Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 2780  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
CASE REPORT
Year : 2009  |  Volume : 54  |  Issue : 5  |  Page : 5-7
Skin metastasis: A rare localization from laryngeal carcinoma and overview of similar cases


1 Department of Pathology, Gorgan University of Medical Sciences, Iran
2 Department of Otolaryngology, Gorgan University of Medical Sciences, Iran
3 Department of Embryology and Histology, Gorgan University of Medical Sciences, Iran
4 Department of General Surgery, Gorgan University of Medical Sciences, Iran

Correspondence Address:
Ramin Azarhoush
Pathology Lab; 5th Azar Hospital, 5th Azar Blv., Gorgan, P.O.Box: 49177-61551
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

   Abstract 

Cutaneous metastases from carcinoma of the larynx are very rare. Distant metastases in squamous cell carcinoma of the larynx have an incidence of 6.5-7.2% and most commonly involve the lungs, liver and bone. Metastases to the skin are exceedingly rare. We observed a 75-year-old Iranian patient with squamous cell carcinoma of the larynx who developed a subcutaneous nodule on the buttock. It was found to be a metastatic tumor from the laryngeal cancer, histopathologically. Skin metastases may represent the first clinical evidence of impending locoregional recurrence, suggest distant metastatic spread, or rarely, be the first sign of 'silent' laryngeal tumor. They are usually considered a poor prognostic sign and most often affect the supradiaphragmatic area, i.e. the head, neck, thorax or upper extremities. From stand point of topography, buttock metastasis is exceptional.


Keywords: Buttock, cutaneous metastasis, laryngeal carcinoma


How to cite this article:
Azarhoush R, Taziki MH, Golalipour MJ, Arya B. Skin metastasis: A rare localization from laryngeal carcinoma and overview of similar cases. Indian J Dermatol 2009;54, Suppl S1:5-7

How to cite this URL:
Azarhoush R, Taziki MH, Golalipour MJ, Arya B. Skin metastasis: A rare localization from laryngeal carcinoma and overview of similar cases. Indian J Dermatol [serial online] 2009 [cited 2019 Oct 20];54, Suppl S1:5-7. Available from: http://www.e-ijd.org/text.asp?2009/54/5/5/45430



   Introduction Top


Cutaneous metastases are quite uncommon. The frequency of cutaneous metastasis from internal carcinomas ranges from 0.7 to 10% according to different authors. [1],[2],[3],[4],[5],[6]

Lung, large intestine and oral cavity carcinomas are the most common underlying tumors in male, whereas in females, breast carcinoma is the internal neoplasm that the most frequently cause of skin metastasis. [7]

Nodular, inflammatory, telangiectatic and bullous are various forms of clinical presentations of skin metastasis. [7],[8],[9],[10]

Inflammtory cutaneous metastases are frequently observed in patients affected by breast carcinoma. [11],[12] However this type of meastasis has also been reported in patients with carcinoma of pancreas, rectum, lung, ovary, parotid gland and urinary bladder. [13],[14],[15],[16],[17],[18],[19] The nodular carcinoma, the most common form of metastasis caused by lymphatic dissemination, asymptomatic, firm nodules are located in the skin and subcutaneous tissue. [20] These located in the skin may cause ulceration of the skin. Skin metastases may represent the first clinical evidence of impending locoregional recurrence, suggest distant metastatic spread, or rarely, be the first sign of 'silent' laryngeal tumor. They often affect the supradiaphragmatic area, i.e. the head, neck, thorax or upper extremities. [21]


   Case History Top


A 75-year-old male a smoker farmer, presented with a cutaneous nodule sited in his left buttock. 18 months before, the patient had undergone a total laryngectomy and radical neck dissection for a squamous cell carcinoma of the larynx. After the operation, the patient received radiotherapy, and was disease free until two months before referring to a surgery clinic, for a small induration in his left buttock which gradually became larger and formed a large subcutaneous nodule (3cm in diameter) and later became ulcerated. The cutaneous mass was resected and histopathological exams revealed a cutaneous metastasis from laryngeal squamous cell carcinoma. Histological examinations revealed scattered islands of tumor cells and fibrosis of the dermis, including cytologically atypical squamous cells extending to the hypodemis, with intact epidermis in serial sectioning [Figure 1],[Figure 2]. Immunohistochemical markers showed only positive staining of atypical cells with monoclonal anti-cytokeratin antibodies, confirming the epithelial origin of metastastic cells.

