LETTERS TO THE EDITOR

 

Sternal cutaneous metastasis of hilar cholangiocarcinoma

Metástasis cutánea esternal de colangiocarcinoma hiliar

 

 

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Key words: Cholangiocarcinoma. Skin neoplasms. Differential diagnosis.

Palabras clave: Colangiocarcinoma. Metástasis cutáneas. Diagnóstico diferencial.

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Dear Editor,

Cutaneous metastases occur in 2-10% of visceral tumors (1,2) and represent up to 2% of all skin tumors (2). They may be identified before their original primary tumor in an advanced stage with a poor prognosis.

 

Case report

We report the case of a 72-year-old female patient with severe heart failure, pulmonary hypertension and chronic renal impairment. She presented with a non-painful, erythematous, hard, 2 cm subcutaneous growth in the sternal region. The lesion was excised and the pathology analysis described a tissue layout consistent with subcutaneous metastasis of a mucinous cystadenocarcinoma that originated in the bile duct (Fig. 1A). Abdominal computed tomography (CT) showed a central liver lesion compatible with hilar cholangiocarcinoma or a Klatskin tumor (Fig. 1B). In view of the patient's baseline status, palliative care was initiated.

 

 

Discussion

Cholangiocarcinoma usually metastasizes to retroperitoneal nodes, the peritoneum, liver and lungs (1). Twenty cases of skin metastasis have been reported, most of them by direct extension following percutaneous puncturing (50%) (2,3) that were described as papules at the puncture site (4).

The mean age at presentation is 60 years (3) and the most typical lesion is a non-painful, erythematous, occasionally ulcerated nodule or papule (4). The scalp is the most commonly reported site (3).

The pathophysiology of these rare skin metastases of cholangiocarcinoma is unknown. This may be related to their poor prognosis (5-year overall survival below 5% [5]), their non-painful nature or their common location in unexposed areas of the skin.

 

Antonio José Fernández-López¹, María Encarnación Tamayo-Rodríguez^1,2 and María Ángeles Paniza-Mendoza^1
1Department of General Surgery. Hospital General Universitario Reina Sofía. Murcia, Spain.
²Department of Surgery. Universidad de Murcia. Murcia, Spain

 

References

1. Lee WJ, Kim MS, Chang SE, et al. Multiple cutaneous metastases from hiliar cholangiocarcinoma. Cli Exp Dermatol 2009;34(5):174-6. DOI: 10.1111/j.1365-2230.2008.03022.x.         [ Links ]

2. Landaluce Olavaria A, Estraviz Mateos B, Sarabia García S. Cutaneous metastasis in a patient with cholangiocarcinoma. Rev Esp Enferm Dig 2007;99(2):118-9.         [ Links ]

3. Liu M, Liu B-L, Liu B, et al. Cutaneous metastasis of cholangiocarcinoma. World J Gastroenterol 2015;21(10):3066-71. DOI: 10.3748/wjg.v21.i10.3066.         [ Links ]

4. Lu CI, Wong WR, Hong HS. Distant cutaneous metastases of cholangiocarcinoma: Report of two cases of a previously unreported condition. J Am Acad Dermatol 2004;51(2):108-11. DOI: 10.1016/j.jaad.2004.01.042.         [ Links ]

5. Yanagi T, Marsumura T, Yoshizaki N. Cholangiocarcinoma with skin metastases. J Am Acad Dermatol 2007;56(2):S58-60. DOI: 10.1016/j.jaad.2006.02.057.         [ Links ]