lane L, Murray G, Raghallaigh SN. Subcutaneous nodules as an initial presentation of metastatic gastric carcinoma. Our Dermatol Online. 2020;11(3):301-302.

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This 83-year-old man presented with a four month history of multiple, hard subcutaneous nodules (Fig. 1) on a background of fatigue and weight loss. He denied any gastrointestinal symptoms. His full blood count showed a haemoglobin of 8.3g/dL (normal, 13-16g/dL) and white cell count 28×109/L (normal, 4-11×109/L). Histology from a skin biopsy showed an invasive, poorly differentiated neoplasm infiltrating the dermis but not connected to the overlying epidermis, while histology of his bone marrow also demonstrated a poorly differentiated neoplasm. The tumour cells were positive for pancytokeratin (AE1/AE13) confirming the tumour was a carcinoma and epithelial in origin. Further staining showed positivity for CDX2 (Fig. 2) suggesting a gastrointestinal origin. A gastroscopy showed a large black irregular mass in his stomach (Fig. 3). The patient died five weeks later from metastatic gastric cancer. Less than 1% of gastric cancers present with skin metastasis [1,2].

Figure 1: Multiple subcutaneous nodules.
Figure 2: Tumour cells showing scattered positivity with CDX2.                                 
Figure 3: Gatroscopy showing gastric carcinoma.

Consent

The examination of the patient was conducted according to the Declaration of Helsinki principles.

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

REFERENCES

1. He FJ, Zhang P, Wang MJ, Chen Y, Zhuang W. Left armpit subcutaneous metastasis of gastric cancer:A case report. World J Clin Cases. 2019;7:4137-43.

2. Namikawa T, Munekage E, Munekage M, Maeda H, Yatabe T, Kitagawa H, et al. Subcutaneous metastasis arising from gastric cancer:a case report. Mol Clin Oncol. 2017;6:515–6.

Notes

Source of Support: Nil,

Conflict of Interest: None declared.

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