The patient died three month after the diagnosis of cutaneous metastasis due to massive pulmonary tumor infiltrations.


   Discussion Top


Squamous cell carcinoma is responsible for 95% of carcinoma of the larynx in adults and is the most common tumor in upper respiratory tract. [22]

This tumor originates from glottis (59%), supraglottis (40%) or infraglottis (1%) [23] and generally spreads to regional lymph nodes or, through blood, to the pulmonary system. Skin metastasis has rarely been described, always as multiple or solitary nodules. [7],[24],[25] Another skin lesion frequently observed in patients after laryngectomy is "stomal recurrence". [26],[27],[28],[29],[30] The lesion usually presents as a nodule, plaque or exuberant granulation tissue. [31] Skin metastases may represent the first clinical evidence of impending locoregional recurrence, suggest distant metastatic spread, or rarely, be the first sign of 'silent' laryngeal tumor. They are usually considered a poor prognostic sign and most often affect the supradiaphragmatic area, i.e. the head, neck, thorax or upper extremities. Infradiaphragmatic presentation of metastatic laryngeal squamous cell carcinoma is exceptional, with only four cases reported in the literature. [21]

Krunic et al, reported a case of laryngeal squamous cell carcinoma with inferadiaphragmatic metastasis that is a very rare presentation, [31] as is our case. Horiuchi reported a case with abdominal wall skin metastasis. [32] Dissemination may take place through the lymphatics or through the blood stream, and may appear in any area of the skin. [5],[20] Aguilar reported four cases of metastatic epidermotrophic tumor that one of cases was as folliculotropism tumor. [33] Multiple skin metastatic tumors reported by Bhandarkar [34] and such skin metstatic tumor has a poor prognosis. Veraldi reported a case with metastatic laryngeal tumor in the form of localized nodules in frontal area and arm in a patient with laryngeal tumor. [24] Also, Lee reported three patients with skin metastatic tumor originated from malignant laryngeal tumor. In his patients, skin presentation was in the form of skin abscess in the neck. [35]

Bottoni reported a patient with metastatic laryngeal carcinoma in the form of infiltrate erythema in supra and infra clavicular regions after four years of primary surgical treatment. [36]

In conclusion, we reported this case because of the rarity of the cutaneous metastasis from squamous cell carcinoma of the larynx, especially to buttock.

Moreover, since such metastasis normally presents with nodules with or without ulceration, therefore every skin lesion in patients with history of laryngeal carcinoma should be considered as a probable skin metastasis.


   Acknowledgment Top


The author acknowledges the assistance of 5th Azar hospital pathology Lab for preparation of the necessary histopathological slides and photographs, also extends special regards to Dr.A.Homayounpour.

