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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 24  |  Issue : 2  |  Page : 211-213

A Rare and Sinister Presentation of Cutaneous Metastasis over Right Lower Limb in a Case of Ovarian Carcinoma


1 Sr Adv & HoD (Dermatology), Base Hospital, Lucknow, Uttar Pradesh, India
2 Classified Specialist (Dermatology), Base Hospital, Lucknow, Uttar Pradesh, India
3 Classified Specialist (Pathology), Command Hospital, Lucknow, Uttar Pradesh, India
4 Resident(Dermatology), Base Hospital, Lucknow, Uttar Pradesh, India

Date of Submission01-Feb-2022
Date of Decision10-Feb-2022
Date of Acceptance11-Feb-2022
Date of Web Publication10-Aug-2022

Correspondence Address:
Dr. Preema Sinha
Department of Dermatology, Base Hospital, Lucknow - 226 002, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmms.jmms_18_22

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How to cite this article:
Sinha P, Kamboj P, Sinha A, Sharma J. A Rare and Sinister Presentation of Cutaneous Metastasis over Right Lower Limb in a Case of Ovarian Carcinoma. J Mar Med Soc 2022;24:211-3

How to cite this URL:
Sinha P, Kamboj P, Sinha A, Sharma J. A Rare and Sinister Presentation of Cutaneous Metastasis over Right Lower Limb in a Case of Ovarian Carcinoma. J Mar Med Soc [serial online] 2022 [cited 2022 Dec 1];24:211-3. Available from: https://www.marinemedicalsociety.in/text.asp?2022/24/2/211/353648



Sir,

Breast and ovarian malignancy in women are the most common primary tumors developing skin metastasis after exclusion of melanoma, leukemia, and lymphoma.[1] Incidence of cutaneous metastasis in ovarian carcinoma although rare ranges from 0.9% to 5.8%.[1],[2] The most common metastatic sites to the skin are the abdominal wall, followed by the chest wall and breast. Cutaneous metastatic ovarian carcinoma most commonly presents as solitary, grouped papules, and nodules on the trunk. Only 12% of cases of cutaneous metastasis from ovarian carcinoma occur on the limbs, with most metastatic skin lesions occurring in the skin adjacent to the primary ovarian cancer including the abdominal wall.[2]

We discuss a rare case of cutaneous metastasis in a case of endometrioid ovarian carcinoma over the right lower limb.

A 46-year-old female a diagnosed case of endometrioid ovarian carcinoma (International Federation of Gynecology and Obstetrics stage III) 15 months back and was treated with cytoreductive surgery in the form of bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissection, and para-aortic lymph node dissection along with six cycles of adjuvant chemotherapy consisting of paclitaxel(@175mg/m2) and carboplatin (carboplatin-Area Under the Curve 5) every 3 weeks, in remission since the last 6 months on tablet tamoxifen 20mg daily reported with a history of multiple painful erythematous nodules with a burning sensation involving the upper part of the right thigh of 4-week duration.

On examination, multiple polysized erythematous, firm, tender, nodules, restricted to the lower part of the abdomen, extending till the lower part of the right thigh in segmental pattern with a concentration of lesions more on upper one-third of the right thigh was seen [Figure 1]. Few lesions were covered with yellowish crust.
Figure 1: Shows multiple polysized erythematous, firm, tender, nodules, restricted to lower part of abdomen, extending till lower part of right thigh with concentration of lesions more on upper one third of right thigh

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An excisional biopsy sample taken from a firm nodule revealed dermal infiltration by malignant cells forming nests, sheets, and glands showing features of adenocarcinoma [Figure 2]. CA125 immunohistochemistry showed tumor cells with distinct membranous staining [Figure 3] and strong nuclear staining with WT1 [Figure 4].
Figure 2: (×400; H and E) shows dermal infiltration by adenocarcinoma cells forming nests and glands

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Figure 3: (×1000; immunohistochemistry)- Tumor cells show distinct membranous staining with CA125

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Figure 4: (×1000; immunohistochemistry) – Tumor cells show strong nuclear staining with WT1

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Based on the above findings, a diagnosis of cutaneous metastasis due to ovarian carcinoma was made and the patient was advised for localized radiotherapy. However, the patient refused treatment and was managed with only palliative care. She succumbed to her disease in the next 20 days due to extensive disseminated carcinomatosis and sepsis.

The common sites for metastasis of ovarian cancer are the pleura, liver, bone, lung, and lymph nodes, whereas cutaneous metastases in ovarian carcinoma are rare.[2]The incidence of skin metastases may be increasing in recent years as different modalities for the treatment of ovarian carcinoma have improved survival, allowing metastases in rare distant sites to implant, grow, and become a clinically evident disease.[3]

Although the intraperitoneal route of dissemination is considered the most common, ovarian cancer may also metastasize through the lymphatic channels and the hematogenous route.[4] Distant metastases may occur at the time of ovarian cancer diagnosis (stage IV disease) or can arise during the evolution of the disease.[5]

Cutaneous metastases in ovarian carcinoma are found at or around abdominal wall incisions, from laparotomy, laparoscopy, port, and catheter, or drainage sites and in the vicinity of metastatic superficial lymph nodes.[2],[3]

Based on the site of the lesion, skin metastases are classified as metastatic umbilical tumors, which are known as Sister Joseph nodules (SJNs), and non-SJN skin metastases.[1]

Skin metastases can also be divided according to the time of appearance that is skin metastases at initial diagnosis and skin recurrences. Non-SJN skin metastases usually develop in recurrent settings.[1]

The lesions involved are often described as flesh-colored, pink, or violaceous cutaneous or subcutaneous nodules. Other morphological variants of cutaneous metastatic ovarian carcinoma described include herpetiform-pattern metastatic nodules, erythema annulare, cutaneous metastases with calcospherites, scalp nodules, subungual metastases, subcutaneous metastases, and lymphangiosis carcinomatosa of the skin.[4]

Median survival after diagnosis of skin metastasis from ovarian cancer is generally around 4 months, however, our patient succumbed to her illness in just 50 days of the appearance of cutaneous metastasis indicating a very poor and sinister prognosis.

Limb involvement is considered a rare site in the case of ovarian cutaneous metastasis. We report this case to bring out a rare presentation of an uncommon case.



 
  References Top

1.
Otsuka I. Cutaneous metastases in ovarian cancer. Cancers (Basel) 2019;11:1292.  Back to cited text no. 1
    
2.
Cormio G, Capotorto M, Di Vagno G, Cazzolla A, Carriero C, Selvaggi L. Skin metastases in ovarian carcinoma: A report of nine cases and a review of the literature. Gynecol Oncol 2003;90:682-5.  Back to cited text no. 2
    
3.
Kim MK, Kim SH, Lee YY, Choi CH, Kim TJ, Lee JW, et al. Metastatic skin lesions on lower extremities in a patient with recurrent serous papillary ovarian carcinoma: A case report and literature review. Cancer Res Treat 2012;44:142-5.  Back to cited text no. 3
    
4.
McDonald HH, Moore MR, Meffert JJ. Cutaneous metastases from adenocarcinoma of the ovary. JAAD Case Rep 2016;2:406-7.  Back to cited text no. 4
    
5.
Cheng B, Lu W, Xiaoyun W, YaXia C, Xie X. Extra-abdominal metastases from epithelial ovarian carcinoma: An analysis of 20 cases. Int J Gynecol Cancer 2009;19:611-4.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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