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E-CORRESPONDENCE
Year : 2014  |  Volume : 59  |  Issue : 1  |  Page : 106
Carcinoma erysipeloides as the presenting feature of lung malignancy


1 Department of Dermatology and Venereology, Government Medical College Thrissur, India
2 Department of Pathology, Government Medical College Thrissur, India

Date of Web Publication23-Dec-2013

Correspondence Address:
Priya Prathap
Department of Dermatology and Venereology, Government Medical College Thrissur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.123547

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How to cite this article:
Prathap P, Jayalakshmy P S. Carcinoma erysipeloides as the presenting feature of lung malignancy. Indian J Dermatol 2014;59:106

How to cite this URL:
Prathap P, Jayalakshmy P S. Carcinoma erysipeloides as the presenting feature of lung malignancy. Indian J Dermatol [serial online] 2014 [cited 2019 Dec 13];59:106. Available from: http://www.e-ijd.org/text.asp?2014/59/1/106/123547


Sir,

Carcinoma Erysipeloides (CE) is an uncommon metastatic pattern arising from visceral carcinoma. [1] We report a case in which CE was the presenting feature in a patient with lung carcinoma. To my knowledge, only two cases of CE secondary to lung carcinoma have been reported in the literature so far.

A 65-year-old man was admitted to the Department of Pulmonary Medicine with complaints of dyspnoea and cough. He was a chronic smoker and asthmatic. He had nearly month-old reddish raised skin lesions, which were gradually increasing in size on the right side of the neck. There was no history of pulmonary tuberculosis, recent episodes of fever or weight loss.

On examination, right supraclavicular lymph nodes were enlarged (1 × 0.5 to 1 × 2 cm, firm, mobile, non-tender). Grade 3 clubbing was present. On the right side of the neck, there was an erythematous plaque measuring 10 cm × 4 cm with irregular margins and the surface showed multiple ulcers measuring from 0.5 cm × 0.5 cm to 1 cm × 1.5 cm with sloping edges [Figure 1]. Examination of the respiratory system revealed decreased breath sounds and dullness on percussion over right infraclavicular area. Per rectal examination revealed no prostatomegaly. ENT consultation did not reveal any throat/thyroid lesions.
Figure 1: Erythematous plaque on neck with multiple ulcers on its surface

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A provisional diagnosis of scrofuloderma/cutaneous metastases was made.

On investigation, Blood Hb, total and differential counts were normal.

Erythrocyte sedimentation rate (ESR) was 102 mm/hr. No microorganisms were detected on Gram stain, AFB stain and pus culture. Mantoux test was negative. Ultrasonography (USG) of the abdomen was normal. Chest X-ray showed non-homogeneous opacity on the right upper zone with hilar adenopathy, suggestive of malignancy [Figure 2]. Computerised tomography (CT) of chest was advised, but the patient died within few days. Fine Needle Aspiration Cytology (FNAC) of right supra clavicular lymph node → Malignant cells from a poorly differentiated carcinoma [Figure 3]. Skin biopsy → Tumour emboli in lymphatic vessels [Figure 4]. Tumour emboli were composed of poorly differentiated squamous cell carcinoma.
Figure 2: Chest X-ray; Non-homogeneous opacity on right upper zone and hilar adenopathy

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Figure 3: FNAC lymph node; Malignant cells from a poorly differentiated carcinoma

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Figure 4: Skin biopsy; Tumour emboli in lymphatic vessels

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Cutaneous metastases from solid internal cancers usually present as nodular tumours. CE is a rare presentation. [2] CE is most commonly associated with breast carcinoma, but rarely with lung cancer. [3],[4],[5] Clinical progression usually involves rapid enlargement of the affected area without skin ulceration. Our patient had ulceration over the plaque mimicking that of scrofuloderma. Adenocarcinomas are the most frequent cancers to metastasize to the skin. [1] It is noteworthy that this patient had squamous cell carcinoma. Carcinoma Erysipeloides suggests a grave prognosis as happened in our case.

 
   References Top

1.Mollet TW, Garcia CA, Koester G. Skin metastases from lung cancer. Dermatol Online J 2009;15:1.  Back to cited text no. 1
    
2.Ikeda Y, Niimi M, Takami H, Kodaira S. Successfully treated carcinoma erysipeloides from gastric cancer. Ann Oncol 2003;14:1328-9.  Back to cited text no. 2
[PUBMED]    
3.Homler HJ, Goetz CS, Weisenburger DD. Lymphangitic cutaneous metastases from lung cancer mimicking cellulitis. Carcinoma erysipeloides. West J Med 1986;144:610-2.  Back to cited text no. 3
[PUBMED]    
4.Canpolat F, Akpinar H, Eskioglu F, Genel N, Oktay M. A case of inflammatory breast carcinoma: Carcinoma erysipeloides. Indian J Dermatol Venereol Leprol 2010;76:215.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.Vega Gutiérrez, Rodríguez MA. Carcinoma erysipeloides associated with breast carcinoma. Int J Dermatol 2007;46:613-4.  Back to cited text no. 5
    


    Figures

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



 

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