 
   References Top

1.McWorther JE, Cloud AW. Malignant tumors and their metastases: A summery of the necropsies on hundred sixty-five cases performed at the Bellevue hospital of New York. Ann Surg 1930;92:434-43.  Back to cited text no. 1    
2.Gates O. Cutaneous metastases of malignant disease. Am J Cancer 1937;30:718-30.  Back to cited text no. 2    
3.Abrams HL, Siro R, Gldestein N. Metastases in carcinoma: Analysis of 1, 1000 autopside cases. Cancer 1950;3:74-85.  Back to cited text no. 3    
4.Enticknap JB. An analysis of 1,1000 cases of cancer with special reference to metastasis. Guys Hosp Rep 1952;101:273-9.  Back to cited text no. 4  [PUBMED]  
5.Reingold IM. Cutaneous metastases from carcinoma. Cancer 1996;19:162-8.  Back to cited text no. 5    
6.Spencer PS, Helm TN. Skin metastases in cancer patients. Cuits 1987;39:119-21.  Back to cited text no. 6    
7.Looking bill DP, Spangler N, Helm KF. Cutaneous metastases in patients with metastatic carcinoma: A retrospective study of 4, 020 patients. J Am Acad Dermatol 1993;29:228-36.  Back to cited text no. 7    
8.Calvieiri S, Chimenti S, Zampetti M, Bottoni U, Nini G, Ribuffo M. Metastases skin cancer visceral. Am Clin Dermatol 1980;34:349-56.  Back to cited text no. 8    
9.Weber FP. Bilateral thoracic zosteris spreading marginate telangiectatic probably a variety of carcinoma and better termed carcinoma telangectasicum. Br J Dermatol 1933;45:418-24.  Back to cited text no. 9    
10.Innocenzi D, Bianchi L, Barduagni O, Carlesimo PA 2 nd . Carcinoma telangectasico of Parkes-Weber. Giorn It Derm Vener 1988;123:19-24.  Back to cited text no. 10    
11.Tschen EH, Apisarnthanarax P. Inflammatory metastatic carcinoma of the breast. Arch Dermatol 1981;117:120-1.  Back to cited text no. 11  [PUBMED]  
12.Rasch C. Carcinoma erysipelatodes. Br J Dermatol Syphilol 1931;43:351-4.  Back to cited text no. 12    
13.Edelstein JM. Pancreatic carcinoma with unusual metastasis to the skin and subcutaneous tissue simulating cellulites. N Engl J Med 1950;242:779-81.  Back to cited text no. 13  [PUBMED]  
14.Reuter MJ, Nomland R. Inflammatory cutaneous metastatic carcinoma. Wis Med 1941;40:196-201.  Back to cited text no. 14    
15.Kauffman CL. Sina B. Metastatic inflammatory carcinoma of the rectum: Tumor spread by three routes. Am J Dermatopathol 1997;19:528-32.  Back to cited text no. 15    
16.Hazelrigg DE, Rudolph AH. Inflammatory metastatic carcinoma. Arch Dermatol 1977;113:69-70.  Back to cited text no. 16  [PUBMED]  
17.Krishnan EU, Philips AK, Randell A, Taylor B, Garg SK. Bilateral metastatic inflammatory carcinoma in the breast from primary ovarian caner. Obstet Gynecol 1980;55:94-6.  Back to cited text no. 17    
18.Schwartz RA, Rubenstein DJ, Raventos A, Lambert WC. Inflammatory metastatic carcinoma of the parotid. Arch Dermatol 1984;120:796-7.  Back to cited text no. 18  [PUBMED]  
19.Aloi F, Colonna SM, Appino A. Metastases to issue inflammatory skin cancer parotideo. Giorn It Derm Vener 1987;122:193-5.  Back to cited text no. 19    
20.Brownstein MH, Helwig EB. Patterns of cutaneous metastasis. Arch Dermatol 1972;105:862-8.  Back to cited text no. 20  [PUBMED]  
21.Krunic AL, Cockerell CJ, Truelson J, Taylor RS. Laryngeal squamous cell carcinoma with infradiafragmatic presentation of skin metastasis. Clin Exp Dermatol 2006;31:242-4.  Back to cited text no. 21  [PUBMED]  [FULLTEXT]
22.Adams GL, Maisel RH. Malignant tumors of the larynx and hypopharynx. In : Cummings CW, Fredrickson J, Harker LA, etal , editors. Otolaryngology head and neck surgery. 3rd ed, vol. St. Louis: Three Mosby Company; 1998. p. 2130.  Back to cited text no. 22    
23.Thawley SE. Cysts and tumors of the larynx. In : Paparella Shumrick DA, Gluckman JL, Meyerhoff WL. Otolaryngology. Vol. 3 (Head and neck). 3rd ed. Philadelphia: WB Saunders; 1991. p. 2314.  Back to cited text no. 23    
24.Veraldi S, Cantu A 2nd, Sala F, Schianchi R, Gasparini G. Cutaneous metastases from laryngeal carcinoma. J Dermatol Surg Oncol 1988;14:562-4.  Back to cited text no. 24  [PUBMED]  
25.Shamsaidini S, Taheri A, Dabiri S, Damavandi KF, Salahi S. Grouped skin metastases from laryngeal squamous cell carcinoma and overview of similar cases. Dermatol Online J 2003;9:27.  Back to cited text no. 25    
26.Batsakis JG, Hybels R, Rice DH. Laryngeal carcinoma: Stomal recurrences and distant metastases. Can J Otolaryngol 1975;4:906-16.  Back to cited text no. 26  [PUBMED]  
27.Griebie MS, Adams GL. Emergency laryngectomy and stomal recurrence. Laryngoscope 1987;97:1020-4.  Back to cited text no. 27  [PUBMED]  
28.Barr GD, Robertson AG, Liu KC. Stomal recurrence: A separate entity? J Surg Oncol 1990;44:176-9.  Back to cited text no. 28  [PUBMED]  
29.Rubin J, Johnsom JT, Myers EN. Stomal recurrence after laryngectomy: Interrelated risk factor study. Otolaryngol Head Neck Surg 1990;103:805-12.  Back to cited text no. 29    
30.Rockley TJ. Powell J, Robin PE, Reid AP. Post-laryngectomy stomal recurrence: Tumour implantation or paratracheal lymphatic metastasis? Clin Otolaryngol 1991;16:43-7.  Back to cited text no. 30    
31.Zbaren P, Greiner R, Kengelbacher M. Stomal recurrence after laryngectomy: An analysis of risk factors. Otolaryngol Head Neck Surg 1996;114:569-75.  Back to cited text no. 31    
32.Horiuchi N, Tagami H. Skin metastasis in laryngeal carcinoma. Clin Exp Dermatol 1992;17:282-3.  Back to cited text no. 32  [PUBMED]  
33.Aguilar A, Schoendroff C, Lopez Redondo MJ, Ambrojo P, Requena L, Sanchez J, et al . Epidermotropic metastases from internal carcinoma. Am J Dermatol 1991;13:452-8.  Back to cited text no. 33    
34.Bhandarkar P, Green KM, de Carpentier JP. Multiple cutaneous metastases from laryngeal carcinoma. J Laryngol Otol 1997;11:654-5.  Back to cited text no. 34    
35.Lee WC, Walsh RM, Tse A. Squamous cell carcinoma of the pharynx and larynx presenting as a neck abscess or cellulites. J Laryngol Otol 1996;110:893-5  Back to cited text no. 35  [PUBMED]  
36.Bottoni U, Inocenzi D, Mannooranparampic TJ, Richetta A, Del Guidice M, Calvieri S. Inflammatory cutaneous metastases from laryngeal carcinoma. Eur J Dermatol 2001;11:124-6  Back to cited text no. 36    


    Figures

  [Figure 1], [Figure 2]

This article has been cited by
1 Cytologic differentiation of squamous elements in the pancreas
Bixler, H.A., Castro, M.J., Stewart III, J.
Diagnostic Cytopathology. 2011; 39(7): 536-540
[Pubmed]



 

Top
Print this article  Email this article
 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (675 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Case History
    Discussion
    Acknowledgment
    References
    Article Figures

 Article Access Statistics
    Viewed2728    
    Printed85    
    Emailed0    
    PDF Downloaded131    
    Comments [Add]    
    Cited by others 1    

Recommend this journal